Pulmonary Tuberculosis in the Elderly Table 4. Radiologic and laboratory finding of the young and the elderly pulmonary tuberculosis patients Table 5. Prognosis of the young and the elderly pulmonary tuber- culosis patients during treatment Youn(gn=(<26057)yr, %) Elderly(n(=≥11695)yr, %) p value Youn(gn=(<16551)yr, %) Elderly(n(≥=8615) yr, %) p value Radiologic finding Location of TB lesion Upper* 185 (89.4) Lower 22 (10.6) Appearance of lesion Typical feature 187 (90.3) Pneumonia like 15 (7.2) Mass like 5 (2.4) Others 0 (0) Sputum acid fast bacilli Smear (+) 119 (57.5) Culture (+) 154 (74.4) Hematologic findings Leukocyte count (/ L) 8,413±3,435 ESR (mm/hr) 45.0±31.6 Leukocytosis 48 (23.2) 92 (77.3) 27 (22.7) 72 (60.5) 28 (23.5) 17 (14.3) 2 (1.7) 68 (57.1) 84 (70.6) 8,180±3,085 55.8±32.0 31 (26.1) 0.003 <0.001 0.952 0.709 0.545 0.010 0.569 *: Lesion on the upper lobe only or upper lobe plus other lobe. : Fibrous nodular and/or cavity. : Erythrocyte sedimentation rate. : White blood cell >104/ L. Underlying diseases Results are shown in Table 3. The number of active pul- monary TB patients with an underlying illness was signifi- cantly higher in the elderly group. Diabetes mellitus and liver disease (including alcoholic liver disease) composed the majority of underlying illnesses in both groups. Elderly had significantly higher frequencies of cardiovascular and chronic lung disease including pneumoconiosis and chronic obstruc- tive lung disease, and the young had significantly higher fre- quencies of liver diseases. However, no statistically significant differences were found between the frequencies of other under- lying diseases in the two groups. Radiological features Radiological features are summarized in Table 4. In both groups, the active pulmonary TB lesion involved the upper lobe in the majority, but the elderly had a significantly high- er frequency of isolated mid or lower lobe involvement. Typi- cal fibrous nodular type with or without a cavitary lesion was more frequent in the young, whereas pneumonia or a mass like lesion were more frequent in the elderly (p<0.001). Laboratory findings In laboratory findings (Table 4), no differences were found between the two groups in terms of positive sputum AFB smear (57.5% vs. 57.1%, p=0.952) or culture (74.4% vs. 70.6 %, p=0.679), and complete blood counts showed no signifi- cant differences between mean leukocyte counts or the inci- 787 0.054 0.001 0.131 0.052 0.052 0.053 <0.001 <0.001 <0.001 Adverse drug reaction Hepatitis* Skin Dysesthesia Arthralgia Flu-like syndrome Severe GI trouble Total Treatment result Completed treatment Expired Tuberculosis related Other disease 16 (10.6) 8 (5.3) 3 (2.0) 1 (0.7) 0 (0) 4 (2.6) 28 (18.5) 149 (98.7) 2 (1.3) 0 (0) 16 (19.8) 15 (18.5) 5 (6.2) 4 (4.9) 2 (2.5) 7 (8.6) 33 (40.7) 71 (87.7) 9 (11.1) 1 (1.2) *: Transient or permanent change of one or more medication during treatment. : Gastrointestinal. dences of leukocytosis. However, the erythrocyte sedimenta- tion rate was higher in the elderly (p=0.010). Drug adverse reactions and prognosis The following analysis was performed using the data of the 232 pulmonary TB patients who completed anti-TB medi- cation at our hospital. Results are shown in Table 5. The most commonly observed side effects were liver toxicity and skin side effects in both groups. The frequency of skin side effects was statistically higher in the elderly. However, although the frequencies of drug-induced hepatitis, neurotoxicity, gastroin- testinal troubles, arthralgia, and flu-like syndrome were some- what higher in the elderly, they were without significance. The number of patients who experienced a drug adverse reac- tion was significantly higher in the elderly (p<0.001). TB related mortality occurred in 2 young patients and in 9 elder- ly. One elderly patient died due to a cerebral infarction dur- ing treatment. And thus, mortalities due to tuberculosis in the young and elderly were significantly different (p<0.001). DISCUSSION This study showed that symptoms like hemoptysis and a febrile sense occured more frequently in the young, whereas nonspecific symptoms like anorexia, weakness, weight loss and mental change occured more frequently in elderly pul- monary TB patients. Though the young patients complained of a febrile sense more frequently, no significant difference was observed between the two groups in terms of body tempera- ture measures >37.5℃. This apparent anomaly may be due to a reduced perception of fever in the elderly group. The above results agree with those of others (6, 7), who found more classic respiratory symptoms in younger populations. Van den Brande