J Korean Med Sci 2005; 20: 784-9 ISSN 1011-8934 Copyright The Korean Academy of Medical Sciences Diagnostic and Therapeutic Problems of Pulmonary Tuberculosis in Elderly Patients To identify differences in the clinical, radiologic, and microbiologic features of pul- monary tuberculosis (TB) in the young (<64 yr) and elderly (≥65 yr), we performed a retrospective analysis of the medical charts and chest radiographs of 207 young and 119 elderly pulmonary TB patients. Hemoptysis and a febrile sense were more frequent in the young, whereas weakness, dyspnea, anorexia, and mental change were more frequent in the elderly. Elderly patients showed higher frequen- cies of cardiovascular and chronic lung diseases, whereas the young showed a higher proportion of underlying liver disease. In addition, chest radiography showed a significantly higher frequency of mid or lower lung involvement by TB lesions in the elderly (10.6% vs. 22.7%, p<0.05). Lesions were frequently misdiagnosed as pneumonia or lung cancer in the elderly. However, there was no difference between these two groups in terms of sputum acid-fast bacilli positivity. The elderly showed a higher frequency of adverse drug reactions (18.5% vs. 40.7%, p<0.05), and higher TB-related mortality (1.3% vs. 11.1%, p<0.05). In conclusion this study showed that young and elderly pulmonary TB patients have similar microbiologic features; however, the elderly showed higher frequencies of atypical clinical and radiologic presentations, adverse drug reactions, and higher TB-related mortality. Key Words : Aged; Tuberculosis; Symptom; Radiography; Microbiology; Diagnosis, Differential; Drug Reac- tion; Prognosis; Sputum Jae Ho Lee, Dae Hee Han*, Jae Woo Song , Hee Soon Chung Division of Respiratory and Critical Care Medicine, Department of Internal Medicine; Department of Radiology*, Seoul National University College of Medicine, Seoul; Department of Radiology , Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Received : 11 February 2005 Accepted : 19 Arpil 2005 Address for correspondence Jae Ho Lee, M.D. Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam 463-707, Korea Tel : +82.31-787-7011, Fax : +82.31-787-4052 E-mail : jhlee7@snubh.org *This study was supported by a grant from the Seoul National University Bundang Hospital. INTRODUCTION Although the prevalence of active pulmonary tuberculosis (TB) among Koreans above 5 yr old decreased gradually from 5.1% (1,240,000 cases) in 1965 to 1.0% (429,000 cases) in 1995, there are still many TB patients in Korea (1, 2). Even in developed countries where the overall incidence of TB is low, pulmonary TB remains common among the elderly (3). Increases in the elderly population due to prolonged life ex- pectancy have increased the use of drugs that suppress cellular immunity, and may further increase the incidence of pulmo- nary TB among the elderly in the future (4). Many studies have been performed on the pulmonary TB in the elderly (5-19). Some have suggested that pulmonary TB in the elderly presents somewhat atypical symptoms (6, 7) or radiological findings (8-10) or both (11), or that the elderly are more sus- ceptible to adverse drug reactions (12, 13) and more likely to die of the disease (6, 14). Age-related changes in the tuber- culin skin reaction and a high incidence of underlying illnesses also play a role in prolonging the final diagnosis (15). Some have even suggested that pulmonary TB in the elderly should be classified as a separate entity (16). However, many studies (17-19) have reported that TB in the young and elderly shows similar clinical, bacteriological, and radiological features. Pulmonary TB is still one of the 784 most prevalent diseases in Korea, and accordingly most physi- cians and radiologists are familiar with TB, and suspect the presence of TB in cases with undiagnosed pulmonary disease. Studies in this special situation would help our understand- ing of the characteristic clinical features of elderly pulmonary TB in areas where TB prevalence is intermediate. We previ- ously performed a retrospective study to elucidate differences in the clinical, microbiological, and radiological features of TB in the young and elderly (20), and the result concurred with other studies as it suggested that the elderly have atypi- cal clinical and radiologic characteristics. However, the study population was relatively small, and some of the radiological interpretations were not made by an experienced chest radi- ologist. Thus to confirm our previous study results, the pre- sent study was designed to incorporate a larger study popu- lation and to incorporate more consistent radiologic inter- pretation by experienced chest radiologists. MATERIALS AND METHODS Study population Medical records and chest radiographs of active pulmonary TB patients, who visited the Seoul National University Bora-