Published: 2018-05-25

Clinico-radiological variability of pulmonary tuberculosis in young patients as compared to elder patients prior to RNTCP and after 18 years RNTCP

Jawahar L. Joshi, Sunita Devi, Vinay Mohan, Ritu P. Kaur, Ramandeep Kaur


Background: Tuberculosis, a chronic disease causing high morbidity and mortality with multiple host related and socio-demographic risk factors. Incidence is 3-4 times among in diabetics. HIV is considered to be a most powerful risk factor other being malnutrition, Tubercular contacts, smoking habits and alcoholism. Many ecological and societal threats increase a vulnerability to infection and succession of the disease. Objective was to study and compare various clinico-radiological presentations and clinical risk factors for pulmonary tuberculosis in the young (<50yrs) and elderly (>50yrs) patients.

Methods: Total 300 pulmonary tuberculosis patients each admitted in hospital during 1999 (group ‘A’) and 2016 (group ‘B’) respectively were included in our study. Socio-demographic risk factors and presence of any existing co morbidities and clinical as well radiological presentation data were evaluated.

Results: Majority patients in both group ‘A’ and ‘B’ were males (67% and 61.3%), younger (71.3% and 63.3%) patients. Elder patients had more smokers in both groups (48.8% and 33.6%). COPD trends seems to be receding in group ‘B’ as compared to group ‘A’ in younger (6.3% vs. 8.9%) as well elder (13.6% vs. 29.1%) but on the contrary lifestyle disease trends like DM increased in group ‘B’ than group ‘A’ patients more in elder subgroup (30% vs. 9.3%). HIV infected was more in younger 2.1 % (elder 0.9%) group ‘B’ patients. Haemoptysis (17.8% and 18.6% vs. 13.7% and 9.1%) and cough (~87% vs. ~85%) were almost similar but fever (~90% vs. ~65%) was seen significantly higher in the young patients. Radiologically bilateral upper lobe cavitations (15%-30%) was a higher in group A patients as compared to negligible less than ~3% cavitations in group B, on the contrary infiltrations (15%-32%) was more in group B.

Conclusions: Young adults are more likely to have fever while haemoptysis cough and advanced lung field involvement is more common in elderly. Elderly patients had a higher number of co-morbidities like COPD and DM. The present study reveals that various demographic, socioeconomic and clinical risk factors have a potential role in causation/augmentation of pulmonary tuberculosis hence life style modification, prevention and timely management of these risk factors could be helpful to reduce the burden of disease.


Co- morbidities, Elderly patients, Pulmonary tuberculosis, Risk factors, Risk factors

Full Text:



Buzan MT, Pop CM, Raduta M, Eichinger M, Heussel CP. Respiratory tuberculosis in children and adolescents: Assessment of radiological severity pattern and age-related changes within two decades. Pneumologia (Bucharest, Romania). 2015;64(4):8.

TB India 2016 revised national TB control programme annual status report. New Delhi: central tb division, directorate general of health and family welfare, nirman bhavan; 2011. Available from:

Al-Hajjaj MS. The outcome of tuberculosis treatment after implementation of the national tuberculosis control program in Saudi Arabia. Annals of Saudi medicine. 2000 Mar 1;20(2):125-8.

Campos LC, Rocha MV, Willers DM, Silva DR. Characteristics of patients with smear-negative pulmonary tuberculosis (TB) in a region with high TB and HIV prevalence. PloS one. 2016 Jan 25;11(1):e0147933.

Mohan V, Devi S. Initial higher sputum graded patients treated under category-II RNTCP (DOTS) with Low weight gain tend to have more relapse rate. Int J Sci Res. 2017;6(8):1896-903.

Chandrasekaran V, Gopi PG, Santha T, Subramani R, Narayanan PR. Status of re-registered petients for tuberculosis treatment under DOTS programme. Indian J Tuberculosis. 2007;54(1):12-6.

Aftab H, Ambreen A, Jamil M, Garred P, Petersen JH, Nielsen SD, Bygbjerg IC, et al. High prevalence of diabetes and anthropometric heterogeneity among tuberculosis patients in Pakistan. Tropical Medicine and International Health. 2017 Apr 1;22(4):465-73.

Schoeman JH, Westaway MS, Neethling A. The relationship between socioeconomic factors and pulmonary tuberculosis. International J epidemiology. 1991 Jun;20(2):435-40.

Piel S, Kreuter M, Herth F, Kauczor H-U, Heußel C-P. Pulmonary granulomatous diseases and pulmonary manifestations of systemic granulomatous disease: Including tuberculosis and nontuberculous mycobacteriosis. Radiologe. 2016 Oct;56(10):874-84.

Pinto LM, Dheda K, Theron G, Allwood B, Calligaro G, van Zyl-Smit R, et al. Development of a simple reliable radiographic scoring system to aid the diagnosis of pulmonary tuberculosis. PloS one. 2013 Jan 18;8(1):e54235.

Kistan J, Laher F, Otwombe K, Panchia R, Mawaka N, Lebina L, et al. Pulmonary TB: varying radiological presentations in individuals with HIV in Soweto, South Africa. Transactions of The Royal Society of Tropical Medicine Hygiene. 2017 Mar 1;111(3):132-6.

Stead WW, Lofgren JP, Warren E, Thomas C. Tuberculosis as an endemic and nosocomial infection among the elderly in nursing homes. New England J Medicine. 1985 Jun 6;312(23):1483-7.

Rieder HL, Kelly GD, Bloch AB, Cauthen GM, Snider DE. Tuberculosis diagnosed at death in the United States. Chest. 1991 Sep 1;100(3):678-81.

Rita Sood. The problem of geriatric tuberculosis. J Indian Academy of Clinical Medicine. 2000;5:156-8.

Abbasi A, Rafique M, Saghir A, Abbas K, Shaheen S, Abdullah F. Gender and occupation wise knowledge, Awareness and prevention of tuberculosis among people of district Muzaffarabad AJ and K. Pakistan J Pharmaceutical Sci. 2016 Nov;29(6):1959-68.

Morris JT, Seaworth BJ, McAllister CK. Pulmonary tuberculosis in diabetics. Chest. 1992 Aug 1;102(2):539-41.

Bhatia MS, Bhasin SK, Dubey KK. Psychosocial dysfunction in tuberculosis patients. Indian J Med Sci. 2000 May;54(5):171-3.

Perez-Guzman C, Vargas MH, Torres-Cruz A, Villarreal-Velarde H. Does aging modify pulmonary tuberculosis? A meta-analytical review. Chest. 1999 Oct 1;116(4):961.

Gopi PG, Subramani R, Santha T, Chandrasekaran V, Kolappan C, Selvakumar N, et al. Estimation of burden of tuberculosis in India for the year 2000. Indian J Med Res. 2005 Sep;122:243-8.

Comstock GW, Livesay VT, Woolpert SF. The prognosis of a positive tuberculin reaction in childhood and adolescence. Am J Epidemiol. 1974 Feb 1;99(2):131-8.

Singh U, Mohan V, Singh N, Jhim D, Ramaraj M, Prasanth A, et al. Pleural nodules: A rare presentation of extrapulmonary tuberculosis. Lung India. 2016 Nov 1;33(6):699.

Styblo K. Epidemiology of tuberculosis. 2nd ed. The Hague: Royal Netherlands Tuberculosis Association;1991.

Crofton J, Horne N, Miller F. Clinical tuberculosis. MacMillan,; 1992.

Bai KJ, Lee JJ, Chien ST, Suk CW, Chiang CY. The influence of smoking on pulmonary tuberculosis in diabetic and non-diabetic patients. PloS one. 2016 Jun 7;11(6):e0156677.

Gupta S, Shenoy VP, Mukhopadhyay C, Bairy I, Muralidharan S. Role of risk factors and socio‐economic status in pulmonary tuberculosis: a search for the root cause in patients in a tertiary care hospital, South India. Trop Med Inter Heal. 2011 Jan 1;16(1):74-8.

Asati A, Nayak S, Indurkar M. A study on Factors associated with non-adherence to ATT among pulmonary tuberculosis patients under RNTCP. Int J Med Sci Clin Invent Int J Med Sci Clin Invent. 2017;4(3):2559-63.

Hill PC, Jackson-Sillah D, Donkor SA, Otu J, Adegbola RA, Lienhardt C. Risk factors for pulmonary tuberculosis: a clinic-based case control study in The Gambia. BMC Public Health. 2006 Dec;6(1):156.

Srivatava AB, Jain P, Jain S. Prevalence of diabetes mellitus in active pulmonary tuberculosis patients and clinico-radiological presentation of tubercular diabetic patients. Int J Res Med. 2016;5(2):79-83.

Raghuraman S, Vasudevan KP, Govindarajan S, Chinnakali P, Panigrahi KC. Prevalence of diabetes mellitus among tuberculosis patients in Urban Puducherry. North Am J Medical Sci. 2014 Jan 1;6(1):30.

Singh SK. Pulmonary tuberculosis and Diabetes mellitus. In An update on Respiraroty Medicine. Eds. SK Samaria; JC Matah. 1997;385-9.

Manjareeka M, Palo SK, Swain S, Pati S, Pati S. Diabetes mellitus among newly diagnosed tuberculosis patients in tribal Odisha: an exploratory study. JCDR. 2016 Oct;10(10):LC06.

Abdelbary BE, Garcia-Viveros M, Ramirez-Oropesa H, Rahbar MH, Restrepo BI. Tuberculosis-diabetes epidemiology in the border and non-border regions of Tamaulipas, Mexico. Tuberculosis. 2016 Dec 1;101:S124-34.

Baghaei P, Marjani M, Javanmard P, Tabarsi P, Masjedi MR. Diabetes mellitus and tuberculosis facts and controversies. J Diab Meta Dis. 2013 Dec;12(1):58.

Sanghani RN, Udwadia ZF. The association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax. 2013 Mar 1;68(3):202-3.

Tan KK, CherianA, and Teo SK. Tuberculosis in the elderly. Singapore medical J. 1991;32(6):423-6.

Rawat J, Sindhwani G, Juyal R. Clinico-radiological profile of new smear positive pulmonary tuberculosis cases among young adult and elderly people in a tertiary care hospital at Deheradun (Uttarakhand). Ind J Tuber. 2008 Apr;55(2):84-90.

Patel AK, Rami KC, Ghanchi F. clinical profile of sputum positive pulmonary tuberculosis patients with diabetes mellitus in a teaching hospital at Jamnagar, Gujarat. National J Med Res. 2012;2(3):309-12.

Umeki S. Comparison of younger and elderly patients with pulmonary tuberculosis. Respiration. 1989;55(2):75-83.

Ahmad Z, Zaheer MS. Lower lung field tuberculosis-A clinical study. J Indian Academy Clinical Medicine. 2003 Apr;4(2):117.

Hariprasad S, Ramakrishna MR, Trupti RR, Avinash SS. The study of pulmonary tuberculosis in diabetes mellitus patients. 2013 Apr;4(2):559-71.