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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizamos 55 casos de tuberculosis en enfermos mayores de 65 a&#241;os con diagn&#243;stico de certeza&#44; que representan el 9&#37; del total de pacientes controlados en nuestros dispensarios durante un per&#237;odo de 5 a&#241;os&#46; La edad media fue de 72&#46;4 y la relaci&#243;n var&#243;n&#47;mujer de 4&#47;1&#46; Las patolog&#237;as asociadas m&#225;s frecuentes fueron el tabaquismo &#40;49&#37;&#41;&#44; EPOC &#40;33&#37;&#41;&#44; enolismo cr&#243;nico &#40;25&#37;&#41; y tuberculosis previa &#40;20&#37;&#41;&#46; La forma de presentaci&#243;n cl&#237;nica m&#225;s com&#250;n fue la pulmonar &#40;76&#37;&#41;&#46; seguida de la pleural &#40;9&#37;&#41; y &#243;sea &#40;7&#37;&#41;&#46; El cuadro cl&#237;nico fue inespec&#237;fico con un 13&#37; de enfermos asintom&#225;ticos&#46; El s&#237;ntoma m&#225;s constante fue la tos &#40;45&#37;&#41;&#46; El dato radiol&#243;gico m&#225;s frecuente fue el infiltrado fibroulcerativo unilateral y apical&#46; El derrame pleural y la cavitaci&#243;n se demostraron en el 14 y 22&#37;&#44; respectivamente&#46; Un 44&#37; de pacientes ten&#237;an alteraciones radiol&#243;gicas de tipo cicatricial&#46; La tuberculina fue positiva en el 88&#37; de los casos en que se practic&#243;&#46; La media de retraso en el diagn&#243;stico fue de 3&#44;4 meses&#46; El 62&#37; de enfermos se diagnosticaron por baciloscopia&#44; el 11&#37; por cultivo y el 27&#37; mediante histolog&#237;a&#46; La mortalidad de la serie&#44; debida a la propia tuberculosis&#44; fue de un 4&#37;&#46; Tres pacientes abandonaron el tratamiento y se detectaron un fracaso y una reca&#237;da en el control terap&#233;utico&#46; Apreciamos reacciones adversas en el 33&#37; de enfermos y al comparar los dos esquemas terap&#233;uticos utilizados &#40;2 meses rifampicina &#91;R&#93; m&#225;s isoniacida &#91;H&#93; y etambutol &#91;E&#93; &#47; 7 meses RH y 2 meses RHEZ &#91;Z&#59; pirazinamida&#93; &#47;4 meses RH&#41; no observamos diferencias estad&#237;sticamente significativas&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La tuberculosis senil en nuestro medio tiene poca incidencia y cl&#237;nicamente se comporta de forma muy similar al resto de poblaci&#243;n adulta&#46; Tanto la eficacia como la tolerancia del tratamiento pueden considerarse &#243;ptimas&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We analyzed 55 confirmed cases of tuberculosis in patients over 65&#44; a sample that amounted to 9&#37; of all patients seen in our practice over a period of 5 years&#46; Mean age was 72&#46;4 and the male&#47;female ratio was 4&#47;1&#46; The most frequently associated diseases were tobacco addiction &#40;49&#37;&#41;&#44; chronic obstructive pulmonary disease &#40;33&#37;&#41;&#44; alcoholism &#40;25&#37;&#41; and prior diagnosis of tuberculosis &#40;20&#37;&#41;&#46; Lung involvement was the most common clinical presentation &#40;76&#37;&#41;&#44; followed by pleural &#40;9&#37;&#41; and skeletal &#40;7&#37;&#41; involvement&#46; The clinical picture was non specific&#44; with 13&#37; remaining asymptomatic&#46; Cough was the most frequent symptom &#40;45&#37;&#41; and unilateral apical fibrosis with ulceration was the most frequent radiological finding&#46; Pleural discharge and cavitation were demonstrated in 14 and 22&#37;&#44; respectively&#46; Scarring was visible on <span class="elsevierStyleSmallCaps">X</span>-rays in 44&#37;&#46; The tuberculin test was positive in 88&#37; of the cases in which it was performed&#46; Mean delay in diagnosis was 3&#46;4 months&#59; 62&#37; were diagnosed by sputum test&#44; 11&#37; by culture&#44; and 27&#37; histology&#46; In 4&#37; death was directly caused by tuberculosis&#46; Three patients withdrew from treatment&#44; in one case treatment failed&#44; and there was one relapse detected at follow-up&#46; We observed adverse side effects in 33&#37;&#44; and found no statistically significant differences between the 2 therapeutic protocols used &#40;2 months RHS&#47;7 months RH and 2 months RHZS&#47;4 months RH&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The incidence of tuberculosis among the elderly is low in our practice and the entity behaves much as it does in the rest of the adult population&#46; Both the efficacy and tolerance of treatment can be considered optimal&#46;</p></span>"
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Vol. 32. Issue 3.
Pages 122-126 (March 1996)
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Vol. 32. Issue 3.
Pages 122-126 (March 1996)
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Eficacia y tolerancia del tratamiento de la tuberculosis senil
Efficacy and tolerance in the treatment of tuberculosis in the elderly
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J. Ruiz1, A. Teixidó, M. Gallego, J. Ribas, J. Morera
Servicio de Neumologia. Hospital Universitari Germans Trias i Pujol. Badalona. Barcelona
X. Aguilar*, J. Fernández-Muixí*, C. Richart*
* Unidad de Neumología y Servicio de Medicina Interna. Hospital Universitari Joan XXIII. Tarragona
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Analizamos 55 casos de tuberculosis en enfermos mayores de 65 años con diagnóstico de certeza, que representan el 9% del total de pacientes controlados en nuestros dispensarios durante un período de 5 años. La edad media fue de 72.4 y la relación varón/mujer de 4/1. Las patologías asociadas más frecuentes fueron el tabaquismo (49%), EPOC (33%), enolismo crónico (25%) y tuberculosis previa (20%). La forma de presentación clínica más común fue la pulmonar (76%). seguida de la pleural (9%) y ósea (7%). El cuadro clínico fue inespecífico con un 13% de enfermos asintomáticos. El síntoma más constante fue la tos (45%). El dato radiológico más frecuente fue el infiltrado fibroulcerativo unilateral y apical. El derrame pleural y la cavitación se demostraron en el 14 y 22%, respectivamente. Un 44% de pacientes tenían alteraciones radiológicas de tipo cicatricial. La tuberculina fue positiva en el 88% de los casos en que se practicó. La media de retraso en el diagnóstico fue de 3,4 meses. El 62% de enfermos se diagnosticaron por baciloscopia, el 11% por cultivo y el 27% mediante histología. La mortalidad de la serie, debida a la propia tuberculosis, fue de un 4%. Tres pacientes abandonaron el tratamiento y se detectaron un fracaso y una recaída en el control terapéutico. Apreciamos reacciones adversas en el 33% de enfermos y al comparar los dos esquemas terapéuticos utilizados (2 meses rifampicina [R] más isoniacida [H] y etambutol [E] / 7 meses RH y 2 meses RHEZ [Z; pirazinamida] /4 meses RH) no observamos diferencias estadísticamente significativas.

La tuberculosis senil en nuestro medio tiene poca incidencia y clínicamente se comporta de forma muy similar al resto de población adulta. Tanto la eficacia como la tolerancia del tratamiento pueden considerarse óptimas.

Palabras clave:
Tuberculosis
Población senil

We analyzed 55 confirmed cases of tuberculosis in patients over 65, a sample that amounted to 9% of all patients seen in our practice over a period of 5 years. Mean age was 72.4 and the male/female ratio was 4/1. The most frequently associated diseases were tobacco addiction (49%), chronic obstructive pulmonary disease (33%), alcoholism (25%) and prior diagnosis of tuberculosis (20%). Lung involvement was the most common clinical presentation (76%), followed by pleural (9%) and skeletal (7%) involvement. The clinical picture was non specific, with 13% remaining asymptomatic. Cough was the most frequent symptom (45%) and unilateral apical fibrosis with ulceration was the most frequent radiological finding. Pleural discharge and cavitation were demonstrated in 14 and 22%, respectively. Scarring was visible on X-rays in 44%. The tuberculin test was positive in 88% of the cases in which it was performed. Mean delay in diagnosis was 3.4 months; 62% were diagnosed by sputum test, 11% by culture, and 27% histology. In 4% death was directly caused by tuberculosis. Three patients withdrew from treatment, in one case treatment failed, and there was one relapse detected at follow-up. We observed adverse side effects in 33%, and found no statistically significant differences between the 2 therapeutic protocols used (2 months RHS/7 months RH and 2 months RHZS/4 months RH).

The incidence of tuberculosis among the elderly is low in our practice and the entity behaves much as it does in the rest of the adult population. Both the efficacy and tolerance of treatment can be considered optimal.

Key words:
Tuberculosis
Elderly population
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