Aspectos clínicos da tuberculose pulmonar em idosos atendidos em hospital universitário do Rio de Janeiro, RJ, Brasil / Clinical aspects of pulmonary tuberculosis in elderly patients from a university hospital in Rio de Janeiro, Brazil

RESUMO

OBJETIVOS: Avaliar as características clínicas e diagnósticas da tuberculose pulmonar (TP) em idosos. MÉTODOS: Foram comparados 117 pacientes com 60 anos de idade ou mais (idosos) e 464 pacientes entre 15 e 49 anos (não idosos), acompanhados no Instituto de Doenças do Tórax da Universidade Federal do Rio de Janeiro, de 1980 a 1996. RESULTADOS: Nos idosos, predominou história prévia de TP (OR = 2,09; IC95 por cento = 1,26-3,45; p = 0,002) enquanto o contato intradomiciliar de TP predominou nos não idosos (OR = 0,26; IC95 por cento = 0,10-0,66; p = 0,002). O tempo mediano para diagnóstico alcançou 90 dias nos idosos e 60 dias nos não idosos. No grupo idoso, prevaleceu a dispnéia (OR = 1,64; IC95 por cento = 1,06-2,53; p = 0,018) e o emagrecimento (OR = 1,66; IC95 por cento = 1,01-2,82; p = 0,047). Nos não idosos, prevaleceu a hemoptise (OR = 0,51; IC95 por cento = 0,32-0,81; p = 0,002), a dor torácica (OR = 0,62; IC95 por cento = 0,40-0,97; p = 0,027) e a febre (OR = 0,55; IC95 por cento = 0,35-0,86; p = 0,006). No padrão radiológico, predominaram as infiltrações e as cavitações; porém, o acometimento bilateral foi mais freqüente nos idosos (OR = 1,76; IC95 por cento = 1,12-2,78; p = 0.009). Não houve diferenças nas positividades do teste tuberculínico, baciloscopia e cultura de Mycobacterium tuberculosis. CONCLUSÕES: Há poucas diferenças clínicas e laboratoriais entre os grupos etários e o maior tempo de diagnóstico nos idosos deve-se à menor suspeição médica nestes pacientes.

ABSTRACT

OBJECTIVE: To evaluate clinical aspects and the diagnosis of pulmonary tuberculosis (PT) in the aged. METHODS: We compared 117 patients over 60 years of age (elderly group) and 464 patients aged 15 to 49 years old (nonelderly group) treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro, from 1980 to 1996. RESULTS: Previous history of PT was predominant in the elderly group (OR = 2.09; 95 percent CI = 1.26-3.45; p = 0.002), whereas household contact with PT was predominant in the nonelderly group (OR = 0.26; 95 percent CI = 0.10-0.66; p = 0.002). Mean time for diagnosis was 90 days in the elderly group and 60 days in the nonelderly group. In the elderly group, dyspnea (OR = 1.64; 95 percent CI = 1.06-2.53; p = 0.018) and weight loss (OR = 1.66; 95 percent CI = 1.01-2.82; p = 0.047) were predominant. In the nonelderly group, hemoptysis (OR = 0.51; 95 percent CI = 0.32-0.81; p = 0.002), chest pain (OR = 0.62; 95 percent CI = 0.40-0.97; p = 0.027) and fever (OR = 0.55; 95 percent CI = 0.35-0.86; p = 0.006) were more common. The most common radiological abnormalities were infiltrates and cavitations. Bilateral involvement was more common in the elderly patients (OR = 1.76; 95 percent CI = 1.12-2.78; p = 0.009). There were no differences between the two groups regarding positivity for Mycobacterium tuberculosis identified through tuberculin skin testing, sputum smear microscopy and culture. CONCLUSIONS: There are few clinical and laboratory differences between the age groups. The delayed diagnosis in the elderly group can be explained by the low clinical suspicion in these patients.