Adults and elderly patients with pulmonary tuberculosis in Surabaya: a comparative cross-sectional study

Abstract

Age-related physiological and immunological changes may influence the clinical presentation of pulmonary tuberculosis (TB), yet comparative evidence from Surabaya remains limited. This study aimed to compare the clinical characteristics, comorbidities, radiological findings, and laboratory profiles of adult and elderly patients with pulmonary TB. An analytical comparative cross-sectional study was conducted at three directly observed treatment, short-course (DOTS) network facilities in Surabaya from July to September 2026. Using consecutive sampling, 50 patients with active pulmonary TB were enrolled, comprising 25 adults and 25 elderly patients. Demographic characteristics, comorbidities, clinical manifestations, chest radiographic findings, random blood glucose, HIV status, and GeneXpert MTB/RIF results were compared between groups. Binary logistic regression was performed to identify factors independently associated with elderly group membership. Malnutrition was significantly more prevalent among elderly patients than adults (64.0% vs 16.0%; OR 9.33, 95% CI 2.43–35.84; p = 0.001). Elderly patients reported cough less frequently (24.0% vs 84.0%; OR 0.06, 95% CI 0.01–0.25; p < 0.001), but experienced night-time fever (68.0% vs 20.0%; OR 8.50, 95% CI 2.34–30.91; p = 0.001) and weight loss (60.0% vs 24.0%; OR 4.75, 95% CI 1.41–16.05; p = 0.021) more frequently. Although lower lung-zone involvement was more common among elderly patients, the overall radiological distribution did not differ significantly (p = 0.057). No significant differences were observed in random blood glucose or GeneXpert MTB/RIF results, and all participants tested negative for HIV. Multivariable analysis identified malnutrition as the only factor independently associated with elderly group membership (adjusted OR 7.606, 95% CI 1.410–41.029; p = 0.018). These findings suggest that elderly patients with pulmonary TB exhibit greater nutritional vulnerability and a less cough-dominant clinical presentation than younger adults. Age-sensitive clinical assessment and nutritional evaluation may support TB management, although the cross-sectional design and limited sample size preclude causal inference and broader generalization.