Tuberculosis (TB) remains a major global public health concern, particularly among vulnerable populations such as the elderly. According to the World Health Organization (WHO), older adults represent a growing proportion of TB cases worldwide, especially in countries experiencing demographic aging [ 1]. Aging is associated with immunosenescence, malnutrition, and multiple chronic conditions, all of which increase susceptibility to Mycobacterium tuberculosis infection and progression to active disease [ 2,3].

Pulmonary tuberculosis in the elderly presents unique diagnostic and therapeutic challenges. Clinical manifestations are often atypical or nonspecific, frequently mimicking other chronic respiratory or systemic diseases, which may result in delayed diagnosis and increased disease severity at presentation [ 4,5]. Radiological findings can also be less characteristic, further complicating diagnosis in this age group [ 6].

Comorbidities such as diabetes mellitus, arterial hypertension, chronic obstructive pulmonary disease (COPD), and cardiovascular diseases are highly prevalent among elderly TB patients and significantly influence disease progression and treatment outcomes [ 7,8]. Diabetes mellitus, in particular, has been shown to triple the risk of active TB and is associated with delayed sputum conversion and higher relapse rates [ 9]. In addition, polypharmacy and age-related changes in drug metabolism increase the risk of adverse reactions and treatment non-adherence [ 10].

The COVID-19 pandemic has further disrupted TB services globally, leading to reduced case detection, delayed diagnosis, and increased mortality, particularly among elderly individuals who faced greater barriers to accessing healthcare [ 11,12]. Therefore, understanding the epidemiological and clinical characteristics of TB in older adults is essential for strengthening TB control strategies.

This study aims to evaluate the epidemiological, clinical, and bacteriological characteristics of tuberculosis in patients aged 65 years and older over a five-year period, with particular emphasis on comorbidities and treatment outcomes.

A retrospective descriptive study was conducted including all tuberculosis cases reported between 2020 and 2024. The study population consisted of patients aged ≥65 years diagnosed with pulmonary or extrapulmonary tuberculosis.

Data were obtained from the National Tuberculosis Program registry and included demographic variables (age, sex, and residence), clinical form of TB, bacteriological confirmation, comorbidities, and treatment outcomes. Diagnosis and classification of TB cases followed national and WHO guidelines [ 1,13].

Statistical analysis was performed using SPSS software. Descriptive statistics were used to summarize patient characteristics. Associations between age and clinical forms of TB were analyzed using inferential statistical tests, with a p-value <0.05 considered statistically significant.

During the study period (2020&#x02013;2024), a total of 1,335 tuberculosis cases were reported, of which 352 cases (26.4%) occurred in individuals aged 65 years and older. This finding is consistent with previous studies indicating a substantial TB burden among elderly populations [ 3,14].

Among elderly patients, pulmonary tuberculosis accounted for 80.7% of cases, while 19.3% were extrapulmonary TB, a distribution similar to that reported in other epidemiological studies [ 5,15]. The annual distribution showed an increase in cases after the COVID-19 period, particularly in 2022, suggesting delayed diagnosis and underreporting during the pandemic years [ 11,12]. Data collection is presented in theTable 1.

Men represented 63.4% of cases, consistent with the male predominance reported in TB epidemiology globally [ 1,16]. Urban residents accounted for 56.8% of cases, possibly reflecting better access to diagnostic services or higher population density [ 17].

Bacteriological confirmation was achieved in 82% of pulmonary TB cases, indicating effective diagnostic capacity. Treatment success exceeded 85%, aligning with WHO treatment success targets and comparable studies in elderly populations [ 1,18].

Comorbidities were highly prevalent. Diabetes mellitus was present in 26.5% of cases, while arterial hypertension was observed in 31%. These findings reflect the well-documented association between TB and chronic non-communicable diseases in older adults [ 7,9]. A statistically significant association between age and clinical form of TB was observed (p < 0.001).

The results confirm that elderly individuals represent a high-risk group for tuberculosis, particularly pulmonary TB. The elevated proportion of TB cases in this age group may be explained by immune system decline, cumulative exposure to infection, and reactivation of latent TB infection acquired earlier in life [ 2,19].

The high prevalence of diabetes mellitus among elderly TB patients is of particular concern, as diabetes impairs innate and adaptive immune responses, increases bacillary load, and negatively affects treatment outcomes [ 9]. Arterial hypertension, while not directly linked to TB susceptibility, complicates clinical management due to polypharmacy and increased risk of cardiovascular complications during treatment [ 10].

Despite these challenges, the high bacteriological confirmation and treatment success rates observed in this study indicate that existing TB control programs remain effective in elderly populations. However, previous studies emphasize that older patients are at increased risk of adverse drug reactions and require closer monitoring throughout treatment.

The observed increase in TB cases following the COVID-19 pandemic supports global evidence showing that disruptions in TB services have disproportionately affected vulnerable populations, including the elderly [ 11,12].

Pulmonary tuberculosis remains a significant public health issue among elderly individuals and is frequently associated with chronic comorbidities such as diabetes mellitus and arterial hypertension. These conditions complicate diagnosis, delay treatment initiation, and influence therapeutic outcomes.

Although treatment success rates remain high, the findings underscore the need for an integrated and multidisciplinary approach that includes early detection, systematic screening for comorbidities, and individualized treatment strategies. Strengthening TB services for elderly populations is essential to improve disease control and reduce TB-related morbidity and mortality.