Tuberculosis In Elderly Patients Research Articles

Tuberculosis and aging: a global health problem.

Despite the World Health Organization's declaration that the spread of tuberculosis is a global emergency and despite the implementation of strong tuberculosis-control initiatives, this highly infectious disease continues to affect all vulnerable populations, including the elderly population (age > or =65 years). Tuberculosis in aging adults remains a clinical and epidemiological challenge. Atypical clinical manifestations of tuberculosis in older persons can result in delay in diagnosis and initiation of treatment; thus, unfortunately, higher rates of morbidity and mortality from this treatable infection can occur. Underlying illnesses, age-related diminution in immune function, the increased frequency of adverse drug reactions, and institutionalization can complicate the overall clinical approach to tuberculosis in elderly patients; maintenance of a high index of suspicion for tuberculosis in this vulnerable population is, thus, undoubtedly justifiable.

Clinical Features of Pulmonary Tuberculosis In The Elderly

Background Pulmonary tuberculosis(TB) is still prevalent and remains a significant clinical problem for the elderly. However, the disease presents in many ways, and there are frequent adverse drug reactions that may prevent the early diagnosis and treatment of elderly TB patients compared to the young. The purpose of this study was to determine whether or not there are any differences in the clinical feature of pulmonary tuberculosis(TB) in both the diagnosis and treatment between the young (less than 64 years) and the elderly (65 years and more). Methods The medical records of 125 young and 70 elderly pulmonary TB patients, who were diagnosed with and treated for pulmonary TB at the Seoul Municipal Boramae Hospital from November 1991 to January 1997, were analyzed retrospectively. Results Anorexia(12% vs. 31.4%), general weakness (20.0% vs. 54.3%), dyspnea(21.6% vs. 37.1%) and an abnormal mentality (0.8% vs. 15.7%) were more frequent presenting symptoms in elderly TB patients, whereas hemoptysis (32.8% vs. 10.0%) and fever (BT>37℃ 58.4% vs. 35.7%) were more frequent in the young. The elderly had a higher number of cardiovascular and chronic obstructive pulmonary diseases as underlying illnesses. In chest PA, there were no differences in the location of the TB lesion, but the appearances were initially diagnosed more frequently as pneumonia or lung cancer (8.8% vs. 30.0%, p<0.05) in the elderly. There was no difference in the detection rate of acid fast bacilli(AFB) in the sputum between the two groups. There were no differences in the treatment response and follow-up loss. However, adverse drug reactions (13.6% vs. 45.7%, p<0.05), and changes in medication (4.9% vs. 25.7%, p<0.05) during treatment occurred more frequently in the elderly. One among the 125 young patients died from tuberculosis whereas 6 among the 70 elderly patients died from the disease. Conclusion Because the clinical and radiological presentations were more atypical, a sputum AFB smear and culture should be done immediately in the elderly who are TB. The elderly experienced more frequent adverse drug reactions and mortality during treatment, but the response to treatment was good and rapid.

Clinical Spectrum of Endobronchial Tuberculosis in Elderly Patients

We describe 11 elderly patients with bacteriologically proved endobronchial tuberculosis, representing 15% of our 73 geriatric patients with pulmonary tuberculosis in the period 1980 to 1987. In seven (64%) of the 11 patients, an incorrect diagnosis was initially made. Cough, mostly nonproductive, was invariably present, and general symptoms (fever, anorexia, weight loss) predominated over specific pulmonary symptoms. The radiographic features were rather "unusual": in only two (18%) of the 11 cases, apicoposterior consolidations with or without cavitation were found. Fiberoptic bronchoscopy showed a range of endobronchial abnormalities that included ulcerations, mass lesions, and fibrostenoses. Antituberculous treatment generally led to satisfactory results. Still, residual bronchostenosis was observed in four (57%) of seven patients in whom a control bronchoscopy was done. In one of these four patients, a pneumonectomy had to be performed for uncontrollable retro-obstructive infections, and in another, repeated endoscopic dilatations were effective. In elderly patients, endobronchial tuberculosis should be considered in the differential diagnosis, especially in the presence of chronic cough. In these patients, the chest roentgenogram may be clear or suggestive of bronchial carcinoma or pneumonitis.

Clinical spectrum of endobronchial tuberculosis in elderly patients

We describe 11 elderly patients with bacteriologically proved endobronchial tuberculosis, representing 15% of our 73 geriatric patients with pulmonary tuberculosis in the period 1980 to 1987. In seven (64%) of the 11 patients, an incorrect diagnosis was initially made. Cough, mostly nonproductive, was invariably present, and general symptoms (fever, anorexia, weight loss) predominated over specific pulmonary symptoms. The radiographic features were rather "unusual": in only two (18%) of the 11 cases, apicoposterior consolidations with or without cavitation were found. Fiberoptic bronchoscopy showed a range of endobronchial abnormalities that included ulcerations, mass lesions, and fibrostenoses. Antituberculous treatment generally led to satisfactory results. Still, residual bronchostenosis was observed in four (57%) of seven patients in whom a control bronchoscopy was done. In one of these four patients, a pneumonectomy had to be performed for uncontrollable retro-obstructive infections, and in another, repeated endoscopic dilatations were effective. In elderly patients, endobronchial tuberculosis should be considered in the differential diagnosis, especially in the presence of chronic cough. In these patients, the chest roentgenogram may be clear or suggestive of bronchial carcinoma or pneumonitis.

Should Isoniazid be Used to Prevent Tuberculosis in Elderly Patients?

Should Isoniazid be Used to Prevent Tuberculosis in Elderly Patients?

Pulmonary tuberculosis in elderly men

The clinical manifestations, predisposing factors, and diagnostic approach to 29 young men and 35 elderly men with pulmonary tuberculosis admitted to a Veterans Administration hospital were compared. Elderly men had a higher number of underlying conditions such as atherosclerosis, previous gastrectomy, and malignancy, whereas alcoholism was more prevalent in the younger group. The classic symptoms and signs of tuberculosis were noted in a significantly higher proportion of the younger group: fever (62 percent versus 31 percent), weight loss (76 percent versus 34 percent), night sweats (48 percent versus 6 percent), sputum production (76 percent versus 48 percent), and hemoptysis (40 percent versus 17 percent) (p <0.05). Abnormal mentation was more common in the elderly group (31 percent versus 10 percent) (p <0.05). Radiographic findings were similar in both groups. Mortality related to tuberculosis was 20 percent in elderly men versus 3 percent in the younger men (p <0.05). Tuberculosis is frequently not considered in the differential diagnosis when elderly patients present with multiple medical problems and nonspecific complaints. Since there are differences in the clinical presentation and the outcome of pulmonary tuberculosis in elderly patients, a high index of suspicion for the disease should be maintained.

Tests of activity in pulmonary tuberculosis in elderly patients: serum angiotensin converting enzyme and serum albumin

International Journal of Clinical PracticeVolume 40, Issue 11 p. 459-461 Clinical Study Tests of activity in pulmonary tuberculosis in elderly patients: serum angiotensin converting enzyme and serum albumin K O Lee BSc, MRCP, K O Lee BSc, MRCP Lecturer, Visiting fellow University Department of Medicine IISearch for more papers by this authorL B Teh MB, MRCP, L B Teh MB, MRCP Senior Registrar Department of Nuclear Medicine, Singapore General HospitalSearch for more papers by this authorY Y Ong MB, FRACP, Y Y Ong MB, FRACP Consultant Physician Department of Nuclear Medicine, Singapore General HospitalSearch for more papers by this authorS E Aw PhD, FRCPath, S E Aw PhD, FRCPath Head Department of Nuclear Medicine, Singapore General HospitalSearch for more papers by this author K O Lee BSc, MRCP, K O Lee BSc, MRCP Lecturer, Visiting fellow University Department of Medicine IISearch for more papers by this authorL B Teh MB, MRCP, L B Teh MB, MRCP Senior Registrar Department of Nuclear Medicine, Singapore General HospitalSearch for more papers by this authorY Y Ong MB, FRACP, Y Y Ong MB, FRACP Consultant Physician Department of Nuclear Medicine, Singapore General HospitalSearch for more papers by this authorS E Aw PhD, FRCPath, S E Aw PhD, FRCPath Head Department of Nuclear Medicine, Singapore General HospitalSearch for more papers by this author First published: 01 November 1986 https://doi.org/10.1111/j.1742-1241.1986.tb08031.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume40, Issue11November 1986Pages 459-461 RelatedInformation

Reactivation of Tuberculosis: A Problem of Aging

Six examples demonstrate the reactivation of pulmonary tuberculosis in elderly patients. In 3 cases the tuberculosis became reactivated 25, 47 and 51 years respectively after the initial diagnosis. In aged patients with pulmonary symptoms and abnormal x-ray findings, the presence of reactivated tuberculosis should always be considered. Sometimes steroid or x-ray therapy for other disease may be the reactivating factor.

Physicians' attitudes toward inactive tuberculosis in elderly patients.

Physicians' attitudes toward inactive tuberculosis in elderly patients.