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Tuberculosis and the older patient

Part of: Bespoke shallow archive Weizmann

Published online by Cambridge University Press:  04 May 2010

S Haney  and
SC Stenton
S Haney
Affiliation:
Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
SC Stenton*
Affiliation:
Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK
*
Address for correspondence: Dr SC Stenton, Consultant Physician and Senior Lecturer, Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK. Email: Chris.Stenton@nuth.nhs.uk
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Summary

Tuberculosis (TB) rates in the UK have increased by about 25% over the last 20 years. About 12% of cases occur in those over 65. Their diagnosis and treatment is similar to that of younger patients, but their presentation is often atypical, diagnosis is often delayed, there is a higher frequency of treatment side-effects and there is greater potential for drug interactions. Mortality increases markedly with age and more than half of those aged 80 years or more die before completing treatment. About 75% of TB in older patients is due to reactivation of latent disease acquired in childhood. The risk of reactivation is particularly increased by human immunodeficiency virus (HIV) infection and anti-tumour necrosis factor (anti-TNF) medication. Active disease spreads by the inhalation of airborne droplets, particularly in enclosed environments such as nursing homes. Interferon gamma release assays (IGRAs) are an important new development in recognizing latent infection. They should allow better targeting of treatment in those with recently acquired infection, or who are at risk of reactivation. With appropriate effort it should be possible to substantially reduce TB rates to fewer than 1 per million per year, the current US target.

Keywords

tuberculosisageinginterferon gamma release assayepidemiologymanagement
Type
Clinical geriatrics
Information
Reviews in Clinical Gerontology , Volume 20 , Issue 2 , May 2010 , pp. 81 - 91
Copyright
Copyright © Cambridge University Press 2010

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