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[Tuberculosis in elderly]
Toshinobu Yokoyama1, Toru Rikimaru, Rumi Gohara
1First Department of Internal Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume-shi, Fukuoka 830-0011, Japan. yokoyama-t@nyc.odn.ne.jp
Kekkaku : [Tuberculosis]
|August 23, 2003
Summary
Older tuberculosis patients exhibit weakened immune responses, including higher rates of anergy to purified protein derivative (PPD) skin tests and lower interferon-gamma levels. However, age did not impact sputum culture conversion time.
Area of Science:
- Immunology
- Geriatrics
- Infectious Diseases
Background:
- Tuberculosis (TB) disproportionately affects older adults, presenting unique clinical and immunological challenges.
- Understanding age-related differences in TB pathogenesis and treatment response is crucial for effective management.
Purpose of the Study:
- To compare the immunologic and clinical features of active tuberculosis in patients aged 65 and above versus those younger than 65.
- To identify factors influencing treatment outcomes, specifically sputum culture conversion time, in different age groups.
Main Methods:
- Retrospective comparison of active TB patients treated at Kurume University Hospital.
- Analysis of immunologic markers (PPD anergy, lymphocyte counts, interferon-gamma levels) and clinical features.
- Evaluation of time to negative sputum culture conversion.
Main Results:
- Patients over 65 showed higher rates of PPD anergy (14% vs 7%) and lower peripheral blood lymphocyte and serum interferon-gamma levels.
- Older patients experienced more frequent complications.
- Sputum culture conversion time did not significantly differ by age.
- Chemotherapy regimen adequacy and drug sensitivity were key determinants of culture conversion.
Conclusions:
- Older adults with TB have distinct immunologic profiles and higher complication rates.
- Effective chemotherapy and drug sensitivity are critical for TB treatment success, irrespective of age.
- Concurrent diseases and functional status are major challenges in managing TB in the elderly.