When to consider tuberculosis: bronchiectasis in the elderly population
Caitlin Rose Morgan1, Georgina K Russell2, Onn Min Kon2
1Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK caitlin.morgan@doctors.org.uk.
BMJ Case Reports
|March 5, 2021
Summary
Older adults in England face over 4-month delays for pulmonary tuberculosis (TB) diagnosis. This delay, often due to atypical symptoms and pre-existing lung conditions like bronchiectasis, impacts timely treatment initiation.
Area of Science:
- Pulmonology
- Infectious Diseases
- Geriatrics
Background:
- Pulmonary tuberculosis (TB) diagnosis in patients aged 65+ in England is significantly delayed.
- Average delay exceeds 4 months from symptom onset to diagnosis.
- This impacts effective treatment and patient outcomes.
Observation:
- This report details three cases of elderly patients with pulmonary TB.
- All cases involved significant delays in both diagnosis and treatment.
- Each patient had a history of bronchiectasis, complicating initial symptom assessment.
Findings:
- Symptoms were initially misattributed to pre-existing lung conditions, such as bronchiectasis.
- Factors contributing to diagnostic delays include immunosenescence, atypical TB presentation in the elderly, and pre-existing lung disease.
- Delays occur at both primary care and specialist levels.
Implications:
- Delayed diagnosis and treatment of pulmonary TB in older adults can lead to poorer prognoses.
- Healthcare providers need increased awareness of atypical TB presentations in geriatric populations.
- Strategies to shorten diagnostic timelines for pulmonary TB in the elderly are crucial.
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