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Tuberculosis in the elderly

P D Davies1

  • 1Tuberculosis Research Unit, Cardiothoracic Centre, Liverpool, UK.

The Journal of Antimicrobial Chemotherapy
|August 1, 1994
PubMed
Summary
This summary is machine-generated.

Tuberculosis (TB) notifications are increasing in England and Wales, with a significant rise observed in individuals over 75. This demographic requires careful consideration for diagnosis and treatment due to unique presentation and increased risk of adverse effects.

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Geriatrics

Background:

  • Tuberculosis (TB) incidence has been rising in England and Wales since 1987.
  • The elderly population (over 75) shows a disproportionately higher increase in TB notifications compared to the general population.

Observation:

  • While classic TB symptoms persist in the elderly, there's an emerging trend of insidious, cryptic miliary disease with often normal chest X-rays.
  • Diagnosis in the elderly may rely on clinical suspicion, initiating treatment before definitive microbiological confirmation.
  • Older adults are more susceptible to adverse effects from anti-TB chemotherapy, necessitating cautious management.

Findings:

  • Drug resistance in TB is uncommon among the elderly in the UK.
  • Standard treatment involves isoniazid, rifampicin, and pyrazinamide for two months, followed by isoniazid and rifampicin for four months (longer for TB meningitis).

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  • Preventative therapy with isoniazid or isoniazid/rifampicin is generally not recommended for the elderly in the UK due to frequent anergy and negative tuberculin tests.

    • Implications:

    • Healthcare providers must maintain a high index of suspicion for TB in the elderly, even with atypical presentations.
    • Treatment protocols need to balance efficacy with the increased risk of adverse drug reactions in older patients.
    • Current UK guidelines suggest preventative therapy is not a primary strategy for TB control in this age group.