Abstract
Despite comprising only 15% of the total population, older adults (age 65 years and over) account for the majority of active tuberculosis (TB) and residents of long-term care are at particularly high risk.
Aging of the immune system (i.e., immune senescence), poor nutrition (particularly vitamin D deficiency), and comorbidities contribute to the risk of Mycobacterium tuberculosis reactivation in older adults.
When compared with young adults, older adults are less likely to have classic symptoms of TB which include fever, night sweats, hemoptysis or weight loss, but they are more likely to present with nonspecific symptoms such as dizziness and mental “dullness.”
Radiographic changes in older adults with pulmonary TB are less likely to be upper lobe and cavitary than in younger adults; further, pulmonary TB in older adults is often mistaken for community-acquired pneumonia, an error that can lead to delayed diagnosis/treatment, exposure of healthcare workers to TB, and an increased risk of drug resistance.
Treatment of TB does not vary by age but toxicities of anti-tuberculous therapy may be more prevalent with advanced age, and drug interactions are common.
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Suggested Reading
Chan, E.D., Welsh, C.H. (1998). Respiratory medicine. Chest, 114, 1704–1733.
Perez-Guzman, C., Vargas, M.H., Torres-Cruz, A., Villarreal-Villarde, H. (1999). Does aging modify tuberculosis: A meta-analytical review. Chest, 116, 961–967.
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Marion, C.R., High, K.P. (2009). Tuberculosis in Older Adults. In: Norman, D., Yoshikawa, T. (eds) Infectious Disease in the Aging. Infectious Disease. Humana Press. https://doi.org/10.1007/978-1-60327-534-7_8
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