TAILIEUCHUNG - Tuberculosis in the elderly

Although the last decade has been marked by a major decline in the incidence of tuberculosis (TB) in the United States, TB remains an important diagnosis to consider among older individuals. The clinical presentation is often insidious and non-specific, as is the radiological presentation. The elderly account for a large proportion of TB cases discovered at autopsy, illustrating the difficulty of clinical diagnosis in this age group. The last decade has also seen changes in tuberculin skin testing (TST) strategies and in the treatment guidelines for latent TB. In the past, TST was recommended for almost all individuals as a part of routine health screening. TST is now targeted. | Clin Geriatr Med 19 2003 121-138 CLINICS IN GERIATRIC MEDICINE Tuberculosis in the elderly Mabel Zevallos MDa Jessica E. Justman MDb Department of Medicine Bronx-Lebanon Hospital Center 1650 Grand Concourse Bronx NY 10457 USA Division of Infectious Diseases Bronx-Lebanon Hospital Center 1650 Grand Concourse Bronx NY 10457 USA Although the last decade has been marked by a major decline in the incidence of tuberculosis TB in the United States TB remains an important diagnosis to consider among older individuals. The clinical presentation is often insidious and non-specific as is the radiological presentation. The elderly account for a large proportion of TB cases discovered at autopsy illustrating the difficulty of clinical diagnosis in this age group. The last decade has also seen changes in tuberculin skin testing TST strategies and in the treatment guidelines for latent TB. In the past TST was recommended for almost all individuals as a part of routine health screening. TST is now targeted at persons who have risk factors for developing active TB including nursing home residents. Clarification of nomenclature has accompanied the most recent guidelines on TST. Those with reactive TSTs have latent TB infection LTBI and receive treatment for LTBI rather than chemoprophylaxis. Isoniazid continues to be the best method of preventing LTBI from becoming an active infection. In the past nursing home residents or immigrants with a positive TST of unknown duration who were over age 35 were not given isoniazid unless certain comorbid conditions were present because of the risk of hepatotoxicity. Current guidelines no longer use age as an exclusionary condition however. Treatment of active disease in the elderly does not significantly differ from treatment of younger patients. Management dilemmas may arise when the diagnosis of active TB infection is suspected but not proven. In view of the poor outcome of untreated TB empiric TB treatment should be more readily considered in

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