Older subjects are today the main reservoir of tuberculosis infection in the indigenous population of industrialized countries. The incidence of tuberculosis in patients aged over 65 is higher than in all other age groups, except for HIV-infected subjects. In Switzerland, the incidence of tuberculosis in patients aged over 70 (20/105 inhabitants) is 2.5 times that of the general population. Comorbidities, immunosenescence, malnutrition, and immunosuppressive therapy all contribute to the higher incidence of tuberculosis in this age group.
Clinical presentations of mycobacterial infection in the elderly are often atypical, leading to delayed diagnosis. Thus, mortality of tuberculosis is much higher than in younger age groups, and increases with age. When compared to younger adults, elderly patients with active tuberculosis have less cough, fever, hemoptysis, and night sweats. Their tuberculin skin test is more often negative (32% vs. 10% in younger subjects) (Katz et al., 1987; Korzeniewska-Kosela et al., 1994; Mathur et al., 1994; Chan et al., 1995). On chest roentgenograms, older subjects have more frequent lower or middle lobe involvement, miliary tuberculosis, and atypical presentations (solitary nodules, pseudo-masses, and infiltrates resembling bronchopneumonia), and a lower incidence of cavitary lesions (Korzeniewska-Kosela et al., 1994; Chan et al., 1995). Finally, tuberculostatic treatment is associated with an age-related increase in side-effects (mainly hepatotoxicity).
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