Due to the psychological characteristics and biological changes, tuberculosis in the elderly has certain features that differ from those in younger individuals. These differences need to be taken into account during diagnosis, treatment planning, and particularly in the use of anti-tuberculosis medications.
In older adults, tuberculosis may manifest through a mechanism known as “reactivation of latent infection.” The disease re-emerges when dormant tuberculosis bacteria “wake up” after lying inactive in the body for a long time. Several factors contribute to the resurgence of the disease, including the frequent use of corticosteroids and the presence of certain illnesses such as cancer and hematological diseases. The primary risk factor for reactivation is exposure to individuals carrying tuberculosis bacteria.
Tuberculosis lesions may be localized in the thoracic cavity (primarily the lungs, followed by the pleura, pericardium, and lymph nodes) and can affect various other parts of the body (including the digestive system, meninges, urinary system, joints, peripheral lymph nodes, and organs within the abdominal cavity).
Diagnosis of tuberculosis in the elderly is often overlooked, and if detected, the disease is usually at an advanced stage, adversely affecting treatment outcomes. There are many reasons for this situation, but two critical factors are:
– Tuberculosis is becoming increasingly less common (though this is not the case currently), leading to a reduced awareness of the disease.
– The clinical presentation of tuberculosis is often atypical: Symptoms may be non-specific, such as isolated fever or significant weight loss. Prominent signs may arise from another organ, for example, heart failure (edema, hepatomegaly, prominent neck veins…) in a patient with hypertension exacerbated by anemia, with the underlying cause being latent pulmonary tuberculosis.
In older adults, treatment strategies are flexible and not rigidly defined. In practice, there are three common scenarios. If there are confirmed results from bacterial or histological tests indicating a positive tuberculosis diagnosis, specific treatment should commence immediately. If bacterial test results are not available yet, but there are clinical symptoms suggestive of tuberculosis (such as clear X-ray findings), treatment can begin without waiting for test results, as long as necessary specimens for bacterial culture are collected. If there are no immediate bacterial test results and the symptoms are not typical of tuberculosis, a trial treatment with anti-tuberculosis drugs may be initiated. While this approach is unacceptable in younger patients, it is considered “acceptable” in geriatrics, as prolonged waiting for results can be detrimental, especially for bedridden patients who are frail or depressed.
However, in the last two scenarios, it is crucial to simultaneously differentiate from other diseases to avoid misdiagnosis.
Dr. Pham Cuong, Health & Life
