Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people

Abstract

With the ageing population globally, tuberculosis (TB) in older people becomes a major clinical and public health challenge. In many Asian countries, especially those located in the eastern and southeastern parts of the continent, geriatric TB is a significant problem. TB in the older patients is more difficult to diagnose in the early course of disease, and has poorer treatment outcomes, largely as increased failure and death. More drug-induced adverse reactions are also experienced by this population during TB therapy. Oxidative stress and mitochondrial dysfunction are now well recognized to be associated with the ageing process, and it is likely that the cellular and molecular perturbations interact inextricably with the immunological dysfunction biophysiologically inherent to ageing. These underlying mechanistic bases putatively contribute to the development of TB in the geriatric population and worsen the disease outcomes, especially when the TB is compounded by co-morbid conditions such as smoking and diabetes mellitus. Unravelling these mechanisms further would yield knowledge that might potentially help to prevent reactivated TB in older people, and also to better manage the established disease with drug regimens and other new therapeutic strategies. In addition, addressing the social elements associated with geriatric TB is also imperative in the relief of individual patient suffering and improvement of overall disease control.

Altered monocyte phenotypes but not impaired peripheral T cell immunity may explain susceptibility of the elderly to develop tuberculosis

“…Conversely, the increased case rate of TB in the elderly could be due to an age-related biological susceptibility to transition from a latent TB infection to active TB (Hochberg and Horsburgh, 2013; Horsburgh et al, 2010; Tocque et al, 1998). In South-East Asia, where new and relapse TB case notification rates are in general on par with case rates in Africa, those older than 55 years of age still have the highest incidence rate of TB, suggesting that the elderly are biologically susceptible to developing active TB (Tocque et al, 1998; WHO, 2017; Yew Wing W. et al, 2018). Our cross-sectional observational study assumes that the elderly are biologically more susceptible to developing active TB.…”

Contemporary Concise Review 2018: Respiratory infections and tuberculosis

“…Yew et al , in their review of the epidemiological, clinical and mechanistic perspectives of TB in older people, highlighted the increasing clinical and public health challenge posed by TB in the ageing population in many Asian countries . The complex interactions among oxidative stress, mitochondrial dysfunction and immunological dysfunction may contribute to the development of TB in the geriatric population and worsen the disease outcomes, especially in presence of co‐morbid conditions such as smoking and diabetes mellitus.…”

Baja captación y éxito en el tratamiento para la tuberculosis en una cárcel de Ecuador

“…Los factores asociados a tratamientos no exitosos son: ser adulto mayor (50-64 años de edad) por la vulnerabilidad que le otorga su estado inmunitario (22, 23), seguido del grupo de 17-24 años; tener tuberculosis pulmonar, lo que eleva el riesgo de contagio dentro de los centros penitenciarios; presentar antecedentes de pérdida de seguimiento en su condición de ingreso, lo que ocasiona dificultad en la adherencia al tratamiento; y coinfección VIH, debido a la problemática clínica de ambas patologías y al tratamiento administrado, con mayor probabilidad de desarrollar reacciones adversas a los medicamentos lo que origina abandono del tratamiento. Estos resultados se corroboran con otros estudios en esta misma población realizados en la Región de las Américas (16, 24).…”