Integrating tuberculosis screening into annual health examinations for the rural elderly improves case detection

Abstract

Integrating TB screening into annual health examinations for the elderly in rural areas was effective in identifying new cases, especially among elderly DM patients with TB symptoms.

The strategic framework of tuberculosis control and prevention in the elderly: a scoping review towards End TB targets

“…Increasing patient access to care, reducing time to treatment by using new diagnostics and/or streamlining the diagnostic pathway are essential interventions to optimize current strategy [15, 19, 25, 29–32]. Systematic screening pathway comprises screening for latent TB infection (LTBI) [6, 13, 15, 19–32] and screening for TB patients [15, 20, 21, 27, 29–31, 33]. The latter is also called active case-finding (ACF).…”

“…In China, it was estimated that screening for LTBI and ACF in the elderly would result in a decline in TB incidence and mortality of 48% (34–64%) and 58% (40–72%) in the next 20 years [15]. ACF in health examinations for TB was effective for the elderly in rural areas, especially among elderly diabetes mellitus (DM) patients with TB symptoms [33]. …”

“…(b) Comorbidities. Elderly TB patients have more risks for chronic obstructive pulmonary disease, DM, liver disease, malignancy, cardiovascular diseases and gastrectomy owing to decreased immunocompetence [6, 13, 19, 20, 22–24, 27, 28, 33]. (c) Atypical presentation [6, 13, 19, 20, 22–28, 34].…”

“…In addition, screening for LTBI/TB is also recommended to high-risk groups including those who are immunosuppressed because of disease (HIV infection) or medications (corticosteroids), recent close contacts of infectious TB patients, and those with abnormal chest radiographs suggestive of prior TB [28]. However, another study showed close contacts may not necessarily pose a greater risk of TB among the elderly [33]. Apart from standardized diagnostic tools, more aggressive diagnostic intervention like fiberoptic bronchoscopy with peripheral biopsy specimens [6, 13, 19, 22, 23, 25, 26] and rapid diagnostic tools of TB [22, 23, 25, 26, 28] should be considered for the elderly.…”

“…Special attentions for treatment in the elderly should be paid to prevent, detect, and manage more risks of: (a) hepatotoxicity for IPT [6, 13, 19, 22–28, 30]; (b) comorbidities [6, 13, 19, 20, 22–24, 27, 28, 33]; (c) drug interaction and adverse effect [6, 13, 19, 22–24, 26, 27, 34]; (d) poor drug tolerance [6, 26, 27]; (e) poor treatment adherence [13, 19, 26, 27] and (f) unfavourable treatment outcome [6, 13, 19, 27, 28]. Accordingly, careful pre-treatment assessment and close clinical monitoring for IPT [6, 13, 19–26, 28], baseline and periodic (monthly or biweekly) laboratory testing for liver function [6, 13, 19, 22, 23, 25, 26, 28], closer monitoring and evaluation during follow-up treatment [13, 19–21, 24, 26–28] and education [6, 20, 28] are crucial to minimize the above potential risks.…”