Tuberculosis in the elderly

Due to physiological characteristics and biological changes, tuberculosis in the elderly has some characteristics unlike those of young people. These differences need to be paid attention to during diagnosis, formulation of treatment regimens, especially the use of anti-tuberculosis drugs.

In the elderly, TB can appear under the mechanism of ' reinfection '. Tuberculosis comes back because TB bacteria ' sleep ' for a long time in the body, now ' awake ', working again and causing illness. There are a number of factors that can help return the disease: use of corticosteroids, some diseases such as cancer, blood disease. The cause of reinfection is the contact with the person carrying the TB bacteria.

Tuberculosis lesions can be localized in the chest ( mainly lungs, then pleura, pericardium, lymph nodes ), and many other places in the body ( digestive organs, meninges, urinary, and joint bones). , peripheral lymph nodes and abdominal organs .

Often, diagnosis of tuberculosis in the elderly is rarely set, or if TB is found, the disease is already in a late stage, adversely affecting the quality of treatment. There are many reasons for this situation, but there are two very important reasons:

- TB is getting less and less (but it's not like that now), so people don't think about it at all.

- Atypical tuberculosis clinical manifestations: Atypical symptoms, only a single fever, lonely thin. Remarkable signs are the disease in another organ, for example: heart failure (edema, enlarged liver, floating neck veins .) in a hypertensive patient with severe changes due to anemia, etiology It is latent tuberculosis.

In the elderly, treatment strategies are flexible, non-principle, rigid. In fact, there are 3 common situations. If there is a bacteriological or histological test result, that is TB positive, specific treatment should be performed immediately. If bacterial test results are not immediately available, but there are clinical symptoms of tuberculosis suspected (X-ray images are clear), TB treatment can be given immediately, without waiting for test results, After taking the required specimens for testing for TB bacteria. If bacterial testing results and symptoms are not typical of tuberculosis, trial treatment can be performed with anti-tuberculosis drugs. In young people, this approach is unacceptable, but in geriatrics it is ' accepted ', because it is not beneficial for patients to wait too long, especially when the patient is bedridden, Depression, depression.

However, in the last two situations, at the same time, differential diagnosis with other diseases should be made to avoid confusion.

Dr. Pham Cuong , Health & Life