Active tuberculosis is highly prevalent in the geriatric population. The clinical syndromes and diagnostic indications of the different forms of tuberculosis are described. Reactivation pulmonary tuberculosis and miliary tuberculosis in the elderly are particularly difficult to diagnose. A high index of suspicion, a tuberculin skin test, and appropriate laboratory studies are essential for early diagnosis. Therapy for tuberculosis in the elderly must consider efficacy, patient compliance, and toxicity.
In the United States, an increasing proportion of all forms of reactivation tuberculosis occurs in patients over the age of 60 years. Atypical presentations and presence of chronic illness obscure the diagnosis of tuberculosis in the elderly. Prompt diagnosis requires a high index of suspicion and aggressive procedures for diagnostic microbiology. Short-course (9 months) chemotherapy with isoniazid and rifampin is the treatment of choice for elderly patients with uncomplicated pulmonary tuberculosis. Isoniazid chemoprophylaxis is recommended for selected elderly patients.
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