Host Resistance and Immune Responses in Advanced Age

Castle, Steven; Uyemura, Koichi; Fülöp, Tamás; Makinodan, Takashi

doi:10.1016/j.cger.2007.03.005

Cited by 94 publications

(47 citation statements)

References 67 publications

(97 reference statements)

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“…In some regions, the designation of the group at the highest risk for developing active TB has shifted to the elderly. (12) In our study, we found a higher prevalence of dyspnea in patients over 60 years of age, a finding that has been reported in another study (13) and might be due to age-related changes in pulmonary function. (14) Fibrotic/atelectatic changes on chest X-rays were also more common among the patients over 60 years of age, which suggests that many of them had a history of TB.…”

Section: Discussionsupporting

confidence: 76%

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

et al. 2010

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Objective: To investigate the characteristics of and risk factors for mortality among non-HIV-infected immunocompromised patients with an in-hospital diagnosis of tuberculosis. Methods: This was a two-year, retrospective cohort study of patients with an in-hospital diagnosis of tuberculosis. The predictive factors for mortality were evaluated. Results: During the study period, 337 hospitalized patients were diagnosed with tuberculosis, and 61 of those patients presented with immunosuppression that was unrelated to HIV infection. Extrapulmonary tuberculosis was found in 47.5% of cases. In the latter group, the in-hospital mortality rate was 21.3%, and the mortality rate after discharge was 18.8%. One-year survival was significantly higher among the immunocompetent patients than among the HIV patients (p = 0.008) and the non-HIV-infected immunocompromised patients (p = 0.015), although there was no such difference between the two latter groups (p = 0.848). Among the non-HIV-infected immunocompromised patients, the only factor statistically associated with mortality was the need for mechanical ventilation. Among the patients over 60 years of age, fibrosis/atelectasis on chest X-rays and dyspnea were more common, whereas fever and consolidations were less common. Fever was also less common among the patients with neoplasms. The time from admission to the initiation of treatment was significant longer in patients over 60 years of age, as well as in those with diabetes and those with end-stage renal disease. Weight loss was least common in patients with diabetes and in those using corticosteroids. Conclusions: The lower prevalence of classic symptoms, the occurrence of extrapulmonary tuberculosis, the delayed initiation of treatment, and the high mortality rate reflect the diagnostic and therapeutic challenges of tuberculosis in non-HIV-infected immunocompromised patients. Keywords: Hospitalization; Immunosuppression; Risk factors; Tuberculosis/mortality; Immunocompromised host. ResumoObjetivo: Investigar as características de pacientes imunocomprometidos não HIV com diagnóstico intrahospitalar de tuberculose e determinar os fatores de risco para mortalidade. Métodos: Durante um período de dois anos, foi realizado um estudo de coorte retrospectivo que incluiu os pacientes com diagnóstico de tuberculose após a internação. Os fatores preditores de mortalidade foram coletados. Resultados: Durante o período do estudo, 337 pacientes foram internados e diagnosticados com TB, e desses, 61 apresentavam imunossupressão não decorrente da infecção pelo HIV. A tuberculose extrapulmonar estava presente em 47,5% dos casos. Nesse grupo, a taxa de mortalidade intra-hospitalar foi de 21,3%, e a mortalidade após a alta foi de 18,8%. Os pacientes imunocompetentes tiveram sobrevida em um ano maior que os pacientes com HIV (p = 0,008) e que os imunocomprometidos não HIV (p = 0,015), mas não houve diferença na sobrevida entre esses dois últimos grupos (p = 0,848). Entre os pacientes imunocomprometidos não HIV, o único fator estatis...

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Section: Discussionsupporting

confidence: 76%

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

et al. 2010

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“…One major difficulty here is to dissect the role of aging in the decreased immune response compared to the role of chronic disease, itself causing immune alterations exacerbating other chronic diseases (Castle et al 2005(Castle et al , 2007. The question is whether a high chronic disease burden leads to impaired immunity or the impaired immunity leads to high chronic disease burden or perhaps more likely, interactions in both directions.…”

Section: Frailty and Age-related Diseasesmentioning

confidence: 98%

“…The question is whether a high chronic disease burden leads to impaired immunity or the impaired immunity leads to high chronic disease burden or perhaps more likely, interactions in both directions. Recent studies at UCLA (Castle et al 2007;Rafi et al 2005) on the burden of chronic diseases used the CIRS for quantifying this parameter via the determination of health status. CIRS measures disease burden in individuals who have different chronic diseases but no evidence of acute deterioration or infection.…”

Section: Frailty and Age-related Diseasesmentioning

confidence: 99%

Aging, frailty and age-related diseases

et al. 2010

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The concept of frailty as a medically distinct syndrome has evolved based on the clinical experience of geriatricians and is clinically well recognizable. Frailty is a nonspecific state of vulnerability, which reflects multisystem physiological change. These changes underlying frailty do not always achieve disease status, so some people, usually very elderly, are frail without a specific life threatening illness. Current thinking is that not only physical but also psychological, cognitive and social factors contribute to this syndrome and need to be taken into account in its definition and treatment. Together, these signs and symptoms seem to reflect a reduced functional reserve and consequent decrease in adaptation (resilience) to any sort of stressor and perhaps even in the absence of extrinsic stressors. The overall consequence is that frail elderly are at higher risk for accelerated physical and cognitive decline, disability and death. All these characteristics associated with frailty can easily be applied to the definition and characterization of the aging process per se and there is little consensus in the literature concerning the physiological/biological pathways associated with or determining frailty. It is probably true to say that a consensus view would implicate heightened chronic systemic inflammation as a major contributor to frailty. This review will focus on the relationship between aging, frailty and age-related diseases, and will highlight possible interventions to reduce the occurrence and effects of frailty in elderly people.

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“…Indeed, the increased death rate found in aged populations is due in great proportion to infections (5,6) . The profound impact of ageing on immunity is presently accepted.…”

Section: Proceedings Of the Nutrition Societymentioning

confidence: 99%

Murine models of premature ageing for the study of diet-induced immune changes: improvement of leucocyte functions in two strains of old prematurely ageing mice by dietary supplementation with sulphur-containing antioxidants

Fuente

2010

Proc. Nutr. Soc.

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Several immune functions are markers of health, biological age and predictors of longevity. A chronic oxidative and inflammatory state is the main cause of ageing and the immune system is involved in the rate of ageing. Thus, several murine models of premature ageing have been proposed owing to their early immunosenescence and oxidative stress, such as ovariectomised rats and mice, obese rats and anxious mice. In the last model, the most extensively studied by us, mice showing anxiety have an aged immune function and redox status as well as a shorter longevity in comparison with animals without anxiety of the same chronological age, being denominated prematurely ageing mice. A confirmation of the above is that the administration of diets supplemented with antioxidants improves the redox status and immune functions and increases the longevity of prematurely ageing mice. Antioxidant precursors of glutathione such as thioproline or N-acetylcysteine, which have a relevant role in ageing, have been the most widely investigated in adult prematurely ageing mice in our laboratory. In the present work, we have studied the effects of the ingestion for 5 weeks of a diet supplemented with 0 . 1 % (w/w) thioproline + N-acetylcysteine on several functions of leucocytes from chronological old (69-73 weeks of age) prematurely ageing mice of two strains (Swiss and BALB/c). The results show an improvement of the immune functions, with their values becoming closer to those in adult animals (24°2 weeks). Thus, an adequate nutrition with antioxidants, even in aged subjects, could be a good strategy to retard ageing.

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Host Resistance and Immune Responses in Advanced Age

Cited by 94 publications

References 67 publications

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Características clínicas e evolução de pacientes imunocomprometidos não HIV com diagnóstico intra-hospitalar de tuberculose

Aging, frailty and age-related diseases

Murine models of premature ageing for the study of diet-induced immune changes: improvement of leucocyte functions in two strains of old prematurely ageing mice by dietary supplementation with sulphur-containing antioxidants

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