Tuberculosis in the Elderly

Diamantis, S.; Wazières, B. de; Gallien, Sébastien

doi:10.3390/jcm10245888

Cited by 51 publications

(42 citation statements)

References 77 publications

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“…This could be explained by the higher disease severity at baseline and the presence of multiple comorbidities such as cerebrovascular disease and dementia, which complicate treatment adherence in older adults. Also, age-related physiological and pharmacokinetic changes may further reduce the efficacy of treatment [35][36][37]. Hence, approaches that can reduce treatment toxicity while maintaining the positive effects of treatment on quality of life [21] should be pursued in older adults with MAC-PD.…”

Section: Discussionmentioning

confidence: 99%

Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease

Kim

Jung

et al. 2022

BMC Pulm Med

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Background The number of patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) is rapidly increasing globally, especially in the older population. However, there is a dearth of evidence regarding the impact of aging on the treatment outcomes of NTM-PD. Methods We analyzed consecutive patients who satisfied the diagnostic criteria for Mycobacterium avium complex (MAC)-PD and received antibiotic treatment between January 2009 and December 2020 at a tertiary referral hospital in Korea. The main outcomes were (1) long-term treatment success, defined by negative culture conversion for more than 12 months; and (2) adverse drug reactions (ADRs). Multivariable logistic regression model was used to evaluate the association between age and main outcomes. Results A total of 614 patients (median age, 65 years, interquartile range [IQR] 57–73 years; men, 35.3%) were included. Median treatment duration (530 days, IQR 290–678 days; P for trend < 0.001) and long-term treatment success (P for trend = 0.026) decreased, whereas ADRs (P for trend < 0.001) increased significantly with age. Multivariable analyses demonstrated that age ≥ 80 years was an independent factor associated with ADRs (adjusted odds ratio [aOR] 3.29; 95% confidence interval [CI] 1.05–10.28) and worse treatment outcome (aOR 0.42; 95% CI 0.19–0.91). Conclusions Aging is associated with worse treatment outcome and frequent ADRs of patients with MAC-PD. Individualized treatment with reduced-intensity may be a reasonable alternative for older adults.

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Section: Discussionmentioning

confidence: 99%

Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease

Kim

Jung

et al. 2022

BMC Pulm Med

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“…Our results revealed that the drug resistance rate in the elderly was 5.86% in Zhejiang Province. Considering the reactivation of previous latent infection, the drug resistance rate in the elderly might be lower than that in the general group [ 4 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Tuberculosis (TB) ranks 13th among the leading causes of death globally and is also the top cause of death from a single infectious agent, which has been a substantial public health concern and an urgent global public health priority [1,2]. Nearly a quarter of the global population is infected with Mycobacterium tuberculosis, although only <10% of the people developed active TB during their lifetime, especially in lowand middle-income areas [3][4][5]. According to the Global Tuberculosis Report 2021 released by the World Health Organization (WHO), an estimated 9.9 million people developed illness with an incidence of 127/100,000 in 2020 [6].…”

Section: Introductionmentioning

confidence: 99%

Bridging the Gap in End Tuberculosis Targets in the Elderly Population in Eastern China: Observational Study From 2015 to 2020

Liu¹,

Xie²,

Xie³

et al. 2022

JMIR Public Health Surveill

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Background With a progressive increase in the aging process, the challenges posed by pulmonary tuberculosis (PTB) are also increasing for the elderly population. Objective This study aimed to identify the epidemiological distribution of PTB among the elderly, forecast the achievement of the World Health Organization’s 2025 goal in this specific group, and predict further advancement of PTB in the eastern area of China. Methods All notified active PTB cases aged ≥65 years from Zhejiang Province were screened and analyzed. The general epidemiological characteristics were depicted and presented using the ArcGIS software. Further prediction of PTB was performed using R and SPSS software programs. Results Altogether 41,431 cases aged ≥65 years were identified by the surveillance system from 2015 to 2020. After excluding extrapulmonary TB cases, we identified 39,832 PTB cases, including laboratory-confirmed (23,664, 59.41%) and clinically diagnosed (16,168, 40.59%) PTB. The notified PTB incidence indicated an evident downward trend with a reduction of 30%; however, the incidence of bacteriologically positive cases was steady at approximately 60/100,000. Based on the geographical distribution, Quzhou and Jinhua Cities had a higher PTB incidence among the elderly. The delay in PTB diagnosis was identified, and a significantly prolonged treatment course was observed in the elderly. Moreover, a 50% reduction of PTB incidence by the middle of 2024 was predicted using a linear regression model. It was found that using the exponential smoothing model would be better to predict the PTB trend in the elderly than a seasonal autoregressive integrated moving average model. Conclusions More comprehensive and effective interventions such as active PTB screening combined with physical checkup and succinct health education should be implemented and strengthened in the elderly. A more systematic assessment of the PTB epidemic trend in the elderly population should be considered to incorporate more predictive factors.

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“…LTBI in the elderly is highly heterogeneous and may arise from recent or very distant M. tuberculosis infection. Unfortunately, neither the TST nor IGRAs can distinguish between recent and remote infections [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Interferon-Gamma Release Assays for Tuberculosis in the Immunocompromised Population

Yang

Wang

et al. 2022

Diagnostics

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Interferon-gamma release assays (IGRAs) are widely used in the diagnosis of Mycobacterium tuberculosis (M. tuberculosis) infection by detecting interferon-γ released by previously sensitized T-cells in-vitro. Currently, there are two assays based on either enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunospot (ELISPOT) technology, with several generations of products available. The diagnostic value of IGRAs in the immunocompromised population is significantly different from that in the immunocompetent population because their results are strongly affected by the host immune function. Both physiological and pathological factors can lead to an immunocompromised situation. We summarized the diagnostic value and clinical recommendations of IGRAs for different immunocompromised populations, including peoplewith physiological factors (pregnant and puerperal women, children, and older people), as well as people with pathological factors (solid organ transplantation recipients, combination with human immunodeficiency virus infection, diabetes mellitus, end-stage renal disease, end-stage liver disease, and chronic immune-mediated inflammatory diseases). Though the performance of IGRAs is not perfect and often requires a combination with other diagnostic strategies, it still has some value in the immunocompromised population. Hopefully, the newly developed IGRAs could better target this population.

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Tuberculosis in the Elderly

Cited by 51 publications

References 77 publications

Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease

Old age is associated with worse treatment outcome and frequent adverse drug reaction in Mycobacterium avium complex pulmonary disease

Bridging the Gap in End Tuberculosis Targets in the Elderly Population in Eastern China: Observational Study From 2015 to 2020

Diagnostic Value of Interferon-Gamma Release Assays for Tuberculosis in the Immunocompromised Population

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