Tuberculosis (Twenty-First Century Medical Library)

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Consequently, the great majority of these strains are not resistant to the usual medication, 11,14 and, since the pharmacodynamics of anti-TB drugs is the same for the elderly except for a potential increase in side effects and drug interaction , most elderly individuals present favorable outcomes. In the elderly, TB diagnosis is frequently delayed due to the difficulty of recognizing the clinical profile, which is often confused with the inherent alterations of aging or is not properly reported by the patient.

This might have been the result of the changes that have taken place in the organization of the health care facilities after the decentralization of the TB control plans. Reinforcing this hypothesis, we observed that there was no statistically significant difference between the elderly and the young adults in Recife in terms of their treatment-seeking behavior.

In addition, similar percentages of individuals in the two groups received treatment in health care units located in their districts and neighborhoods of residence. Nevertheless, it is not possible to overlook the fact that a delay of over 60 days before the initiation of treatment, common to the whole population, shows a failing of the health care system in the area studied.

It should be noted that early detection of TB is one of the responsibilities of the Family Health Program. Therefore, there should be greater efficacy in the detection of cases, translating to a shorter period of time to the initiation of treatment, both for the elderly and for the younger patients. A study carried out in New York, USA, reports that there was a delay of over two weeks in the diagnosis of the elderly, 9 revealing a reality of access to health care facilities and socio-economic conditions appropriate to developed countries. Another study, carried out in Brazil, in the state of Rio de Janeiro, 16 reported a median of time from the onset of symptoms up to diagnosis, for the population in general, of 60 days, which can indicate problems of access to health care facilities similar to those that were found in the present study.

A common explanation given as an excuse for the delay in the initiation of the treatment among the elderly is related to the differences in the clinical presentation of the disease. This can be explained by the reduced cough reflex, the lower production of interleukins in the inflammatory reactions and the altered pain threshold, inherent to the process of normal aging.

However, among those who lost weight, the elderly presented a more pronounced loss over 10 kg Table 3 , aggravating the malnutrition profiles already prevalent in this age bracket.

Tuberculosis, 2nd Edition

Among the elderly, the most common form of TB is the pulmonary form, 3,5,11,13,14 as it is for individuals of any age. However, the limitation of this analysis the small number of cases with these clinical forms should be noted.

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There are also difficulties related to the diagnostic investigation in the elderly, both regarding the performance and the interpretation of the tests. Nevertheless, it is of note that 2 of the 29 elderly individuals studied tested positive for HIV. It must be borne in mind that the elderly of today come from a generation in which safe sex was not habitually practiced, and that the libido can remain intact, even in elderly people, which potentially exposes these individuals to acquired immunodeficiency syndrome 21 and therefore to concomitant TB and acquired immunodeficiency syndrome.

Of those who were submitted to bacteriological confirmation, fewer elderly individuals tested positive in sputum smear microscopy and culture, which is in agreement with the literature. In the elderly, it is not always possible to perform this test, due to the lower frequency of cough, and consequently lower production of sputum, as well as to cognitive limitations which result in problems in the collection of the material.


It is important to observe that, although sputum smear microscopy is, in the context of public health, the test recommended for the diagnosis of the disease, 17 approximately one-fourth of the patients in our study were not submitted to this test. As for the tuberculin test results, there was no difference between the groups. What calls our attention is the fact that only a small number of patients were submitted to this test, perhaps due to the limited availability of the test or because this test was not requested by the health professionals. However, the tuberculin test can be quite important for the diagnosis of latent TB and can inform decisions regarding chemoprophylaxis.

Various authors 3,5,9, report that the severity of TB is greater in the elderly than in young adults. In the USA, the elderly present a mortality rate ten times higher than that of adults from 25 to 44 years of age.

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However, after the multivariate analysis, we found that the risk of death and the chance of cure were no higher among the elderly. We found that, in Recife, when elderly individuals with TB are compared to young adults with TB, the elderly presented less alcoholism; higher rates of illiteracy; higher income as the head of the household; greater previous adherence to treatment; lower frequency of cough and backache; more accentuated weight loss; and lower frequency of positivity in sputum smear tests for Koch's bacillus. Regarding the outcome of the treatment, neither death nor cure was associated with being elderly Table 5.

As mentioned above, the elderly constitute a populational group at risk for TB and, therefore, should be given special attention by TB control programs, which should take into consideration the peculiarities of this age bracket. We would like to thank the Pernambuco State Coordination of the Program of Tuberculosis Control for providing access to important information.

We are also grateful to the health professionals of the Unified Health Care System network of Recife for their cooperation in the collection of data and the Central Library of the Federal University of Pernambuco for the assistance provided in the conducting the bibliographical review, as well as the Brazilian Network of Tuberculosis Research and the National Council for Scientific and Technological Development for providing financial support for our research. Rio de Janeiro. World Health Organization.

Global Tuberculosis Control. WHO Report Geneva: WHO; Chaimowicz F. Litvak J. Bol Oficina Sanit Panam. Rajagopalan S. Tuberculosis and aging: a global health problem.

The Tuberculosis Treatment Pipeline: A Breakthrough Year for the Treatment of XDR-TB

Clin Infect Dis. Tuberculose pulmonar. Tratado de geriatria e gerontologia. Rio de Janeiro: Guanabara Koogan; Tuberculosis pleuropulmonar en el anciano: estudio comparativo con otras edades. Rev Inst Nac Enfermedades Respir. Clinical features of pulmonary tuberculosis in young and old veterans. J Am Geriatr Soc.

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Rev Latino-Am Enfermagem. Yoshikawa TT. Tuberculosis in aging adults. Rev Bras Clin Ter.

Tuberculose pulmonar em idosos - Parte II. Rajagopalan S, Yoshikawa TT. Tuberculosis in long-term-care facilities. Infect Control Hosp Epidemiol. Governo do Estado de Pernambuco. J Bras Pneumol. Ruffino-Neto A. Inf Epidemiol SUS. Gavazzi G, Krause KH. About this Item: 21st Century. Condition: GOOD. Spine creases, wear to binding and pages from reading. May contain limited notes, underlining or highlighting that does affect the text. Accessories such as CD, codes, toys, may not be included. Seller Inventory More information about this seller Contact this seller 2. Condition: Good.

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