Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Current Geriatrics Reports
Published in: Current Geriatrics Reports 2/2020

01-06-2020 | Tuberculosis | Pulmonology and Respiratory Care (D Breen, Section Editor)

Diagnosing Pulmonary Tuberculosis in the Elderly

Authors: Michael J. Symes, Ben Probyn, Cyrus Daneshvar, Lilanganee Telisinghe

Published in: Current Geriatrics Reports | Issue 2/2020

Login to get access

Abstract

Purpose of Review

Pulmonary tuberculosis (TB) remains a diagnostic challenge, particularly in low endemic settings with ageing populations. The impact has both individual and infection control implications.

Recent Findings

Over the past 20 years, progress has been made in trying to improve TB diagnostics. International recommendations for investigation however still rely heavily on the index of suspicion, imaging and ultimately culturing Mycobacterium tuberculosis which remains the gold standard for diagnosing TB disease. Recent advances include molecular diagnostics with the ability to rapidly identify TB disease and drug resistance and whole-genome sequencing.

Summary

In this review, we explore the validity of TB diagnostics in the elderly to assist the practicing clinician in the diagnostic workup in this population.
Appendix
Available only for authorised users
Literature
1.
2.
Public Health England. Tuberculosis in England: 2019 Report. PHE Publications; 2019.
3.
Abbara A, Collin SM, Kon OM, Buell K, Sullivan A, Barrett J, et al. Time to diagnosis of tuberculosis is greater in older patients: a retrospective cohort review. ERJ Open Res. 2019;5(4):00228–2018.PubMedPubMedCentral
4.
•• Drain PK, Bajema KL, Dowdy D, Dheda K, Naidoo K, Schumacher SG, et al. Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection. Clin Microbiol Rev. 2018;31(4). An excellent review of the spectrum of TB infection, highlighting the different stages of infection with elimination, latent TB, incipient TB, subclinical and active disease. The literature around these stages of disease is reviewed giving insight into contemporary understanding of this complex disease.
5.
Yeh JJ, Chen SC, Chen CR, Yeh TC, Lin HK, Hong JB, et al. A high-resolution computed tomography-based scoring system to differentiate the most infectious active pulmonary tuberculosis from community-acquired pneumonia in elderly and non-elderly patients. Eur Radiol. 24(10):2372–84.
6.
Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017;64(2):111–5.PubMedPubMedCentral
7.
NICE. guidelines. Tuberculosis. 2016; NICE guidelines NG33. UK.
8.
Schluger NW. Tuberculosis and nontuberculous mycobacterial infections in older adults. Clin Chest Med. 2007;28(4):773–81 vi.PubMedPubMedCentral
9.
Pande JN, Singh SP, Khilnani GC, Khilnani S, Tandon RK. Risk factors for hepatotoxicity from antituberculosis drugs: a case-control study. Thorax. 1996;51(2):132–6.PubMedPubMedCentral
10.
Hosford JD, von Fricken ME, Lauzardo M, Chang M, Dai Y, Lyon JA, et al. Hepatotoxicity from antituberculous therapy in the elderly: a systematic review. Tuberculosis (Edinb). 2015;95(2):112–22.
11.
Chang CH, Chen YF, Wu VC, Shu CC, Lee CH, Wang JY, et al. Acute kidney injury due to anti-tuberculosis drugs: a five-year experience in an aging population. BMC Infect Dis. 2014;14:23.PubMedPubMedCentral
12.
Smith BM, Schwartzman K, Bartlett G, Menzies D. Adverse events associated with treatment of latent tuberculosis in the general population. CMAJ. 2011;183(3):E173–9.PubMedPubMedCentral
13.
14.
Ferrara G, Murray M, Winthrop K, Centis R, Sotgiu G, Migliori GB, et al. Risk factors associated with pulmonary tuberculosis: smoking, diabetes and anti-TNFalpha drugs. Curr Opin Pulm Med. 2012;18(3):233–40.PubMed
15.
Teng CJ, Huon LK, Zheng YM, Yeh CM, Tsai CK, Liu JH, et al. Increased risk of tuberculosis in oral cancer patients in an endemic area: a nationwide population-based study. Clin Oral Investig. 2019;23(12):4223–31.PubMed
16.
Ganzel C, Silverman B, Chemtob D, Ben Shoham A, Wiener-Well Y. The risk of tuberculosis in cancer patients is greatest in lymphoma and myelodysplastic syndrome/myeloproliferative neoplasm: a large population-based cohort study. Leuk Lymphoma. 2019;60(3):720–5.PubMed
17.
Cheng MP, Abou Chakra CN, Yansouni CP, Cnossen S, Shrier I, Menzies D, et al. Risk of active tuberculosis in patients with Cancer: a systematic review and meta-analysis. Clin Infect Dis. 2017;64(5):635–44.PubMed
18.
Nardell EA. Tuberculosis in homeless, residential care facilities, prisons, nursing homes, and other close communities. Semin Respir Infect. 1989;4(3):206–15.PubMed
19.
20.
Katz PR, Reichman W, Dube D, Feather J. Clinical features of pulmonary tuberculosis in young and old veterans. J Am Geriatr Soc. 1987;35(6):512–5.PubMed
21.
Korzeniewska-Kosela M, Krysl J, Müller N, Black W, Allen E, FitzGerald JM. Tuberculosis in young adults and the elderly: a prospective comparison study. CHEST. 1994;106(1):28–32.PubMed
22.
Van Dijk JM, Rosin AJ. A comparison of clinical features of mycobacterial infections in young and elderly patients. Neth J Med. 1993;42(1):12–5.PubMed
23.
Perez-Guzman C, Vargas MH, Torres-Cruz A, Villarreal-Velarde H. Does aging modify pulmonary tuberculosis?: a meta-analytical review. Chest. 1999;116(4):961–7.PubMed
24.
Bhushan B, Kajal NC, Maske A, Singh SP. Manifestations of tuberculosis in elderly versus young hospitalised patients in Amritsar, India. Int J Tuberc Lung Dis. 2012;16(9):1210–3.PubMed
25.
•• Cruz-Hervert LP, Garcia-Garcia L, Ferreyra-Reyes L, Bobadilla-del-Valle M, Cano-Arellano B, Canizales-Quintero S, et al. Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes. Age Ageing. 2012;41(4):488–95. This prospective study is specific to the aging population and describes the clinical spectrum and compares to younger age groups. PubMedPubMedCentral
26.
Kwon YS, Chi SY, Oh IJ, Kim KS, Kim YI, Lim SC, et al. Clinical characteristics and treatment outcomes of tuberculosis in the elderly: a case control study. BMC Infect Dis. 2013;13(1):121.PubMedPubMedCentral
27.
Migliori GB, Sotgiu G, Rosales-Klintz S, Centis R, D'Ambrosio L, Abubakar I, et al. ERS/ECDC Statement: European Union standards for tuberculosis care, 2017 update. Eur Respir J. 2018;51(5).
28.
Rozenshtein A, Hao F, Starc MT, Pearson GD. Radiographic appearance of pulmonary tuberculosis: dogma disproved. AJR Am J Roentgenol. 2015;204(5):974–8.PubMed
29.
Cohen R, Muzaffar S, Capellan J, Azar H, Chinikamwala M. The validity of classic symptoms and chest radiographic configuration in predicting pulmonary tuberculosis. Chest. 1996;109(2):420–3.PubMed
30.
Lee JH, Han DH, Song JW, Chung HS. Diagnostic and therapeutic problems of pulmonary tuberculosis in elderly patients. J Korean Med Sci. 2005;20(5):784–9.PubMedPubMedCentral
31.
Morris CD, Nell H. Epidemic of pulmonary tuberculosis in geriatric homes. S Afr Med J Suid-Afrikaanse Tydskrif Vir Geneeskunde. 1988;74(3):117–20.PubMed
32.
Lin CH, Chen TM, Chang CC, Tsai CH, Chai WH, Wen JH. Unilateral lower lung field opacities on chest radiography: a comparison of the clinical manifestations of tuberculosis and pneumonia. Eur J Radiol. 2011;81(4):e426–30.PubMed
33.
• Kim JH, Kim MJ, Ham SY. Clinical characteristics and chest computed tomography findings of smear-positive and smear-negative pulmonary tuberculosis in hospitalized adult patients. Medicine. 2019;98(34):e16921. A useful contemporary study for clinicians describing the different radiographical features in smear positive and negative patients. PubMedPubMedCentral
34.
Kim YK, Hahn S, Uh Y, Im DJ, Lim YL, Choi HK, et al. Comparable characteristics of tuberculous and non-tuberculous mycobacterial cavitary lung diseases. International Journal of Tuberculosis & Lung Disease. 2014;18(6):725–9.
35.
Deppen SA, Blume JD, Kensinger CD, Morgan AM, Aldrich MC, Massion PP, et al. Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis. JAMA. 2014;312(12):1227–36.PubMedPubMedCentral
36.
Ankrah AO, Glaudemans A, Maes A, Van de Wiele C, Dierckx R, Vorster M, et al. Tuberculosis. Semin Nucl Med. 2018;48(2):108–30.PubMed
37.
Hara T, Kosaka N, Suzuki T, Kudo K, Niino H. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study. Chest. 2003;124(3):893–901.PubMed
38.
Lang S, Sun J, Wang X, Xiao Y, Wang J, Zhang M, et al. Asymptomatic pulmonary tuberculosis mimicking lung cancer on imaging: a retrospective study. Exp Ther Med. 2017;14(3):2180–8.PubMedPubMedCentral
39.
Kim IJ, Lee JS, Kim SJ, Kim YK, Jeong YJ, Jun S, et al. Double-phase 18F-FDG PET-CT for determination of pulmonary tuberculoma activity. Eur J Nucl Med Mol Imaging. 2008;35(4):808–14.PubMed
40.
Soussan M, Brillet PY, Mekinian A, Khafagy A, Nicolas P, Vessieres A, et al. Patterns of pulmonary tuberculosis on FDG-PET/CT. Eur J Radiol. 2012;81(10):2872–6.PubMed
41.
Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis. 2015;32:87–93.PubMed
42.
Schaaf HS, Collins A, Bekker A, Davies PDO. Tuberculosis at extremes of age. Respirology. 2010;15(5):747–63.PubMed
43.
Smith MA, Battafarano RJ, Meyers BF, Zoole JB, Cooper JD, Patterson GA. Prevalence of benign disease in patients undergoing resection for suspected lung cancer. Ann Thorac Surg. 2006;81(5):1824–8. discussion 8-9.PubMed
44.
Wang C-S, Chen H-C, Yang C-J, Wang W-Y, Chong I-W, Hwang J-J, et al. The impact of age on the demographic, clinical, radiographic characteristics and treatment outcomes of pulmonary tuberculosis patients in Taiwan. Infection. 2008;36(4):335–40.PubMed
45.
Cruz-Hervert LP, Garcia-Garcia L, Ferreyra-Reyes L, Bobadilla-del-Valle M, Cano-Arellano B, Canizales-Quintero S, et al. Tuberculosis in ageing: high rates, complex diagnosis and poor clinical outcomes. Age Ageing. 41(4):488–95.
46.
Chinnakali P, Selvaraj K, Thekkur P, Ramasamy G, Thulasingam M, Vasudevan K. Age and sex differences in sputum smear microscopy results for acid fast bacilli in a tertiary care Centre, South India. J Respir Med. 2014;2014:5.
47.
Rieder HL, Lauritsen JM, Naranbat N, Katamba A, Laticevschi D, Mabaera B. Quantitative differences in sputum smear microscopy results for acid-fast bacilli by age and sex in four countries. Int J Tuberc Lung Dis. 2009;13(11):1393–8.PubMed
48.
Chitnis AS, Robsky K, Schecter GF, Westenhouse J, Barry PM. Trends in tuberculosis cases among nursing home residents, California, 2000 to 2009. J Am Geriatr Soc. 2015;63(6):1098–104.PubMed
49.
Pratt RH, Winston CA, Kammerer JS, Armstrong LR. Tuberculosis in older adults in the United States, 1993–2008. J Am Geriatr Soc. 2011;59(5):851–7.PubMed
50.
Horne DJ, Kohli M, Zifodya JS, Schiller I, Dendukuri N, Tollefson D, et al. Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database Syst Rev. 2019;6.
51.
McWilliams T, Wells AU, Harrison AC, Lindstrom S, Cameron RJ, Foskin E. Induced sputum and bronchoscopy in the diagnosis of pulmonary tuberculosis. Thorax. 2002;57(12):1010–4.PubMedPubMedCentral
52.
Anderson C, Inhaber N, Menzies D. Comparison of sputum induction with fiber-optic bronchoscopy in the diagnosis of tuberculosis. Am J Respir Crit Care Med. 1995;152(5 Pt 1):1570–4.PubMed
53.
Patel YR, Mehta JB, Harvill L, Gateley K. Flexible bronchoscopy as a diagnostic tool in the evaluation of pulmonary tuberculosis in an elderly population. J Am Geriatr Soc. 1993;41(6):629–32.PubMed
54.
Malekmohammad M, Marjani M, Tabarsi P, Baghaei P, Sadr Z, Naghan PA, et al. Diagnostic yield of post-bronchoscopy sputum smear in pulmonary tuberculosis. Scand J Infect Dis. 2012;44(5):369–73.PubMed
55.
Mehta J, Krish G, Berro E, Harvill L. Fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis. South Med J. 83(7):753–5.
56.
• Liu X, Hou XF, Gao L, Deng GF, Zhang MX, Deng QY, et al. Indicators for prediction of Mycobacterium tuberculosis positivity detected with bronchoalveolar lavage fluid. Infect Dis Poverty. 2018;7(1):22. This study although retrospective reports on > 1500 smear-negative/non-sputum producers with suspected TB, reporting on the diagnostic yield of bronchoalveolar lavages. PubMedPubMedCentral
57.
Konno A, Narumoto O, Matsui H, Takeda K, Hirano Y, Shinfuku K, et al. The benefit of stool mycobacterial examination to diagnose pulmonary tuberculosis for adult and elderly patients. J Clin Tuberc Other Mycobact Dis. 2019;16(100106).
58.
Chen J, Byanju S, Zhang H, Zhu D, Liao M. CT-guided percutaneous core needle biopsy of pulmonary tuberculosis: diagnostic accuracy and complications. Radiol Infect Dis. 5(2):69–75.
59.
Beresford OD. Tuberculin skin sensitivity in old age. Am Rev Tuberc. 1958;77(2):323–8.PubMed
60.
Dorken E, Grzybowski S, Allen EA. Significance of the tuberculin test in the elderly. Chest. 1987;92(2):237–40.PubMed
61.
Nisar M, Williams CS, Ashby D, Davies PD. Tuberculin testing in residential homes for the elderly. Thorax. 1993;48(12):1257–60.PubMedPubMedCentral
62.
Chan-Yeung M, Dai DLK, Cheung AHK, Chan FHW, Kam KM, Tam CM, et al. Tuberculin skin test reaction and body mass index in old age home residents in Hong Kong. J Am Geriatr Soc. 2007;55(10):1592–7.PubMed
63.
Holden M. Tuberculin sensitivity in elderly patients. Am Rev Respir Dis. 1972;105(5):854–5.PubMed
64.
Kobashi Y, Mouri K, Yagi S, Obase Y, Miyashita N, Okimoto N, et al. Clinical utility of the QuantiFERON TB-2G test for elderly patients with active tuberculosis. Chest. 2008;133(5):1196–202.PubMed
65.
Bae W, Park KU, Song EY, Kim SJ, Lee YJ, Park JS, et al. Comparison of the sensitivity of QuantiFERON-TB gold in-tube and T-SPOT. TB according to patient age. PLoS One. 2016;11.
66.
Teramoto S, Komiya K, Ariga H, Kawashima M, Nagai H. Pitfalls of diagnostic values of the T-SPOT.TB assay to detect tuberculosis infection in elderly patients suspected with pulmonary tuberculosis (PTB) clinically. Am J Respir Crit Care Med Conference: American Thoracic Society International Conference, ATS. 2011;183(1).
67.
Janssens JP. Clinical utility of the interferon-gamma release assay for elderly patients with active tuberculosis: a word of caution. Chest. 2008;134(2):471–2.PubMed
Metadata
Title
Diagnosing Pulmonary Tuberculosis in the Elderly
Authors
Michael J. Symes
Ben Probyn
Cyrus Daneshvar
Lilanganee Telisinghe
Publication date
01-06-2020
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 2/2020
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-020-00319-5

Other articles of this Issue 2/2020

Current Geriatrics Reports 2/2020 Go to the issue

Pulmonology and Respiratory Care (D Breen, Section Editor)

The Unique Role of Lung Cancer Nurse Navigators in Elderly Lung Cancer Patients

Home-Based Monitoring (V Hirth, Section Editor)

The Role of Healthcare Robotics in Providing Support to Older Adults: a Socio-ecological Perspective

Geriatric Urology (H Richter and C Parker-Autry, Section Editor)

Continence: Bowel and Bladder and Physical Function Decline in Women

Home-Based Monitoring (V Hirth, Section Editor)

Behavioral Interventions for Alzheimer’s Management Using Technology: Home-Based Monitoring

Geriatric Urology (H Richter and C Parker-Autry, Section Editor)

Pelvic Floor Muscle Training for Older Women with Urinary Incontinence

Pulmonology and Respiratory Care (D Breen, Section Editor)

Bronchiectasis in the Elderly—a Disease That Has Not Gone Away

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits