Hoheisel Gerhard, Hagert-Winkler Anne, Winkler Jörg, Kahn Thomas, Rodloff Arne C, Wirtz Hubert, Gillissen Adrian
Internistisch-Pneumologische Praxis, Leipzig, Germany.
Med Klin (Munich). 2009 Oct 15;104(10):772-9. doi: 10.1007/s00063-009-1163-y. Epub 2009 Oct 25.
With the increase of the proportion of the elderly in the total population more cases of pulmonary and extrapulmonary tuberculosis (TB) are observed in this age group as well. Symptoms of TB are unspecific, often less apparent in the elderly, and may therefore cause a delay in the diagnostic process. A history of TB and comorbidities are more common in elder as compared to younger TB patients. The tuberculin skin test is less frequently positive. The interferon-gamma-release assay is complementary and together with clinical, radiologic, and bacteriologic test results helpful for the diagnosis or the exclusion of an active or latent TB infection. Medical treatment of TB in the elderly follows the established guidelines in the same way as for younger patients. The likelihood of drug-induced side effects and interactions with concomitant medications, however, is increased. Comorbidity and age-related immunosuppression may lead to a delay in the healing process. Higher age, comorbidity, and immunosuppression are predictors of an increased TB mortality. Even in a low-incidence country like Germany, TB should be recognized as an explanation for clinical symptoms particularly in the elderly patient group in order to allow an early diagnosis and therapy and thus a reduction of mortality and prevention of a further spread of this disease.
随着老年人口在总人口中所占比例的增加，该年龄组中肺内和肺外结核病（TB）的病例也有所增多。结核病的症状不具有特异性，在老年人中往往不太明显，因此可能导致诊断过程延迟。与年轻的结核病患者相比，老年人中结核病病史和合并症更为常见。结核菌素皮肤试验呈阳性的频率较低。干扰素-γ释放试验具有补充作用，与临床、放射学和细菌学检查结果一起，有助于诊断或排除活动性或潜伏性结核感染。老年结核病的药物治疗遵循与年轻患者相同的既定指南。然而，药物引起副作用以及与伴随用药相互作用的可能性增加。合并症和与年龄相关的免疫抑制可能导致愈合过程延迟。高龄、合并症和免疫抑制是结核病死亡率增加的预测因素。即使在德国这样的低发病率国家，结核病也应被视为临床症状的一个解释，特别是在老年患者群体中，以便能够早期诊断和治疗，从而降低死亡率并防止这种疾病的进一步传播。
