Fernandová E, Bielaková K, Matějovská-Kubešová H
Epidemiol Mikrobiol Imunol. 2019 Winter;68(4):184-190.
The incidence of tuberculosis (TB) in the Czech Republic (CR) is decreasing since 1960s. (1965: 76.9; 1975: 60.4; 1985: 45.2; 1995: 17.7; 2005: 9.9; 2015: 4.9 per 100, 000 population). In 2017 men accounted for over than 70% of cases. People aged over 75 years are most frequently affected. Elderly patients tend to develop more of extrapulmonary and atypical manifestation of the disease, the diagnosis of TB can be difficult and consequently overlooked. Multimorbid seniors are suffering from chronic illnesses, malignancies and autoimmune diseases, which translate into higher degree of immunosuppression and add to the generally described process of immunosenescence. Furthermore, therapy of TB in the elderly is challenging because of the increased drug resistance and higher incidence of adverse drug reactions. This article reviews the epidemiology of TB in the CR, immunological aspects, clinical characteristics, diagnosis, management, prevention of TB infection and presents two clinical cases in hospitalized aging adults in the CR.
We present a case of a 79 year old female suffering from chronic obstructive pulmonary disease (COPD), who was repeatedly hospitalized for acute exacerbations of COPD and was consequently diagnosed with TB. Patient developed manifestation of treatment toxicity and drug interactions due to comorbidities and other medications. Secondly, we present a case of a 70 year old male, a lifelong smoker, who was initially admitted for collapsing. TB developed via the endogenic route from a Ghons complex in association with a slowly progressing bronchogenic carcinoma.
Diagnosis and management of TB in the elderly person can be challenging. Age-related factors increase the risk of TB reactivation as well as enhance susceptibility to TB infection. In elderly population we find accumulation of risk factors for developing TB (malnutrition, low socio economic status, smoking and alcoholism). The people most at risk among elderly include fragile institutionalized seniors whose incidence of TB is 2-3 times higher than those living at home. Because the number of seniors is growing and the incidence of TB in this subpopulation is increasing, detailed knowledge of the epidemiological features of TB in this group is needed to optimize healthcare services.
自20世纪60年代以来，捷克共和国（CR）的结核病（TB）发病率一直在下降。（1965年：每10万人中有76.9例；1975年：60.4例；1985年：45.2例；1995年：17.7例；2005年：9.9例；2015年：4.9例）。2017年，男性病例占比超过70%。75岁以上的人群受影响最为频繁。老年患者往往会出现更多的肺外和非典型结核病表现，结核病的诊断可能会很困难，因此容易被忽视。患有多种疾病的老年人患有慢性疾病、恶性肿瘤和自身免疫性疾病，这导致免疫抑制程度更高，并加剧了普遍描述的免疫衰老过程。此外，由于耐药性增加和药物不良反应发生率较高，老年结核病的治疗具有挑战性。本文回顾了捷克共和国结核病的流行病学、免疫学方面、临床特征、诊断、管理、结核感染的预防，并介绍了捷克共和国住院老年成年人中的两个临床病例。
我们报告一例79岁患有慢性阻塞性肺疾病（COPD）的女性病例，该患者因COPD急性加重多次住院，随后被诊断为结核病。由于合并症和其他药物，患者出现了治疗毒性和药物相互作用的表现。其次，我们报告一例70岁男性病例，该患者有长期吸烟史，最初因晕倒入院。结核病通过源自肺原发综合征的内源性途径发展而来，并与缓慢进展的支气管肺癌相关。
老年人结核病的诊断和管理可能具有挑战性。与年龄相关的因素会增加结核病复发的风险，并增强对结核感染的易感性。在老年人群中，我们发现了患结核病的风险因素（营养不良、社会经济地位低下、吸烟和酗酒）的积累。老年人中风险最高的人群包括体弱的机构养老老年人，他们的结核病发病率比居家老年人高出2至3倍。由于老年人数量不断增加，且该亚人群中结核病发病率也在上升，因此需要详细了解该群体结核病的流行病学特征，以优化医疗服务。
