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Tuberculosis (TB) in the Elderly

Tuberculosis or TB is a bacterial infection that primarily involves the lungs. It is a contagious disease caused and normally spread through droplets when an infected person coughs or talks. The prevalence of TB has increased primarily due to HIV infections, which severely weakens the immunity of the person. Apart from HIV, it is a problem for malnourished, severely stress and debilitated individuals. The elderly are often at risk, particularly when they are not eating well, suffering with depression and have lowered immune defenses due to age, medication and chronic diseases.

TB Symptoms

Sometimes there are no symptoms or very mild symptoms present with TB even though the person is carrying the bacteria. This is known as a latent infection as the body blocks the bacteria from damaging lung tissue.  However, when the body’s defenses cannot keep the bacteria at bay, it begins to severely damage the lungs and can easily spread to others. Here it is referred to as an active infection.

The symptoms of pulmonary (lung) tuberculosis includes :

  • Persistent cough
  • Fever
  • Coughing up blood
  • Excessive sweating, usually at night
  • Chills
  • Fatigue
  • Weight loss
  • Loss of appetite
  • Chest pain and breathing difficulty as the infection worsens

The TB bacteria can also infect organs especially the brain, bones or skin, which causes additional symptoms.

Causes

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis. It is highly contagious but an active infection does not occur in a person unless their immune defenses are impaired. When the infected person  sneezes, coughs or talks, droplets containing the TB bacteria are released into the air. Direct contact or inhalation of the droplets can infect a healthy individual.

People at a high risk include the elderly, infants and those with a weakened immune system from diseases such as HIV infection or  AIDS, chemotherapy or certain medications, or people who are malnourished. Although tuberculosis is often associated with poverty and devloping nations, the fact is that it can affect any person, anywhere in the world.

Development of drug resistant TB is a major concern around the world. There are now multi-drug resistant tuberculosis (MDR-TB) and extreme drug-resistant tuberculosis (XDR-TB) that is proving a problem to physicians. Atypical tuberculosis is a form of TB caused by other bacteria of the Mycobacterium family. It can cause similar symptoms, and is difficult to treat.

Treatment

Tuberculosis is treated by antibiotics against the infectious bacteria. Many drug resistant strains of TB have emerged and therefore the course of treatment is by using multiple antibiotics simultaneously. The most commonly used antibiotic is isoniazid in combination with rifampin, pyrazinamide and ethambutol. Although these drugs have various side effects, it should not be discontinued prematurely.

The treatment is continued until all the TB bacteria are eliminated from the body. This usually takes at least 6 months or more. Continued treatment is necessary to eradicate the infection or the bacteria will become drug resistant which is more difficult to treat. The infected person is usually required to stay at home or in the hospital for 2 to 4 weeks to avoid spreading the infection to other people.


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