TUBERCULOSIS CONTROL PROGRAMME FOR THE ELDERLY WITH SPECIAL FOCUS ON EARLY DETECTION

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  • 高齢者の結核対策
  • コウレイシャ ノ ケッカク タイサク
  • The 78th Annual Meeting Symposium
  • 第78回総会シンポジウム

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Abstract

1. Epidemiological trend of TB and its diagnosis among the elderly: Masako OHMORI (Research Institute of Tuberculosis, JATA)<BR>It is estimated that over 10, 000 TB patients will occur among the elderly aged over 75 years of age during 2010 and 2020. Though the new TB patients among the elderly over 65 years of age decreased in number from 1987 to 2001, sputum smear positive patients, which are highly infectious increased by 1.3 times for the same age group, and 2.3 times for that of over 80 years of age. 17.6% of those elderly patients were detected in institutions, either hospitals or nursing homes. These indicate that the elderly will become higher risk of TB for causing early death and infection to others during their admission in the hospitals or nursing homes.<BR>2. Clinical characteristics of TB among the elderly: Nobuhiko NAGATA (Department of Internal Medicine, National Ohmuta Hospital)<BR>Analysis of the 93 elderly TB patients shows that TB diagnosis was delayed among the elderly. For TB diagnosis, 43.2% took over 1 month, and 27.3% over 2 months among the patients over 75 years of age, compared to 22.9% and 9.7% respectively for the patients under 65 years. The prognosis was also poor. Of all who died in the hospital during TB treatment, 40.9% (mostly complicated with other diseases) was among the elderly over 75 years, while it was 6.5% among those under 65 years. Complication of dementia delayed the diagnosis. 79.4% of the smear positive patients over 75 years were diagnosed while admitted in a general ward, and 40% had been admitted 2 weeks or more before diagnosis.<BR>3. Use of serological tests for the diagnosis of TB among the elderly: Atsuyuki KURASHIMA (Department of Clinical Research, National Tokyo Hospital)<BR>As TB diagnosis is difficult for the elderly due to nonspecific appearances of signs/symptoms, X-ray shadows or negative tuberculin reaction, some serological tests, which have been recently developed, can be useful as a supplementary diagnostic tool. One of them is anti-lipoarabinomannan antibody. 74.3% was positive to this among 148 bacteriologically confirmed TB cases ; 77.8% for those aged 65 years and above, and 71.1% for those under 65 years. To and TBGL antibody, 78% of 170 confirmed TB cases were positive ; 75 % for those aged 65 years and above, 79.8% for those less than 65 years. Multi-lipo antibody developed by Japan BCG Laboratory showed higher sensitivity of 91.5%. GPL-core antibody may increase the sensitivity.<BR>4. Mode of TB detection in nursing homes: Shinji SHISHIDO (Research Institute of Tuberculosis, JATA)

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