Epidemiological, clinical and mechanistic perspectives of tuberculosis in older people

• Published in: Respirology (Carlton, Vic.) Vol. 23; no. 6; pp. 567 - 575
• Main Authors: Yew, Wing W., Yoshiyama, Takashi, Leung, Chi C., Chan, Denise P.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.06.2018; Wiley Subscription Services, Inc
• Subjects: Aged; ageing; Aging; Aging - immunology; Aging - metabolism; Antitubercular Agents - therapeutic use; Asia - epidemiology; Australia - epidemiology; Comorbidity; Diabetes mellitus; Diabetes Mellitus - epidemiology; Disease control; Epidemiology; geriatric population; Geriatrics; Humans; Immunosenescence; Latent Tuberculosis - drug therapy; Latent Tuberculosis - epidemiology; Latent Tuberculosis - metabolism; mechanism; Mitochondria; Mitochondria - metabolism; Older people; Oxidative stress; Oxidative Stress - immunology; Patients; Public Health; Respiratory diseases; Smoking; Smoking - epidemiology; Tuberculosis; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis - immunology; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Tuberculosis, Pulmonary - metabolism; ageing; mechanism; geriatric population; tuberculosis
• ISSN: 1323-7799; 1440-1843
• DOI: 10.1111/resp.13303

ABSTRACT With the ageing population globally, tuberculosis (TB) in older people becomes a major clinical and public health challenge. In many Asian countries, especially those located in the eastern and southeastern parts of the continent, geriatric TB is a significant problem. TB in the older patients is more difficult to diagnose in the early course of disease, and has poorer treatment outcomes, largely as increased failure and death. More drug‐induced adverse reactions are also experienced by this population during TB therapy. Oxidative stress and mitochondrial dysfunction are now well recognized to be associated with the ageing process, and it is likely that the cellular and molecular perturbations interact inextricably with the immunological dysfunction biophysiologically inherent to ageing. These underlying mechanistic bases putatively contribute to the development of TB in the geriatric population and worsen the disease outcomes, especially when the TB is compounded by co‐morbid conditions such as smoking and diabetes mellitus. Unravelling these mechanisms further would yield knowledge that might potentially help to prevent reactivated TB in older people, and also to better manage the established disease with drug regimens and other new therapeutic strategies. In addition, addressing the social elements associated with geriatric TB is also imperative in the relief of individual patient suffering and improvement of overall disease control.