Survivors of the Age of Tuberculosis, the Elderly are Still Subject to Reactivation of the Disease

Common Presentations, Diagnostic Strategies, and Principles of Treatment

Michael A. Gardam MSc, MD, CM, FRCPC
Medical Director,
Tuberculosis Clinic,
Associate Hospital Epidemiologist,
University Health Network,Toronto.

The elderly are one of four sub populations in Canada, which also include the foreign born, homeless persons, and Native Canadians, that are at high risk for developing active tuberculosis. There are several reasons why tuberculosis is common among the elderly: Firstly, today's elderly have a high possibility of being infected with M. tuberculosis. They are survivors of the earlier part of the twentieth century in which an estimated three-quarters or more of the population were infected with tuberculosis by the time they were 30 years of age. Secondly, the elderly often suffer from other conditions which predispose them to reactivation of tuberculosis, such as diabetes mellitus, chronic renal failure, malnutrition, and diseases requiring prolonged corticosteroid therapy. Finally, residents of nursing homes and long-term care facilities may become infected or reinfected through contact with other residents with active disease.

While the clinical symptoms of tuberculosis may be vague and non-specific in any age group, this is particularly true in elderly persons. Fever, malaise, weakness, and failure to thrive are the most consistent symptoms.