Skip to main content
SpringerLink
Log in

Tuberkulose der Lunge und Pleura im Alter*

Pulmonary and Pleural Tuberculosis in the Elderly

  • ÜBERSICHT
  • Published:
Medizinische Klinik Aims and scope Submit manuscript

Zusammenfassung

Mit der Zunahme des Anteils älterer Menschen an der Gesamtbevölkerung werden auch vermehrt pulmonale und extrapulmonale Tuberkulosen (TB) in dieser Altersgruppe beobachtet. Symptome einer TB sind unspezifisch, treten bei Älteren oft weniger deutlich in Erscheinung und können dadurch bedingt zu einer verzögerten Diagnosestellung führen. Eine TB in der Vorgeschichte und Komorbiditäten sind bei älteren im Vergleich zu jüngeren TB-Patienten häufiger. Der Tuberkulin-Hauttest ist bei Älteren seltener positiv. Der Interferon-γ-Release-Assay trägt ergänzend und gemeinsam mit den klinischen, radiologischen und bakteriologischen Testergebnissen zur Diagnose oder zum Ausschluss einer aktiven oder latenten TB-Infektion bei. Die antituberkulöse Therapie bei Älteren erfolgt leitliniengerecht in der gleichen Weise wie bei jüngeren Patienten. Die Wahrscheinlichkeit des Auftretens medikamentöser Nebenwirkungen und von Interaktionen mit weiteren Medikamenten ist dagegen erhöht. Komorbidität und altersbedingte Immunschwäche können den Heilungsprozess verzögern. Höheres Lebensalter, Begleiterkrankungen und Immunschwäche sind Prädiktoren einer erhöhten TB-Sterblichkeit. Auch in einem Niedriginzidenzland wie Deutschland sollte gerade bei älteren Patienten eine TB als Ursache von Krankheitssymptomen erkannt werden, um durch frühzeitige Diagnose und Therapie die Mortalität zu senken und eine Weiterverbreitung dieser Erkrankung zu verhindern.

Abstract

With the increase of the proportion of the elderly in the total population more cases of pulmonary and extrapulmonary tuberculosis (TB) are observed in this age group as well. Symptoms of TB are unspecific, often less apparent in the elderly, and may therefore cause a delay in the diagnostic process. A history of TB and comorbidities are more common in elder as compared to younger TB patients. The tuberculin skin test is less frequently positive. The interferon-γ-release assay is complementary and together with clinical, radiologic, and bacteriologic test results helpful for the diagnosis or the exclusion of an active or latent TB infection. Medical treatment of TB in the elderly follows the established guidelines in the same way as for younger patients. The likelihood of drug-induced side effects and interactions with concomitant medications, however, is increased. Comorbidity and age-related immunosuppression may lead to a delay in the healing process. Higher age, comorbidity, and immunosuppression are predictors of an increased TB mortality. Even in a low-incidence country like Germany, TB should be recognized as an explanation for clinical symptoms particularly in the elderly patient group in order to allow an early diagnosis and therapy and thus a reduction of mortality and prevention of a further spread of this disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Davies PDO. The effects of poverty and ageing on the increase in tuberculosis. Monaldi Arch Chest Dis 1999;54:168–171.

    CAS  PubMed  Google Scholar 

  2. Vasankari T, Holmström P, Ollgren J, et al. Risk factors for poor tuberculosis treatment outcome in Finland: a cohort study. BMC Public Health 2007;7:291.

    Article  PubMed  Google Scholar 

  3. Brodhun B, Altmann D Haas W. Bericht zur Epidemiologie der Tuberkulose in Deutschland für 2007. Berlin: Robert Koch-Institut, 2009 ( http://www.rki.de ).

    Google Scholar 

  4. Chan HS, Sun A, Hoheisel GB. Endobronchial tuberculosis — is corticosteroid treatment useful? A report of 8 cases and review of the literature. Postgrad Med J 1990;66:822–826.

    Article  CAS  PubMed  Google Scholar 

  5. DZK 2001. Richtlinien zur medikamentösen Behandlung der Tuberkulose. Pneumologie 2001;55:494–511.

    Article  Google Scholar 

  6. Ewig S, Schaberg T. Diagnostik. In: Ewig S, Hrsg. Tuberkulose heute, 2. Aufl. Oberhaching-München: Dustri, 2007:15–18.

    Google Scholar 

  7. Schaberg T, Hauer B, Haas WH, et al. Latente tuberkulöse Infektion: Empfehlungen zur präventiven Therapie bei Erwachsenen in Deutschland. Pneumologie 2004;58:255–270.

    Article  CAS  PubMed  Google Scholar 

  8. Hoheisel G, Vogtmann M, Winkler J, et al. Spektrum von Tuberkuloseerkrankungen in der pneumologischen Praxis. Med Klin 2008;103:769–777.

    Article  Google Scholar 

  9. Japan Anti-Tuberculosis Association (JATA), National Ohmuta Hospital. Tuberculosis control programme for the elderly with special focus on early detection. Kekkaku 2004;79:55–58.

    Google Scholar 

  10. Vogtmann M, Beer J, Tannapfel A, et al. Zur Differenzialdiagnostik und Therapie bei Husten, Fieber, Brustschmerz und einseitigem Pleuraerguss. Sächs Ärztebl 2004;5:191.

    Google Scholar 

  11. Hoheisel G, Roth M, Chan CH, et al. Procoagulant activity of purified protein derivative-stimulated pleural effusion mononuclear cells in tuberculous pleurisy. Respiration 1997;64:152–158.

    Article  CAS  PubMed  Google Scholar 

  12. Hoheisel G, Izbicki G, Roth M, et al. Compartmentalization of pro-inflammatory cytokines in tuberculous pleurisy. Respir Med 1998;92:14–17.

    Article  CAS  PubMed  Google Scholar 

  13. Hoheisel G, Sack U, Hui DS, et al. Occurrence of matrix metalloproteinases and tissue inhibitors of metalloproteinases in tuberculous pleuritis. Tuberculosis (Edinb) 2001;81:203–209.

    Article  CAS  Google Scholar 

  14. Hoheisel G, Vogtmann M, Chan KS, et al. Pleuritis tuberculosa — therapeutische Wertigkeit wiederholter Pleurapunktionen. Pneumologie 2004;58:23–27.

    Article  CAS  PubMed  Google Scholar 

  15. Chan CH, Arnold M, Chan CY, et al. Clinical and pathological features of tuberculous pleural effusion and its long-term consequences. Respiration 1991;58:171–175.

    Article  CAS  PubMed  Google Scholar 

  16. Wilson R. Bacterial infections of the bronchial tree. Curr Opin Pulm Med 1997;3:105–110.

    Article  CAS  PubMed  Google Scholar 

  17. Konietzko N, Loddenkemper R. Diagnose und Differentialdiagnose der pulmonalen und extrapulmonalen Tuberkulose. In: Konietzko N, Hrsg. Tuberkulose. Stuttgart-New York: Thieme, 1999:89–105.

    Google Scholar 

  18. Kaufmann SHE. Immunologie der Tuberkulose. Pneumologie 1995;49:643–648.

    PubMed  Google Scholar 

  19. Vynnycky E, Fine PE. The natural history of tuberculosis: the implications of age-dependent risks of disease and the role of reinfection. Epidemiol Infect 1997;119:183–201.

    Article  CAS  PubMed  Google Scholar 

  20. Chan-Yeung M, Kam KM, Leung CC, et al. Population-based prospective molecular and conventional epidemiological study of tuberculosis in Hong Kong. Respirology 2006;11:442–448.

    Article  PubMed  Google Scholar 

  21. Leung CC, Yam WC, Yew WW, et al. Comparison of T-Spot.TB and tuberculin skin test among silicotic patients. Eur Respir J 2007;31:266–272.

    Article  PubMed  Google Scholar 

  22. Mosmann TR, Cherwinski H, Bond MW, et al. Two types of murine helper T cell clone. I. Definition according to profiles of lymphokine activities and secreted proteins, J Immunol 1986;136:2348–2357.

    CAS  PubMed  Google Scholar 

  23. Orme I. Processing and presentation of mycobacterial antigens: implications for the development of a new improved vaccine for tuberculosis control. Tubercle 1991;72:250–252.

    Article  CAS  PubMed  Google Scholar 

  24. Rook GA. Mobilising the appropriate T-cell subset: the immune response as taxonomist? Tubercle 1991;72:253–254.

    Article  CAS  PubMed  Google Scholar 

  25. Lesourd B, Mazari L. Nutrition and immunity in the elderly. Proc Nutr Soc 1999;58:685–695.

    Article  CAS  PubMed  Google Scholar 

  26. Francesco FF, Vescovini R, Passeri G, et al. Shortage of circulating naïve CD8(+) T cells provides new insight on immunodeficiency in ageing. Blood 2000;95:2860–2868.

    Google Scholar 

  27. Flynn JL, Goldstein MM, Triebold KJ, et al. Major histocompatibility complex class I restricted T cells are required for resistance to Mycobacterium tuberculosis infection. Proc Natl Acad Sci U S A 1992;89:12013–12017.

    Article  CAS  PubMed  Google Scholar 

  28. Pedrazzini T, Hug K, Louis JA. Importance of L3T4+ and Lyt2+ cells in the immunologic control of infection with Mycobacterium bovis strain bacillus Calmette Guérin in mice. Assessment by elimination of T cell subsets in vivo. J Immunol 1987;139:2032–2037.

    CAS  PubMed  Google Scholar 

  29. Edwards LB, Livesay VT, Acquaviva FA, et al. Height, weight, tuberculous infection, and tuberculous disease. Arch Environ Health 1971;22:106–112.

    CAS  PubMed  Google Scholar 

  30. Tverdal A. Body mass index and incidence of tuberculosis. Eur J Respir Dis 1986;69:355–362.

    CAS  PubMed  Google Scholar 

  31. Van Lettow M, Kumwenda JJ, Harries AD, et al. Malnutrition and the severity of lung disease in adults with pulmonary tuberculosis in Malawi. Int J Tuberc Lung Dis 2004;8:211–217.

    PubMed  Google Scholar 

  32. Zachariah R, Spielmann MP, Harries AD, et al. Moderate to severe malnutrition in patients with tuberculosis is a risk factor associated with early death. Trans R Soc Trop Med Hyg 2002;96:291–294.

    Article  CAS  PubMed  Google Scholar 

  33. Harries AD, Nkhoma WA, Thompson PJ, et al. Nutritional status in Malawian patients with pulmonary tuberculosis and response to chemotherapy. Eur J Clin Nutr 1988;42:445–450.

    CAS  PubMed  Google Scholar 

  34. Iseman MD. Immunity and pathogenesis. In: Iseman MD, ed. A clinician’s guide to tuberculosis. Philadelphia: Lippincott Williams & Wilkins, 2000:63–96.

    Google Scholar 

  35. Leung CC, Lam TH, Chan WM, et al. Lower risk of tuberculosis in obesity. Arch Intern Med 2007;167:1297–1304.

    Article  PubMed  Google Scholar 

  36. Gupta D, Singh N, Kumar R, et al. Manifestations of pulmonary tuberculosis in the elderly: a prospective observational study from north India. Indian J Chest Dis Allied Sci 2008;50:263–267.

    PubMed  Google Scholar 

  37. Lysov AV, Ivanova OG, Mordyk AV, et al. [Infiltrative pulmonary tuberculosis in persons over 60 years of age.] Probl Tuberk Bolezn Legk 2008;1:28–30.

    PubMed  Google Scholar 

  38. Cantalice Filho JP, Bóia MN, Sant Anna CC. [Analysis of the treatment of pulmonary tuberculosis in elderly patients at a university hospital in Rio de Janeiro, Brazil]. J Bras Pneumol 2007};33}:691–

    PubMed  Google Scholar 

  39. Leung CC, Lam TH, Chan WM, et al. Diabetic control and risk of tuberculosis: a cohort study. Am J Epidemiol 2008;167:1486–1494.

    Article  PubMed  Google Scholar 

  40. Alvarez S, Shell C, Berk SL. Pulmonary tuberculosis in elderly men. Am J Med 1987;82:602–606.

    Article  CAS  PubMed  Google Scholar 

  41. King D, Davies PD. Disseminated tuberculosis in the elderly: still a diagnosis overlooked. J R Soc Med 1992;85:48–50.

    CAS  PubMed  Google Scholar 

  42. Tan KK, Cherian A, Teo SK. Tuberculosis in the elderly. Singapore Med J 1991;32:423–426.

    CAS  PubMed  Google Scholar 

  43. Tal S, Guller V, Gurevich A, et al. Fever of unknown origin in the elderly [Review]. J Intern Med 2002;252:295–304.

    Article  CAS  PubMed  Google Scholar 

  44. Knockaert DC, Vanneste LJ, Bobbaers HJ. Fever of unknown origin in the elderly patients. J Am Geriatr Soc 1993;41:1187–1192.

    CAS  PubMed  Google Scholar 

  45. Korzeniewska-Kosela M, Krysl J, Muller N, et al. Tuberculosis in young adults and the elderly. Chest 1994;106:28–32.

    Article  CAS  PubMed  Google Scholar 

  46. Kardos P, Cegla U, Gillissen A, et al. Deutsche Gesellschaft für Pneumologie: Leitlinie zur Diagnose und Therapie von Patienten mit akutem und chronischem Husten. Med Klin 2004;8:468–475.

    Google Scholar 

  47. Lee JH, Park SS, Lee DH, et al. Endobronchial tuberculosis. Clinical and bronchoscopic features in 121 cases [Erratum in: Chest 1993;103:1640]. Chest 1992;102:990–994.

    Article  CAS  PubMed  Google Scholar 

  48. Hoheisel G, Chan BK, Chan CH, et al. Endobronchial tuberculosis: diagnostic features and therapeutic outcome. Respir Med 1994;88:593–597.

    Article  CAS  PubMed  Google Scholar 

  49. Hoheisel G, Teschler H, Chan BK, et al. Röntgenbefunde bei Bronchialtuberkulose. Pneumologie 1994;48:788–792.

    CAS  PubMed  Google Scholar 

  50. Stead WW. Tuberculosis among elderly persons: an outbreak in a nursing home. Ann Intern Med 1981;94:606–610.

    CAS  PubMed  Google Scholar 

  51. Breen RA, Miller RF, Gorsuch T, et al. Adverse events and treatment interruption in tuberculosis patients with and without HIV co-infection. Thorax 2006;61:791–794.

    Article  CAS  PubMed  Google Scholar 

  52. Lange C, Schaberg T, Diel R, et al. Aktueller Stand der Tuberkulosediagnostik. Dtsch Med Wochenschr 2006;131:341–347.

    Article  CAS  PubMed  Google Scholar 

  53. American Thoracic Society. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000;161:S221–247.

    Google Scholar 

  54. Brock I, Weldingh K, Lillebaek T, et al. Comparison of tuberculin skin test and new specific blood test in tuberculosis contacts. Am J Respir Crit Care Med 2004;170:65–69.

    Article  PubMed  Google Scholar 

  55. Hong Kong Chest Service/Tuberculosis Research Centre. A double-blind placebo-controlled clinical trial of three antituberculosis chemoprophylaxis regimens in patients with silicosis in Hong Kong. Am Rev Respir Dis 1992;145:36–41.

    Google Scholar 

  56. Diel R, Forssbohm M, Loytved G, et al. Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose. Pneumologie 2007;61:440–455.

    Article  CAS  PubMed  Google Scholar 

  57. Elmer A, Kortsik CS, Pies U, et al. Intracutaneous tuberculin test using the Mendel-Mantoux technique. Tuberculin reactivity among inpatients in a pneumology department. Pneumologie 2000;54:425–430.

    Article  CAS  PubMed  Google Scholar 

  58. Kang YA, Lee HW, Yoon HI, et al. Discrepancy between the tuberculin skin test and the whole-blood interferon gamma assay for the diagnosis of latent tuberculosis infection in an intermediate tuberculosis-burden country. JAMA 2005;293:2756–2761.

    Article  CAS  PubMed  Google Scholar 

  59. Pai M, Riley LW Jr, Colford JM. Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004;4:761–776.

    Article  CAS  PubMed  Google Scholar 

  60. Stead WW, To T. The significance of the tuberculin skin test in elderly persons. Ann Intern Med 1987;107:837–842.

    CAS  PubMed  Google Scholar 

  61. Dorken E, Grzybowski S, Allen EA. Significance of the tuberculin test in the elderly. Chest 1987;92:237–240.

    Article  CAS  PubMed  Google Scholar 

  62. Kobashi Y, Mouri K, Yagi S, et al. Clinical utility of the QuantiFERON TB-2G test for elderly patients with active tuberculosis. Chest 2008;133:1196–2002.

    Article  PubMed  Google Scholar 

  63. Dewan PK, Grinsdale J, Kawamura LM. Low sensitivity of a whole-blood interferon-γ-release assay for detection of active tuberculosis. Clin Infect Dis 2 2007;44:69–73.

    Article  Google Scholar 

  64. Kang YA, Lee HW, Hwang SS, et al. Usefulness of whole-blood interferon-gamma-assay and interferon-gamma-enzyme-linked immunospot assay in the diagnosis of active pulmonary tuberculosis. Chest 2007;132:959–965.

    Article  PubMed  Google Scholar 

  65. Rieder HL. Epidemiological basis of tuberculosis control. Paris: International Union Against Tuberculosis and Lung Disease, 1999.

    Google Scholar 

  66. Janssens JP. Clinical utility of the interferon-{gamma} release assay for elderly patients with active tuberculosis: a word of caution. Chest 2008;134:471–472.

    Article  PubMed  Google Scholar 

  67. Janssens JP, Roux-Lombard P, Perneger T, et al. Quantitative scoring of an interferon-gamma-assay for differentiating active from latent tuberculosis. Eur Respir J 2007;30:722–728.

    Article  CAS  PubMed  Google Scholar 

  68. Rüsch-Gerdes S, Hillemann D. Modern laboratory diagnostics for mycobacteria, Pneumologie 2008;62:533–540.

    Article  PubMed  Google Scholar 

  69. Diel R, Hauer B, Loddenkemper R, et al. Empfehlungen für das Tuberkulosescreening vor Gabe von TNF-α-Inhibitoren bei rheumatischen Erkrankungen. Pneumologie 2 2009;63:329–334.

    Article  CAS  Google Scholar 

  70. Schaberg T, Forßbohm M, Kirsten D, et al. Richtlinien zur Chemotherapie der Tuberkulose des Erwachsenen und der Kinder. Pneumologie 2001;55:494–511.

    Article  CAS  PubMed  Google Scholar 

  71. Ewig S, Schaberg T. Therapie. In: Ewig S, Hrsg. Tuberkulose heute. Oberhaching-München: Dustri, 2001:25–41.

    Google Scholar 

  72. Lefebvre N, Falzon D. Risk factors for death among tuberculosis cases: analysis of European surveillance data. Eur Respir J 2008;31:1256–1260.

    Article  CAS  PubMed  Google Scholar 

  73. Lubart E, Lidgi M, Leibovitz A, et al. Mortality of patients hospitalized for active tuberculosis in Israel. Isr Med Assoc J 2007;9:870–873.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internistisch-Pneumologische Praxis, Leipzig, Germany

    Gerhard Hoheisel

  2. Institut für Diagnostische Radiologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany

    Anne Hagert-Winkler & Thomas Kahn

  3. Internistisch-Pneumologische Praxis, Leipzig, Germany

    Jörg Winkler

  4. Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig AöR, Leipzig, Germany

    Arne C. Rodloff

  5. Abteilung Pneumologie, Department Innere Medizin, Universitätsklinikum Leipzig AöR, Leipzig, Germany

    Hubert Wirtz

  6. Robert-Koch-Klinik, Thoraxzentrum des Klinikums St. Georg, Leipzig, Germany

    Adrian Gillissen

  7. Innere Medizin, Pneumologie, Allergologie, August-Bebel-Straße 69, 04275, Leipzig, Germany

    Gerhard Hoheisel

Authors
  1. Gerhard Hoheisel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Hagert-Winkler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jörg Winkler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas Kahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arne C. Rodloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hubert Wirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Adrian Gillissen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gerhard Hoheisel.

Additional information

* Unserem verehrten klinischen Lehrer Professor Dr. med. Joachim Schauer zum 70. Geburtstag gewidmet.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hoheisel, G., Hagert-Winkler, A., Winkler, J. et al. Tuberkulose der Lunge und Pleura im Alter*. Med Klin 104, 772–779 (2009). https://doi.org/10.1007/s00063-009-1163-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-009-1163-y

Schlüsselwörter:

Key Words:

Search

Navigation