A narrative review of tuberculosis in the United States among persons aged 65 years and older.
A narrative review of tuberculosis in the United States among persons aged 65 years and older.
复制标题
美国65岁及以上人群结核病的叙述性回顾。
DOI：
10.1016/j.jctube.2022.100321
复制
发表时间：
2022-08
影响因子：
2
通讯作者：
Jaganath, Devan
中科院分区：
文献类型：
--
作者：
Wu, Iris L.;Chitnis, Amit S.;Jaganath, Devan
结核病（TB）是一种可预防的传染性疾病，具有显著的发病率、死亡率和心理社会挑战。由于美国的结核病发病率（美国）从1993年的9.7/10万下降到2020年的2.2/10万，65岁及以上成年人的病例比例增加。我们对美国和其他类似的低结核病负担环境中发表的文献进行了综述，以描述老年人结核病的流行病学和独特的诊断挑战。该叙述性综述还概述了该患者人群的治疗特征、结局和研究空白。老年人延迟结核病诊断的可能性高30%，其促成因素包括抗酸杆菌痰涂片阴性疾病（56%）和非经典临床表现。至少90%的老年人结核病病例是由潜伏性结核感染（LTBI）的再激活引起的，但缺乏关于何时筛查和治疗这些患者LTBI的指导。此外，常规结核病检测方法，如干扰素-γ释放测定法，在老年人中出现假阴性结果的可能性要高出两倍。高龄患者还经常伴有复杂的合并症和药物代谢受损，增加了治疗失败（23%）和死亡（19%）的风险。对老年人结核病独特因素的更深入了解将为临床和公共卫生工作提供信息，以改善美国这一复杂患者人群的结局和结核病控制。
Tuberculosis (TB) is a preventable infectious disease that confers significant morbidity, mortality, and psychosocial challenges. As TB incidence in the United States (U.S.) decreased from 9.7/100,000 to 2.2/100,000 from 1993 to 2020, the proportion of cases occurring among adults aged 65 and older increased. We conducted a review of published literature in the U.S. and other similar low-TB-burden settings to characterize the epidemiology and unique diagnostic challenges of TB in older adults. This narrative review also provides an overview of treatment characteristics, outcomes, and research gaps in this patient population. Older adults had a 30% higher likelihood of delayed TB diagnosis, with contributing factors such as acid-fast bacilli sputum smear-negative disease (56%) and non-classical clinical presentation. At least 90% of TB cases among older adults resulted from reactivation of latent TB infection (LTBI), but guidance around when to screen and treat LTBI in these patients is lacking. In addition, routine TB testing methods such as interferon-gamma release assays were two times more likely to have false-negative results among older adults. Advanced age was also often accompanied by complex comorbidities and impaired drug metabolism, increasing the risk of treatment failure (23%) and death (19%). A greater understanding of the unique factors of TB among older adults will inform clinical and public health efforts to improve outcomes in this complex patient population and TB control in the U.S.
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影响因子：
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作者：
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