Tuberculosis - I. T. Pyatnochka 2005

Peculiarities of the course of respiratory tuberculosis in different age groups

According to the international Classification, the age periods are defined as follows: infancy is up to 14 years, adolescence ranges from 15 to 17, young adulthood from 18 to 29, early middle age from 30 to 45, mature age from 46 to 59, elderly age from 60 to 74, senile age from 75 to 89, and longevity is 90 years and older.

Tuberculosis in children. Among the various parameters determining the course of tuberculosis, age is a critical factor. In infants, the tuberculous process tends to progress and generalize rapidly, often leading to Miliary tuberculosis and meningitis. From the age of 1 year until Puberty, primary foci of tuberculosis typically heal, yet they remain a potential source for The Development of tuberculosis later in life. Individuals infected during adulthood carry a relatively low risk of developing active tuberculosis within the first few years following infection.

Tuberculosis in children is characterized by a relatively benign clinical course without prominent local manifestations, manifesting primarily as a symptom complex of tuberculosis intoxication or simply as a tuberculin Skin test conversion.

In general, the classic signs of Primary tuberculosis include tuberculin skin test conversion, significant involvement of The Lymphatic system (Lymph Nodes AND vessels), frequent involvement of the Bronchi and serous membranes, and body hypersensitivity. This is accompanied by a tendency toward disease generalization via hematogenous, lymphogenous, and bronchogenous routes, as well as the appearance of paraspecific toxic-allergic reactions (blepharitis, keratoconjunctivitis, phlyctenules, erythema nodosum, etc.). Additionally, the specific process in the lymph nodes tends toward caseous degeneration, but also carries a potential for self-recovery.

Among all pediatric tuberculosis cases, pre-pubertal children are of particular importance, as endocrine shifts serve as the main factor triggering endogenous tuberculosis infection in this age group. The specific pathological process is characterized by pronounced Changes in the lymph nodes, segmental and lobar involvement, and bronchial lesions (in 14.7% of cases).

Large residual changes in the form of metatuberculous pneumosclerosis following complicated intrathoracic lymph node tuberculosis can act as a source of relapses and a Background for non-specific diseases in 17.6% of children. Furthermore, acceleration is a significant factor influencing the course of tuberculosis in pre-pubertal children. This involves an increase in body length and other physical parameters, early puberty, and Nervous system lability. It has been established that "accelerated" children, who outpace their chronological age, often experience an asymptomatic course of tuberculosis, and frequently (in 1/3 of cases) develop rapid breakdown of focal and infiltrative processes. Therefore, only early Diagnosis of Primary infection ("conversion"), tuberculin hypersensitivity, and initial local manifestations of tuberculosis, followed by prompt Treatment in children, can significantly reduce the number of X-ray positive individuals who otherwise form the main pool of adult tuberculosis patients.

Tuberculosis in adolescents. Adolescence is a complex developmental period characterized by the diversity and instability of functional relationships among major physiological systems. It has been established that in the early pubertal period, chronic diseases of immunological and infectious-allergic genesis present with marked exudative inflammatory reactions and a clinically acute onset. Conversely, In the second half of puberty and upon its completion, the inflammatory process features a weakly expressed exudative component, a predominantly productive character of tissue reactions, a protracted latent course, and a tendency toward relapse.

Due to physiological characteristics associated with hormonal shifts and acceleration phenomena, adolescents are considered a "risk group" in both general pathology and phthisiology. They can develop both Primary and secondary forms of tuberculosis. Recently, primary forms have become more frequent among adolescents, encompassing not only intrathoracic lymph node tuberculosis and the Primary tuberculous complex, but also focal and infiltrative forms, which follow a more favorable course than their secondary counterparts. Moreover, despite mildly expressed clinical symptoms, there is often a breakdown of lung tissue, mycobacterial excretion, and marked tuberculin sensitivity. Adolescent girls with tuberculosis frequently experience menstrual irregularities (48.7% of cases) due to tuberculosis intoxication. In the majority of cases, primary tuberculosis in adolescents is complicated, with endobronchitis (29%) and exudative Pleurisy (14.5%) being the most frequent complications.

Treatment. The main course of antimycobacterial therapy should last 6-8 months (inpatient, day care, or sanatorium Setting). Surgical intervention is applied in certain cases, particularly for isolated cavities, large tuberculomas, and cirrhosis complicated by Bronchiectasis.

Adolescents with significant residual changes are monitored under dispensary group 5.1.

Tuberculosis in elderly and senile patients. In Ukraine, as in many countries worldwide, there is an ongoing demographic Aging trend, with a growing proportion of elderly and senile individuals. The share of older people among newly diagnosed patients has increased by a factor of 2 to 3. Chronic obstructive pulmonary disease (COPD) has become significantly more prevalent among the elderly. Mass population screenings reveal COPD in 60% of individuals over 60 years of age, while the co-occurrence of tuberculosis and COPD is observed in 48% of cases. The incidence rate among contacts of elderly and senile bacterivexcretors is 8 times higher than among contacts of younger index patients.

Thus, Structure/149.html">The problem of tuberculosis in elderly and senile individuals is highly relevant. This is driven by several factors: high incidence rates within this age group, delayed diagnosis due to difficulties in engaging them in screening programs, high epidemiological hazard, distinctive clinical presentations and disease courses, and treatment complexities arising from comorbidities, functional disorders, and poor drug tolerance, particularly regarding Antimycobacterial agents.

The Clinical presentation of tuberculosis in elderly and senile individuals possesses specific features linked to age-related physiological changes and comorbid conditions. Involutionary processes in older adults affect all Components of the lung parenchyma, bronchi, Blood Vessels, and lymphatic apparatus. The resulting structural alterations create favorable conditions for Inflammatory Diseases of the bronchopulmonary system, notably tuberculosis.

Clinical variants of tuberculosis in elderly and senile patients include:

1) "old" tuberculosis;

2) "senile" tuberculosis (typically secondary, yet retaining certain features of primary tuberculosis).

Old tuberculosis originates in youth, early adulthood, or middle age and persists into old or senile age. It is characterized by a chronic, wave-like course and typically manifests as chronic disseminated, fibro-cavitary, or Cirrhotic Pulmonary Tuberculosis.

Senile tuberculosis develops in elderly individuals primarily due to the endogenous reactivation of primary and post-primary foci in the Lungs and intrathoracic lymph nodes. Most commonly, senile tuberculosis exhibits a typical course characteristic of secondary tuberculosis, occasionally presenting with a blurred, atypical clinical picture. Rather rarely, it may proceed with certain features of primary tuberculosis, specifically intrathoracic lymph node tuberculosis and pleurisy.

Treatment. Adverse reactions to antimycobacterial therapy in patients over 60 years of age occur 1.5 times more frequently than in younger individuals, with complete drug intolerance observed in 5.1% of cases. Due to the poor tolerability of chemotherapeutic agents, elderly patients should be prescribed lower daily doses (reduced by 25-30%) along with less toxic drugs such as rifampicin and ethambutol. After 2-3 months of continuous antimycobacterial therapy, it is preferable to switch to an intermittent dosing schedule. Overall, the treatment regimens for elderly patients are generally similar to those for younger age groups. Pathogenetic Therapy aimed at improving metabolic processes and boosting the body's adaptive capacities (Vitamins, expectorants, geriatric remedies, and anabolics) is of paramount importance.

Review Questions

1. Classification of human age groups according to the international standard.

2. Peculiarities of the clinical course of tuberculosis in infants.

3. The course of tuberculosis in children.

4. Classic signs of primary tuberculosis.

5. Clinical Features of tuberculosis in adolescents and its treatment.

6. Which dispensary monitoring group includes adolescents with major post-tuberculous changes?

7. Tuberculosis in elderly and senile patients: clinical presentation, diagnosis, and treatment.