Tuberculosis Management in Aging Populations

Tuberculosis in older adults presents unique clinical and public health challenges driven by age-related changes in immunity, comorbidities and frailty. Immunosenescence reduces cellular immunity, increasing the risk of reactivation of latent infection and blunting responses to standard therapies. Diagnostic yields are often lower owing to atypical radiological findings and diminished sputum production, while polypharmacy and organ dysfunction heighten the risk of adverse reactions to first-line agents. Comprehensive management therefore requires tailored screening strategies, vigilant monitoring of drug toxicity, dose adjustments based on physiological reserve and integration of social support to ensure adherence. Preventive measures such as latent-infection screening in high-risk elderly cohorts, combined with enhanced case-finding and geriatric assessment, are essential to reduce morbidity and mortality in ageing societies worldwide.

Research from Nature Portfolio

A multicentre retrospective study of very elderly inpatients (aged ≥ 80 years) with pulmonary tuberculosis has identified low serum albumin, respiratory failure and dependency in activities of daily living as independent predictors of early adverse drug reactions or death. Notably, a reduced rifampicin dose (< 8 mg/kg/day) was associated with fewer toxic events without prolonging time to sputum culture conversion. These findings support a risk-stratified approach in geriatric TB care, emphasising dose individualisation and close monitoring to improve safety while preserving efficacy.

Tuberculosis Management in Aging Populations publication trend

The graph below shows the total number of articles in tuberculosis management in aging populations across all publications each year (not limited to Nature Index journals).

Technical terms

Adverse drug reaction: An unintended, harmful response to a medication at normal doses.

Extrapulmonary tuberculosis: Infection by Mycobacterium tuberculosis at sites outside the lungs, such as lymph nodes or bones.

Sputum smear microscopy (acid-fast bacilli test): A diagnostic technique that detects mycobacteria in respiratory secretions stained to reveal acid-fast organisms.

Mitochondrial transplantation: The transfer of healthy mitochondria into cells to restore metabolic function and modulate immune responses in ageing or diseased tissue.

References

1. Factors associated with adverse drug reactions or death in very elderly hospitalized patients with pulmonary tuberculosis. Scientific Reports (2023).
2. Mitochondrial Transplantation Promotes Protective Effector and Memory CD4+ T Cell Response During Mycobacterium Tuberculosis Infection and Diminishes Exhaustion and Senescence in Elderly CD4+ T cells. Advanced Science (2024).
3. Safety of pyrazinamide in elderly patients with tuberculosis in Japan: A nationwide cohort study. Respirology (2024).
4. Reduced bacillary load in elderly patients with active extrapulmonary and pulmonary tuberculosis in Peru: analysis of confirmatory culture after acid-fast bacilli test. Frontiers in Microbiology (2024).