Features of detection of respiratory tuberculosis in elderly patients with senile asthenia

BACKGROUND. In patients over 60 years of age, senile asthenia (SA), the main geriatric syndrome, may be the background for tuberculosis. The development of SA is accompanied by a decrease in physical and functional activity, adaptive and restorative reserves of the body, which makes the elderly vulnerable to infectious diseases, including tuberculosis.

OBJECTIVE. To study the features of detection and diagnosis of respiratory tuberculosis in patients with senile asthenia over the age of 60 in 2018–2024.

MATERIALS AND METHODS. A retrospective prospective cohort study wasconducted, which included 301 patients over 60 years of age with newly diagnosed respiratory tuberculosis in 2018–2024 in the Yaroslavl and Kostroma regions. The diagnosis of tuberculosis in all patients was carried out using clinical, laboratory, and instrumental examination methods generally accepted in phthisiology. All patients were screened for SA using the «Age is not a hindrance» questionnaire; asthenia was recorded with a score of 5 or more (Senile asthenia. Clinical guidelines, 2018, 2024). The patients were divided into two groups: 51 patients with SA in the first group, 250 patients without SA in the second group.

RESULTS. The time frame for detecting tuberculosis from the moment of contacting the general medical network to the diagnosis was more than one month in 59.1 % of patients over 60 years of age. In most cases (44.8 %), tuberculosis was detected by internists in the general treatment network (GTN) when patients complained of intoxication and bronchopulmonary disorders that had been bothering them for more than 3 weeks. In the group of patients with SA, disseminated (52.3 %) and infiltrative (31.3 %) forms prevailed, and tuberculosis of the bronchi (8.3 %) and tuberculosis of the bronchi (8.3 %) also occurred. Classical radiological signs of pulmonary tuberculosis in patients over 60 years of age werefound in 90.8 % of cases. Patients with SA were more likely to have a negative Mantoux test result with 2 TE than among patients without SA (39.2 % and 64.0 %; p <0.01). The ELISPOT test (T-SPOT.TV) was positive in 100% of cases.

CONCLUSIONS. In patients over 60 years of age with SA, there is a late diagnosis of tuberculosis. Tuberculosis is  detected mainly by  complaints of  the development of  widespread, disseminated processes against the background of reduced immune reactivity. It is advisable to include computed tomography of the chest organs, sputum analysis for Mycobacterium tuberculosis by molecular genetic methods, microscopy and culture, as well as immunological tests for tuberculosis using the ELISPOT method in the algorithms for diagnosing tuberculosis in patients over 60 years of age.

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