Age-related changes in the manifestations of tuberculosis. Implications for drug therapy.

Although the overall number of tuberculosis cases reported in developed countries has decreased markedly since about the middle of the twentieth century, at present active tuberculosis in the geriatric population is highly prevalent even in developed countries. With an increase in the aged population and striking progress in medicine during the past two decades, the development of tuberculosis infections and the active disease has been gradually changed; namely, the number of older people at risk of infection has been increasing. In the elderly, postprimary pulmonary tuberculosis and miliary tuberculosis are particularly difficult to diagnose. A high index of suspicion, a tuberculin skin test, and appropriate laboratory studies are essential for early diagnosis. In choosing the proper therapy for tuberculosis in the elderly, efficacy, patient compliance, and toxicity must be considered. During this decade, more so than ever before, much time and work will be required to more completely understand the factors that place a patient at risk for infection and to accomplish eradication of tuberculosis.