The Elderly

® Many clinical findings are muted in the elderly or absent altogether, so there can be considerable diagnostic uncertainty. Positive skin tests, fevers, night sweats, sputum production, or hemoptysis may be absent, making TB hard to distinguish from

other bacterial or viral infections or chronic lung diseases. ''' In contrast, mental status changes are twice as common in the elderly, and CNS disease must be considered when TB is entertained. Mortality is six times higher in the elderly in part owing to delays in diagnosis.2,19,26 Ethnic distributions of disease are different in the elderly and include more white patients because these patients often were infected decades ago, when TB was more prevalent in the United States.

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