Tuberculosis: a strategy to detect and treat new and reactivated infections.

Adults age 65 and older are among those most likely to develop active tuberculosis (TB). Classic symptoms include fatigue, anorexia, weight loss, and a persistent low-grade fever. Older patients may have atypical symptoms, and studies show they have significantly more weight loss and more crackles in the lung fields than younger patients. Skin testing is a useful screening tool and is indicated in individuals suspected of active TB, those in whom prophylaxis would be considered, and nursing home residents. Definitive diagnosis is based on a positive sputum culture. Combination therapy with first-line antituberculous drugs is usually effective and well-tolerated in older patients. Preventive therapy is indicated in tuberculin reactors who have been recently infected.