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A "forgotten germ" returns revisiting the elderly with a vengeance.

Because tuberculosis has not disappeared but merely gone into hiding, the incidence of the disease has multiplied in numbers and is striking many of the elderly whose immune systems have diminished in strength.

More than one third of the cases of tuberculosis reported to the Centers for Disease Control in Atlanta, Georgia, occurred in people over the age of 60.

When today's elderly were young, tuberculosis afflicted great numbers of people. It was viewed as a dreaded disease. Although the cause of the illness was already understood, the cure remained elusive -- not to arrive for at least a decade.

Tuberculosis, although predominant among the poor and underfed and rampant among those living in unsanitary surroundings, did not discriminate. It attacked the middle class and took its toll among the wealthy.

Many individuals, young at the time and making up the elderly group now, survived the raging epidemic. Their immune systems succeeded in "fighting the germ to a draw." But the invader remained, content to live quietly in its host temporarily encapsuled by antibodies but awaiting the opportune moment for return.

There are at least three conditions that make possible the tubercular germ's ability to break through the antibody entrapment, all the result of a weakening of the immune system.

Diseases such as diabetes, nutritional deficiencies, or disabling ailments such as chronic fatigue syndrome may create vulnerability. The immune system can also be compromised by the use of drugs such as cortisone. Environmental factors can reduce effectiveness of immune function. Poorly ventilated rooms, unsanitary accumulations of trash and garbage, and unhealthful food (contaminated and otherwise) contribute to reactivation of an old infection. Nursing homes, improperly maintained, are breeding grounds, especially when they serve as "collection centers" for the elderly who bring in their individual potential for spreading the tuberculosis germ.

Fortunately, many nursing homes test each new resident with tuberculin, an effective skin test that can reveal varying degrees of old or new infections.
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Title Annotation:Special Issue: Tuberculosis
Publication:Nutrition Health Review
Date:Jun 22, 1991
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