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Berklapróf meðal aldraðra

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L1992-05-78-F4.pdf
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Authors
Helga Hansdóttir
Hlynur Þorsteinsson
Þorsteinn Blöndal
Ársæll Jónsson
Issue Date
1992-11-01

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Citation
Læknablaðið 1992, 78(5):186-9
Abstract
In 1987 a survey of tuberculin reactivity was carried out amongst residents in geriatric wards in Borgarspitalinn and associated nursing homes. Included were 215 individuals, 46 males (mean age 84.2 years) and 169 females (mean age 84.1 years). A standard 5-TU Mantoux test (PPD RT-23) was performed and the skin reaction considered positive if an area of induration equal or more than 8 mm developed within 48-72 hours of testing. The prevalence of tuberculin positivity was found to be 29.3% irrespective of nursing dependency or mental test score and 38% in 61 with history or findings suggestive of previous tuberculosis and 43% in 29 residents with documented positive Mantoux test up to 30 years earlier. By December 1990, 118 residents (55%) had died. Survival was compared with tuberculin reactivity up to three years earlier and also whether previous documented positive tuberculin reactivity had been maintained. Neither tuberculin reactivity in old age nor the loss of previous Mantoux positiveness were found to be associated with survival in longterm institutional care.
Niðurstöður berklaprófa hafa lengi verið notaðar til að meta útbreiðslu á mýkóbakteríusýkingum og þá sérstaklega sýkingu af völdum Mycobacterium tuberculosis - berklasýkils. Góð gögn eru til um niðurstöður berklaprófa í aldursflokkum 6-16 ára og hjá miðaldra fólki (1) en engin skipulögð berklapróf hafa verið gerð meðal aldraðs fólk hérlendis þótt vitað sé að stærsti hluti nýrra berklatilfella komi einmitt fram meðal þeirra öldruðu sem tóku berklabakteríuna á sínum yngri árum (2). Berklar voru útbreiddir á Íslandi á fyrstu áratugum þessarar aldar. Mætti því ætla að jákvæð berklapróf séu algeng meðal þeirra sem eru gamlir nú. Væg tegund ónæmisbæklunar á sér stað samfara háum lífaldri (3-5). Athyglisvert væri að vita hvort það sé vegna ellinnar sjálfrar eða vegna þeirra margvíslegu sjúkdóma sem hrjá gamalt fólk, þar á meðal heilabilun (dementia). Svörun líkamans við tuberkúlíni byggist á síðkominni ofnæmissvörun og er þekkt að sú svörun getur týnst í ýmsum sjúkdómum. Erlendar athuganir hafa bent til að minnkuð frumubundin ofnæmissvörun sé samfara minnkuðum lífslíkum aldraðs fólks á hjúkrunarheimilum (6-9). Það þótti því áhugavert að gera berklapróf á fólki á sjúkrastofnunum fyrir aldraða og skoða niðurstöður með tilliti til þessara þátta.
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