Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-04-30T16:11:11.824Z Has data issue: false hasContentIssue false

Chapter 24 - Serious Infections

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Lauren Hartman ,
Rosanne Tiller ,
David Alain Wohl  and
David van Duin
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
Get access

Summary

As the population in the United States continues to age, familiarity with the clinical presentation, diagnosis, and management of the major serious infections of elderly individuals becomes an increasingly critical component of general medicine and primary care. While modern medicine has significantly reduced early death due to infection, diseases caused by infectious pathogens remain a major cause of illness and death among elderly persons. This chapter reviews the immunology of the elder host and environmental factors that make older adults uniquely vulnerable to infectious diseases. We propose an approach to the elderly patient with suspected infectious disease and highlight the differences in clinical presentation among older and younger patients, as well as addressing diagnosis and management of common and serious infectious diseases of older adults including urinary tract infection, bacterial pneumonia, influenza, herpes zoster, and Clostridioides difficile.

Keywords

elderlygeriatricinfectionantibioticspneumoniainfluenzaherpes zosterimmunization
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 297 - 309
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Miniño, AM, Heron, MP, Murphy, SL, Kochanek, KD. Deaths: Final data for 2004. Natl Vital Stat Rep. 2007; 55(19):1–119.Google Scholar
Grubeck-Loebenstein, B, Wick, G. The aging of the immune system. Adv Immunol. 2002; 80:243–284.Google Scholar
Linton, PJ, Dorshkind, K. Age-related changes in lymphocyte development and function. Nat Immunol. 2004; 5(2):133–139.CrossRefGoogle ScholarPubMed
Aspinall, R. Age-related changes in the function of T cells. Microsc Res Tech. 2003; 62(6):508–513.Google Scholar
Plackett, TP, Boehmer, ED, Faunce, DE, Kovacs, EJ. Aging and innate immune cells. J Leukoc Biol. 2004; 76(2):291–299.CrossRefGoogle ScholarPubMed
van Duin, D, Mohanty, S, Thomas, V, et al. Age-associated defect in human TLR-1/2 function. J Immunol. 2007; 178(2):970–975.Google Scholar
van Duin, D, Allore, HG, Mohanty, S, et al. Prevaccine determination of the expression of costimulatory B7 molecules in activated monocytes predicts influenza vaccine responses in young and older adults. J Infect Dis. 2007; 195(11):1590–1597.CrossRefGoogle ScholarPubMed
van Duin, D, Shaw, AC. Toll-like receptors in older adults. J Am Geriatr Soc. 2007; 55(9):1438–1444.Google Scholar
Vallejo, AN. CD28 extinction in human T cells: Altered functions and the program of T-cell senescence. Immunol Rev. 2005; 205:158–169.Google Scholar
Posnett, DN, Sinha, R, Kabak, S, Russo, C. Clonal populations of T cells in normal elderly humans: The T cell equivalent to “benign monoclonal gammapathy.” J Exp Med. 1994; 179(2):609–618.Google Scholar
Howells, CH, Vesselinova-Jenkins, CK, Evans, AD, James, J. Influenza vaccination and mortality from bronchopneumonia in the elderly. Lancet. 1975; 1(7903):381–383.Google Scholar
Ammann, AJ, Schiffman, G, Austrian, R. The antibody responses to pneumococcal capsular polysaccharides in aged individuals. Proc Soc Exp Biol Med. 1980; 164(3):312–316.Google Scholar
2018 Profile of Older Americans. Administration on Aging, Administration for Community Living, US Department of Health and Human Services, 2018.Google Scholar
Branson, BM, Handsfield, HH, Lampe, MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006; 55(RR-14):1–17; quiz CE11–14.Google ScholarPubMed
Mouton, CP, Bazaldua, OV, Pierce, B, Espino, DV. Common infections in older adults. Health Care Food Nutr Focus. 2001; 18(3):1, 3–7.Google Scholar
Norman, DC, Yoshikawa, TT. Fever in the elderly. Infect Dis Clin North Am. 1996; 10(1):93–99.Google Scholar
Castle, SC, Norman, DC, Yeh, M, Miller, D, Yoshikawa, TT. Fever response in elderly nursing home residents: Are the older truly colder? J Am Geriatr Soc. 1991; 39(9):853–857.Google Scholar
Ashraf, MS, Gaur, S, Bushen, OY, et al. Diagnosis, treatment, and prevention of urinary tract infections in post-acute and long-term care settings: A consensus statement from AMDA’s Infection Advisory Subcommittee. J Am Med Dir Assoc. 2020; 21(1):12–24.e12.Google Scholar
Pfisterer, MH, Griffiths, DJ, Schaefer, W, Resnick, NM. The effect of age on lower urinary tract function: A study in women. J Am Geriatr Soc. 2006; 54(3):405–412.CrossRefGoogle ScholarPubMed
Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010; 50(5):625–663.CrossRefGoogle ScholarPubMed
Genao, L, Buhr, GT. Urinary tract infections in older adults residing in long-term care facilities. Ann Longterm Care. 2012; 20(4):33–38.Google Scholar
Zhanel, GG, Harding, GK, Guay, DR. Asymptomatic bacteriuria: Which patients should be treated? Arch Intern Med. 1990; 150(7):1389–1396.Google Scholar
Potts, L, Cross, S, MacLennan, WJ, Watt, B. A double-blind comparative study of norfloxacin versus placebo in hospitalised elderly patients with asymptomatic bacteriuria. Arch Gerontol Geriatr. 1996; 23(2):153–161.Google Scholar
Silver, SA, Baillie, L, Simor, AE. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals? Can J Infect Dis Med Microbiol. 2009; 20(4):107–111.CrossRefGoogle Scholar
Dasgupta, M, Brymer, C, Elsayed, S. Treatment of asymptomatic UTI in older delirious medical in-patients: A prospective cohort study. Arch Gerontol Geriatr. 2017; 72:127–134.Google Scholar
Kauffman, CA, Vazquez, JA, Sobel, JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis. 2000; 30(1):14–18.CrossRefGoogle Scholar
Ang, BS, Telenti, A, King, B, Steckelberg, JM, Wilson, WR. Candidemia from a urinary tract source: Microbiological aspects and clinical significance. Clin Infect Dis. 1993; 17(4):662–666.CrossRefGoogle ScholarPubMed
Beck, SM, Finley, DS, Deane, LA. Fungal urosepsis after ureteroscopy in cirrhotic patients: A word of caution. Urology. 2008; 72(2):291–293.Google Scholar
Htwe, TH, Mushtaq, A, Robinson, SB, Rosher, RB, Khardori, N. Infection in the elderly. Infect Dis Clin North Am. 2007; 21(3):711–743, ix.Google Scholar
Meyer, KC. Lung infections and aging. Ageing Res Rev. 2004; 3(1):55–67.Google Scholar
Meyer, KC. Aging. Proc Am Thorac Soc. 2005; 2(5):433–439.Google Scholar
Henig, O, Kaye, KS. Bacterial pneumonia in older adults. Infect Dis Clin North Am. 2017; 31(4):689–713.Google Scholar
Marrie, TJ, File, TM Jr. Bacterial pneumonia in older adults. Clin Geriatr Med. 2016; 32(3):459–477.Google Scholar
Hash, RB, Stephens, JL, Laurens, MB, Vogel, RL. The relationship between volume status, hydration, and radiographic findings in the diagnosis of community-acquired pneumonia. J Fam Pract. 2000; 49(9):833–837.Google Scholar
Metlay, JP, Waterer, GW, Long, AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia: An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019; 200(7):e45–e67.Google Scholar
Loeb, M. Pneumonia in older persons. Clin Infect Dis. 2003; 37(10):1335–1339.Google Scholar
Ruiz, M, Ewig, S, Marcos, MA, et al. Etiology of community-acquired pneumonia: Impact of age, comorbidity, and severity. Am J Respir Crit Care Med. 1999; 160(2):397–405.Google Scholar
Kalil, AC, Metersky, ML, Klompas, M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016; 63(5):e61–e111.Google Scholar
Grohskopf, LA, Sokolow, LZ, Broder, KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2018–2019 Influenza Season. MMWR Recomm Rep. 2018 (Aug. 24); 67(3):1–20.Google Scholar
Lowen, AC, Mubareka, S, Steel, J, Palese, P. Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathog. 2007; 3(10):1470–1476.Google Scholar
Falsey, AR, Baran, A, Walsh, EE. Should clinical case definitions of influenza in hospitalized older adults include fever? Influenza Other Respir Viruses. 2015; 9(Suppl. 1):23–29.Google Scholar
Lam, PP, Coleman, BL, Green, K, et al. Predictors of influenza among older adults in the emergency department. BMC Infect Dis. 2016; 16(1):615.Google Scholar
Talbot, HK, Falsey, AR. The diagnosis of viral respiratory disease in older adults. Clin Infect Dis. 2010; 50(5):747–751.Google ScholarPubMed
Neuraminidase inhibitors for treatment of influenza A and B infections. MMWR Recomm Rep. 1999; 48(RR-14):1–9.Google Scholar
Gravenstein, S, Davidson, HE. Current strategies for management of influenza in the elderly population. Clin Infect Dis. 2002; 35(6):729–737.Google Scholar
Uyeki, TM, Bernstein, HH, Bradley, JS, et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019; 68(6):895–902.Google Scholar
Hayden, FG, Sugaya, N, Hirotsu, N, et al. Baloxavir marboxil for uncomplicated influenza in adults and adolescents. N Engl J Med. 2018; 379(10):913–923.Google Scholar
Domnich, A, Arata, L, Amicizia, D, Puig-Barbera, J, Gasparini, R, Panatto, D. Effectiveness of MF59-adjuvanted seasonal influenza vaccine in the elderly: A systematic review and meta-analysis. Vaccine. 2017; 35(4):513–520.CrossRefGoogle ScholarPubMed
DiazGranados, CA, Dunning, AJ, Kimmel, M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014; 371(7):635–645.CrossRefGoogle ScholarPubMed
Dunkle, LM, Izikson, R, Patriarca, P, et al. Efficacy of recombinant influenza vaccine in adults 50 years of age or older. N Engl J Med. 2017; 376(25):2427–2436.Google Scholar
Grohskopf, LA, Alyanak, E, Broder, KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices – United States, 2020–21 Influenza Season. MMWR Recomm Rep. 2020; 69(8):1–24.Google Scholar
Zevallos, M, Justman, JE. Tuberculosis in the elderly. Clin Geriatr Med. 2003; 19(1):121–138.Google Scholar
Imperato, J, Sanchez, LD. Pulmonary emergencies in the elderly. Emerg Med Clin North Am. 2006; 24(2):317–338, vi.Google Scholar
Rapid diagnostic tests for tuberculosis: What is the appropriate use? American Thoracic Society Workshop. Am J Respir Crit Care Med. 1997; 155(5):1804–1814.CrossRefGoogle Scholar
Force USPST, Bibbins-Domingo, K, Grossman, DC, et al. Screening for latent tuberculosis infection in adults: US Preventive Services Task Force recommendation statement. JAMA. 2016; 316(9):962–969.Google Scholar
Menzies, D. Interpretation of repeated tuberculin tests: Boosting, conversion, and reversion. Am J Respir Crit Care Med. 1999; 159(1):15–21.CrossRefGoogle ScholarPubMed
Zwerling, A, Behr, MA, Verma, A, Brewer, TF, Menzies, D, Pai, M. The BCG World Atlas: A database of global BCG vaccination policies and practices. PLoS Med. 2011; 8(3):e1001012.Google Scholar
Menzies, D, Pai, M, Comstock, G. Meta-analysis: New tests for the diagnosis of latent tuberculosis infection – Areas of uncertainty and recommendations for research. Ann Intern Med. 2007; 146(5):340–354.Google Scholar
Pai, M, Riley, LW, Colford, JM. Interferon-gamma assays in the immunodiagnosis of tuberculosis: A systematic review. Lancet Infect Dis. 2004; 4(12):761–776.Google Scholar
Mazurek, GH, Jereb, J, Lobue, P, et al. Guidelines for using the QuantiFERON-TB Gold test for detecting Mycobacterium tuberculosis infection, United States. MMWR Recomm Rep. 2005; 54(RR-15):49–55.Google Scholar
Bass, JB, Farer, LS, Hopewell, PC, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention. Am J Respir Crit Care Med. 1994; 149(5):1359–1374.Google Scholar
Nolan, CM, Goldberg, SV, Buskin, SE. Hepatotoxicity associated with isoniazid preventive therapy: A 7-year survey from a public health tuberculosis clinic. JAMA. 1999; 281(11):1014–1018.Google Scholar
Snider, DE. Pyridoxine supplementation during isoniazid therapy. Tubercle. 1980; 61(4):191–196.CrossRefGoogle ScholarPubMed
Dworkin, RH, Johnson, RW, Breuer, J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007; 44(Suppl. 1):S1–26.Google Scholar
Schmader, KE, Studenski, S. Are current therapies useful for the prevention of postherpetic neuralgia? A critical analysis of the literature. J Gen Intern Med. 1989; 4(2):83–89.Google Scholar
Kost, RG, Straus, SE. Postherpetic neuralgia: Pathogenesis, treatment, and prevention. N Engl J Med. 1996; 335(1):32–42.Google Scholar
Cunningham, AL, Lal, H, Kovac, M, et al. Efficacy of the herpes zoster subunit vaccine in adults 70 years of age or older. N Engl J Med. 2016; 375(11):1019–1032.Google Scholar
Lal, H, Cunningham, AL, Godeaux, O, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015; 372(22):2087–2096.CrossRefGoogle ScholarPubMed
Kimberlin, DW, Whitley, RJ. Varicella-zoster vaccine for the prevention of herpes zoster. N Engl J Med. 2007; 356(13):1338–1343.Google Scholar
Oxman, MN, Levin, MJ, Johnson, GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005; 352(22):2271–2284.Google Scholar
Dooling, KL, Guo, A, Patel, M, et al. Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 2018; 67(3):103–108.Google Scholar
Simberkoff, MS, Arbeit, RD, Johnson, GR, et al. Safety of herpes zoster vaccine in the shingles prevention study: A randomized trial. Ann Intern Med. 2010; 152(9):545–554.Google Scholar
CDC. Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: US Department of Health and Human Services, CDC, 2019. www.cdc.gov/DrugResistance/Biggest-Threats.html.Google Scholar
Vardakas, KZ, Rafailidis, PI, Konstantelias, AA, Falagas, ME. Predictors of mortality in patients with infections due to multi-drug resistant Gram negative bacteria: The study, the patient, the bug or the drug? J Infect. 2013; 66(5):401–414.CrossRefGoogle ScholarPubMed
Nelson, RE, Slayton, RB, Stevens, VW, et al. Attributable mortality of healthcare-associated infections due to multidrug-resistant gram-negative bacteria and methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2017; 38(7):848–856.Google Scholar
Hauck, C, Cober, E, Richter, SS, et al. Spectrum of excess mortality due to carbapenem-resistant Klebsiella pneumoniae infections. Clin Microbiol Infect. 2016; 22(6):513–519.Google Scholar
Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016; 62(10):e51–77.Google Scholar
Kourtis, AP, Hatfield, K, Baggs, J, et al. Vital signs: epidemiology and recent trends in methicillin-resistant and in methicillin-susceptible Staphylococcus aureus bloodstream infections – United States. MMWR Morb Mortal Wkly Rep. 2019; 68(9):214–219.Google Scholar
(CDC) CfDCaP. Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections – Los Angeles County, California, 2002–2003. MMWR Morb Mortal Wkly Rep. 2003; 52(5):88.Google Scholar
Crossley, KB, Archer, GL. The Staphylococci in Human Disease. New York: Churchill Livingstone, 1997.Google Scholar
Kaplan, AH. Staphylococci Infections. Netter’s Internal Medicine. Teterboro, NJ: Icon Learning Systems, 2003.Google Scholar
Foster, TJ. The Staphylococcus aureus “superbug.” J Clin Invest. 2004; 114(12):1693–1696.Google Scholar
Liu, C, Chambers, HF. Staphylococcus aureus with heterogeneous resistance to vancomycin: Epidemiology, clinical significance, and critical assessment of diagnostic methods. Antimicrob Agents Chemother. 2003; 47(10):3040–3045.Google Scholar
Leffler, DA, Lamont, JT. Clostridium difficile Infection. N Engl J Med. 2015; 373(3):287–288.Google Scholar
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018; 66(7):987–994.Google Scholar
Guh, AY, Mu, Y, Winston, LG, et al. Trends in U.S. burden of Clostridioides difficile infection and outcomes. N Engl J Med. 2020; 382(14):1320–1330.Google Scholar
McFarland, LV, Surawicz, CM, Rubin, M, Fekety, R, Elmer, GW, Greenberg, RN. Recurrent Clostridium difficile disease: Epidemiology and clinical characteristics. Infect Control Hosp Epidemiol. 1999; 20(1):43–50.Google Scholar
van Nood, E, Vrieze, A, Nieuwdorp, M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013; 368(5):407–415.Google Scholar
Cammarota, G, Masucci, L, Ianiro, G, et al. Randomised clinical trial: Faecal microbiota transplantation by colonoscopy vs. vancomycin for the treatment of recurrent Clostridium difficile infection. Aliment Pharmacol Ther. 2015; 41(9):835–843.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×