Oportunistic

infections in
elderly
Ning Rintiswati
 Elderly
• more frequent or, greater morbidity, and higher
mortality from infectious diseases than the
average population.
• Factors that may affect this increased predilection
-environmental exposure,
-normal physiological changes of aging,
- coexistence of chronic diseases
- alteration of host defense mechanisms.
 Risk Factors for Infection in the Aged
Environmental ExposurePatients
• 65 years : approximately a third of all days
spent in hospital (US)
• average risk of acquiring a nosocomial
infection(NI) is 4 %
that is nearly 3 times that of the general
population.
 Incidence cause by NI
• high incidence of pharyngeal colonization with
Gram-negative bacilli."
• Other kinds of nosocomial infections that the
aged are susceptible to include
Staphylococcus aureus, Candida sp,
herpesvirus group and influenza virus, and
Pneumocystis carinii.
 Physiological change with aging
• There is a general decline in organ function
& structure with age
• many of these alterations may contribute
to the increased risk of infection in the
elderly.
Diseases That Increase Susceptibility to
Infection
• The types of cancer often involve the
stomach, breast, pancreas, lung or prostate.
• Diabetes mellitus is a common disorder of the
aged.
• Prostatic hypertrophy in elderly men is a
common cause of obstructive uropathy and
UTI
Immunocompetence declines with age

• Age-related changes in the immune

system:
- chemical changes within the cells,
- differences of the cell surface
proteins
- alterations in entire organs. www.glycoforum.gr.jp

• the immune system begins to lose

some of its functions
• cannot respond as quickly or as
efficiently to stimuli.
purehealthsystems.com
 Opportunistic infection

• are caused by microorganisms that normally do

not cause serious disease in healthy people.
• may occur in individuals whose immune system
or other physiological defenses are impaired or
compromised in some way.
• are mild to severe infectious diseases in a
compromised host
Opportunistic infections
• may be caused by bacteria, fungi, viruses, or
parasites.
• Symptoms vary according to the
microorganism involved and the extent of
involvement.
• some of these microorganisms may be
resistant to standard antibiotic therapy.
Infections to which the aged are
particularly vulnerable are
• pneumonia
• Influenza
• tuberculosis,
• urinary tract infection,
• Gram-negative bacteremia,
• intra-abdominal sepsis,
• soft tissue infection,
• infective endocarditis, bacterial
• meningitis,
• bacterial arthritis
• herpes zoster infection
 Types of infections
© Dennis Kunkel Microscopy, Inc
sciencephoto.com
• Pneumocystis jirovecii (Pneumocystis
carinii
• Candida albicans
• Staphylococcus aureus
• Streptococcus pyogenes
• Pseudomonas aeruginosa
• Aspergillus sp.
• Cryptosporidium
• Cryptococcus neoformans
• Histoplasma capsulatum
• Clostridium difficile
 PREDISPOSING FACTORS TO INFECTION IN THE ELDERLY
factors expression
Urine catheterization Urosepsis, UTI

Prostatic hypertrophy UTI

Thinning/drying of skin, Skin infections

decreased sebaceous
secretions

COPD GNR peneumonia

Diabetes mellitus Infection and poor WBC function,nosocomial
infections,tuberculosis, gram-negative
pneumonia,malignant external otitis,osteomyelitis,fungal
infection,UTI, influenza, nonclostridial gas
gangrene,extrapulmonary
Klebsiella infections,Clostridium septicum bacteremia
Empysema Nosocomial infections
 Atypical sign/no symtoms that make
diagnosis difficult
bacteremia No Fever
pneumonia No Fever
TB No fever, no weight loss, no night sweats, no sputum
production, no hemoptysis, acid-fast smear results
negative, atypical radiographic manifestations, no cough
influenza No fever
No fever, chills, or joint symptoms
bacteriuria No dysuria, frequency, hesitancy, incontinence, urgency,
suprapubic or flank
pain or fever44-48
Meningitis No stiff neck, headache, chills, fever, tachycardia, confusion,
seizures, or coma
 nosocomial infections

• causing significant morbidity and mortality.

• In the United States, the annual incidence :
2.1 million in acute care hospitals (with 30%
to 40% of patients older than 65 years) and
1.5 million in nursing homes (with greater
than 90% of the residents older than 65 years)
 UTI in elderly
• Bacteriuria ( 105 bacteria in 1 ml of urine) is
common in the elderly, but how much it
matters and whether it should be treated are
unclear.
• dysuria and frequency is poor‘ fever is often
absent
• there are no pus cells
• Bacteriuria in the elderly does seem to be
related to mortality.
• It has often been assumed that bacteriuria in
the elderly, particularly in women, represents
bladder rather than upper urinary tract
infection.
 Pneumonia
• Elderly adults account for >40% of persons
with invasive group B streptococcal (GBS)
disease and for >50% of GBS-associated
deaths in the United States.
• abnormalities in immune responses caused by
immune senescence to pathogenesis
 TUBERCULOSIS
• fewer classical symptoms and signs (fever,
weight loss,night sweats, sputum production,
hemoptysis),
• More abnormal mentation and mortality.
Increased liver enzymes, hypoalbuminemia,
hyponatremia, and hypocalemia
 Refferences
• Flournoy, D.J., &Bernard, M.A. 1993. Problem in diagnosing infections in elderly .
J. The Nat Med Assoc. 85( 11).
• Gavacci, G., Krause , K-H.2002, Ageing and infection .The Lancet Infectious
Diseases :2 (11)
• Morven S. Edwards1 & Carol J. Baker1,2. 2005. Group B Streptococcal Infections in
Elderly Adults. Aging & infectious dis. 41 (15 September)
• Mouton , C.P., & Bazaldua, O.V, Pierce, B., Espino , V. 2001. American Fam
Phsycian www.aafp.org/afp 63(2) .
• Ryan, K.J., and Ray, G.C, 2004. Sherris Medical Microbiology . 4th ed Apleton and
Lange: 439-443T
• Wollscheid-Lengeling, E., & Kerksiek, K. 2009. Infectious Diseases and Aging. Infect
reseach news and perspectives. 19 April.