The changing face of tuberculosis: trends in tuberculosis-associated skeletal changes

Tuberculosis remains a major health problem in many areas of the world. Previous research suggested that the frequency of bone lesions has decreased in the modern (but pre-antibiotic) period, and that the predominantly spinal involvement have changed to affect other parts of the skeleton, in particular ribs. The purpose of this study was to investigate whether bone lesions associated with TB became more or less common in the post-antibiotic period, and if the pattern of skeletal involvement has changed. The skeletons of 147 individuals from South Africa who died from TB were assessed. These were divided into three groups - those dying before 1950 and presumed to have had no antibiotic intervention (n = 52); those dying between 1950 and 1985 presumed to have been treated with antibiotics (n = 34); and those dying after 1985 where co-infection with HIV and drug-resistant disease emerged (n = 61). Overall, 33.3% of all individuals showed signs that could be associated with TB, with corresponding figures in each of the three groups being 21.1%, 38.2% and 41.0%. The increase from group 1 to 3 was statistically significant. Rib lesions are becoming more common, while spinal lesions are decreasing. It may be suggested that patients are surviving for longer due to antibiotic treatment, allowing more time for the development of lesions.