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

Abstract

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 2 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.

Skeletal manifestations of tuberculosis in modern human remains

“…In the study by Steyn et al (), it was found that about one third of all skeletons showed signs that could be associated with TB—this is much higher than the 2–4% that is generally reported in the literature (Vigorita, ; Holloway et al, ), but it should of course be kept in mind that these are people who have died from TB and do not represent the patient cohort at large. Skeletal involvement increased from the pre‐antibiotic period (around 21.1% of individuals), to 38.2% and 41.0% in the pre‐ and post‐1985 skeletons, respectively.…”

“…The sample was divided into three groups based on their date of death—those who died before 1950 (1925–1949) and who probably did not receive any antibiotic treatment, those who died between 1950 and 1985 assumed to have been treated with antibiotics, and those who died after 1985 when co‐infection with HIV and drug‐resistant TB emerged. The date 1950 is used as post‐antibiotic as Streptomycin was introduced in the late 1940s and 1985 is used (somewhat arbitrarily) because the first cases of drug‐resistant TB and co‐infection with HIV in South Africa were reported around that time (Steyn et al, ). Unfortunately, all of the Western Cape skeletons dated from the antibiotic period.…”

Living cheek by jowl: The pathoecology of medieval York

“…The prevalence at York is higher at 3%. However, the crude prevalence rates presented here alongside the non-specific nature of many of the skeletal changes and the fact that majority of those with TB do not develop skeletal changes (Steyn et al 2013), means that the real rates of TB in medieval York are likely to have been higher.…”

The macroscopic and histomorphological properties of periosteal rib lesions and its relation with disease duration: evidence from the Luis Lopes Skeletal Collection (Lisbon, Portugal)

“…According to authors, the high frequency of lesions supports the idea that antibiotics would lead to an extended course of disease, allowing more time for skeletal lesions to develop (Steyn et al. ). In the rib sample studied, the presence of similar lesions in individuals who lived and died before and after the introduction of antibiotics suggests that their immune system was strong enough to ensure relative survival, at least until the development of bone lesions.…”

“…Santos & Roberts, , ; Matos & Santos, ; Steyn et al. ; Mariotti et al. ; Steyn & Buskes, ), in which a possible causal relationship between periosteal rib lesions and pulmonary disorders, particularly tuberculosis, has been found.…”