Abstract:
Paleopathologists study the presence of diseases in the past and as such have a vast
knowledge of skeletal changes associated with different conditions. Tuberculosis is one of
the most studied diseases and still remains a major health problem today. Its manifestations
in past populations have been extensively described, but less is known about its bony
involvement in the post-antibiotic era. The aim of this study was to assess the frequency
and manifestations of skeletal lesions in the post-antibiotic era in a South African sample
and compare it to that found before the introduction of antibiotics. Skeletons of 205
individuals from modern skeletal collections and who are known to have died from TB were
assessed. It was found that 39.2% of all individuals dying in the post-antibiotic era showed
skeletal changes that could be associated with TB, while another 27.5% showed nonspecific
changes. The highest incidences were found in individuals who died after 1985, when coinfection
with HIV and drug resistance became common. While, as expected, vertebral and
rib changes were the most common, the number of individuals who showed changes to the
skull, and specifically intracranially, was surprising. These could most probably be associated
with TB meningitis, although this specific cause of death was noted in only a few individuals.
It seems that individuals may be living longer as a result of long-term antibiotic use, leaving
more time for lesions to develop.
