Bone Tuberculosis

Abstract: The prevalence of tuberculosis15 in the United States has been rising since 1986, with morbidity increasing 14 per cent from 1985 through 1993. In 1986, the rate of tuberculosis in the United States was 9.3 new cases per 100,000 population. In 1991, the rate in New York State12,13 had risen to 17.3 per 100,000, and the rate in central Harlem was 169 per 100,000, which is similar to rates reported in the eastern and central regions of Africa7,12. Much of this increase has been in the rate of pulmonary tuberculosis, but it has been associated with a concomitant rise in the number of adults and children who have tubercular musculoskeletal involvement. In a prospective study of a cohort of intravenous drug abusers in New York City who tested positive with the tuberculin skin test, the risk of active tuberculosis was 14 per cent (seven of forty-nine patients) a year during a two-year follow-up interval76. It is becoming increasingly likely that an orthopaedic surgeon who works in a developed region of the world (especially in a big city) will encounter a patient who has tuberculosis, a disease with which the surgeon may have little experience or training13. Factors that have contributed to the increased rate of tuberculosis are the rise in the number of people who have suppression of the immune system, the development of drug-resistant strains of Mycobacterium, an aging population, and an increase in the number of health-care workers who are exposed to the disease. The human immunodeficiency virus remains the leading known risk factor for the reactivation of latent tuberculous infection65,68,79, and patients with this virus who are exposed to Mycobacterium tuberculosum are more likely to have progression to an …