Rib lesions in chronic pulmonary tuberculosis

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Abstract
The diagnosis of skeletal tuberculosis in human remains has traditionally been based upon the detection of secondary skeletal lesions which result from hemotogenous dissemination of tubercle bacilli. Since such lesions develop in < 7% of cases of human tuberculosis, the paleodemography and paleoepidemiology of this disease have been difficult to assess from skeletal remains. A new diagnostic approach to tuberculosis focusing on the skeletal manifestations of chronic pulmonary disease (which comprises .apprx. 90% of human-form tuberculosis) is presented. Skeletal remains [445] from persons dying of tuberculosis during the 1st half of the 20th century were examined. A total of 70/445 (16%) exhibited skeletal lesions in 1 or more locations as a response to infection. Of these 70, 39 (56%) displayed a specific set of lesions restricted to the internal aspect of the ribs. These lesions take 1 of 2 forms: diffuse periostitis of localized abscess, and appear to correspond to areas of chronic pulmonary infection. The diffuse type of rib lesion is more commonly observed than the localized type. The occurrence of chronic pulmonary tuberculosis is usually mutually exclusive with hematogenous dissemination to secondary bone locations. The detection of rib lesions in cases of chronic pulmonary disease increases the absolute sample size of skeletal tuberculosis by a factor of 2 in this study.

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