1Biological Anthropology and Comparative Anatomy Research Unit, University of Adelaide, 2Centre for Evolutionary Medicine, University of Zürich
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Approximately 3-5 % of individuals with active tuberculosis develop skeletal lesions associated with the disease. The most commonly affected regions are the spine, hip and knee. Typically, anterior regions of vertebrae are destroyed and may lead to collapse of the spine. Posterior elements are usually not involved and in both spinal and non-spinal lesions, no new bone formation occurs beyond fusion of affected vertebral bodies. However, we have previously shown that elimination of the causative agent, Mycobacterium tuberculosis (e.g. by antibiotics), can allow extensive healing of the skeletal lesions to occur. Therefore, it is also possible that healing can occur in the pre-antibiotic time period when an individual’s immune system had successfully controlled the bacteria, rendering the infection inactive. We present several pre-antibiotic cases of tuberculosis skeletal lesions from the Galler Collection (Switzerland) that have healed many years before death. All cases have medical documentation. In several cases of collapsed, kyphotic spinal columns, occurring as a result of extensive vertebral destruction, one individual displayed new bone formation on the anterior region of the twelfth thoracic and first lumbar vertebrae away from the collapsed eighth thoracic vertebra. In another case of tuberculosis that destroyed the talo-calcanean joint, new bone formation resulted in fusion of the tibia and fibula. This information may be used in archeological contexts to show whether the tuberculosis became inactive some time before death as well as for differential diagnoses.