Mycobacterial osteomyelitis and arthritis

Mycobacterium tuberculosis is by far the most common cause of mycobacterial osteomyelitis and arthritis worldwide [1]. Once a rarity, the incidence of nontuberculous mycobacteria (NTM) disease dramatically increased in the 1980s and 1990s, in parallel with the advancing AIDS epidemic. Pulmonary and disseminated disease, however, still account for most cases. Although musculoskeletal infection with M tuberculosis and NTM shares several characteristics, such as bone destruction and relatively slow symptom onset, there are significant differences in their epidemiology and treatment, as discussed later. Tuberculous osteomyelitis plays a unique role in tuberculosis epidemiology, allowing medical historians to assess the presence of M tuberculosis in skeletal remains. Several techniques, including histologic and pathologic examination, radiography, and polymerase chain reaction, have detected tuberculosis bone disease in Egyptian mummies [2-4]. Genetic material from M tuberculosis has been identified using polymerase chain reaction techniques in Iron Age Southeast Asian skeletons [5], and European skeletal remains from the Dark Ages and Middle Ages [6,7]. These studies and others suggest that M tuberculosis has had an intimate relationship with Homo sapiens for millennia. Indeed, it has been proposed that the M tuberculosis bacillus has been present for 15,000 years [8].