9 Tuberculous Osteomyelitis

Tuberculous osteomyelitis without joint involvement is a disease well described in the classic studies; its incidence was high during the "wild tuberculosis" era [Sorrel and Sorrel-Dejerine (1932) reported 649 cases in a series of 4660 chil­ dren with tuberculosis]. It was less frequent in adults during the same period. Sorrel and Sorrel-Dejerine (1932) reported only 40 cases of 1918 adults with tuber­ culosis (2%). The frequency of the disease in children has diminished considerably since the advent of chemotherapy in the treatment of tuberculosis. Twenty-five years ago, Gerard-Marchand pointed out the "extreme rarity" of the lesion in chil­ dren. In adults, tuberculous osteomyelitis still occurs, but it seems that this par­ ticular type of lesion has been more or less forgotten by modem authors - only a few isolated cases have been reported in the literature during the last 20 years (Lindahl 1952; O'Connor et al. 1970; Manzella et al. 1975; Lynder 1982). For this reason, we shall refer in this chapter to our personal experience with tuberculous osteomyelitis (Martini et al. 1981, 1986). This type of lesion occurs frequently in Algeria, involving 20% of cases of bone and joint tubercu­ losis and 25% of cases of chronic osteomyelitis of hematogenous origin. We have been able to observe 130 locations of the disease over a period of 17 years. These figures relate to 116 patients, of whom 105 were adult. We believe this high incidence is due not only to epidemiologic factors, but can also be ac­ counted for in part by the rigorous histologic and bacteriologic tests performed in order to confirm a diagnosis of tuberculosis in the face of any chronic he­ matogenous bone infection.