Skeletal tuberculosis and other granulomatous infections

After several decades of steadily decreasing incidence, tuberculosis has had a resurgence in the past 15 years, not only in the lungs, but also in extrapulmonary sites. This is primarily a result of the AIDS pandemic, considering that HIV specifically affects cellular immunity, which is the first-line defence against tuberculosis. The generally non-specific clinical and radiological patterns of skeletal tuberculosis make it similar to other bacterial, fungal, inflammatory and neoplastic diseases of the bones and joints. Physicians must not omit tuberculosis in the differential diagnosis of any osteo-articular inflammatory process so that specific treatment may be initiated as soon as possible. Anti-tuberculous therapy is beset by important factors that limit its efficacy, such as the emergence of drug toxicity and of resistant or multiresistant mycobacterial strains. Surgical treatment may be indicated in selected cases where medical therapy alone is not sufficient to eradicate the problem.