The association between skeletal lesions and tuberculosis in a pre-antibiotic South African sample

Objective: This study assessed the sensitivity and specificity of skeletal lesions to accurately diagnose TB in a pre-antibiotic South African skeletal sample. Materials: A total of 435 skeletons of individuals who died before 1950 from the Raymond A. Dart Collection of Human Skeletons. 176 died of TB, 109 died of other pulmonary diseases, and 150 died of other causes. Methods: The presence / absence of 23 skeletal lesions were assessed for differences in frequency between groups. Sensitivities and specificities were calculated and compared to Dangvard Pedersen et al. (2019). Results: Lesions on the ventral surface of thoracic and lumbar vertebral bodies were observed significantly more often in TB and pulmonary cases than in other cause of death group and yielded a 55% probability of a true TB diagnosis, if observed. An association between skeletal lesions and TB was found for rib and vertebral lesions. Conclusions: The results suggest that even when not documented to have died of TB, TB-related changes are observed in many individuals in a South African skeletal sample, indicating that they may have been infected with the disease. Significance: The study provides information that can assist palaeopathologists in making inferences about the prevalence of TB in past populations. Limitations: Sample sizes were small, and the inclusion of a pulmonary disease group may have confounded the results. Suggestions for further research: The selection of a control group without any possible contact with TB may improve the results and should be investigated.