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Mycobacterium tuberculosis has affected humans for much of our existence. The incidence of global tuberculosis infection continues to rise, especially in concert with HIV coinfection. Many disease processes, such as diabetes, increase the likelihood of tuberculosis infection. Tuberculosis bacteria can infect any bone, joint, tendon, or bursa; however, the most common musculoskeletal site for infection includes the spine and weight-bearing joints of the hip and knee. Many patients who present with osteoarticular tuberculosis infection will have a gradual onset of pain at the site of infection. Many patients who develop a musculoskeletal tuberculosis infection will have no evidence of a pulmonary tuberculosis infection on x-ray film and many will have very mild symptoms with the initial infection. Healthcare providers must remember that many patients who develop tuberculosis infection do not progress to active tuberculosis disease; however, the latent infection may become active with immune compromise.
History
Tuberculosis (TB) has a very long and yet tragic history with humans. Some have proposed that TB has been present for more than 15,000 years (Gardam & Lim, 2005). The evidence of the historical relationship between TB and humans can be traced back to approximately 3,400 BC. Through the use of various methods, including the evaluation of genetic material, x-ray films, and histology, pathologic evidence of osteoarticular TB has been noted in Egyptian mummies (Abdelwahab, Bianchi, Martinoli, Klein, & Hermann, 2006a; Fitzgerald, Sterling, & Haas, 2009; Gardam & Lim, 2005). Evidence of Sanskrit writings describing spinal TB from approximately 1 ,000 BC has been noted (Abdelwahab et al., 2006a). Pathologic evidence has also been noted in remains of Europeans from the Dark Ages and Middle Ages and in remains from Southeast Asia from the Iron Age (Gardam & Lim, 2005).
Before the 17th century, TB was present in small populations of high density and poor hygiene. An increased spread of disease was noted in the winter months. This was typically associated with poor air exchange and greater exposure to disease (Mihalko & Martinez, 2007). The industrial revolution brought people into more crowded conditions. A greater number of people living in crowded conditions lead to a significant increase in disease transmission and number of people infected with TB. At worst, the TB epidemic in Europe during the 17th and...