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The Skull & Tuberculosis

Tuberculosis is a chronic infectious disease caused by mycobacterium tuberculosis bacteria. Because of its chronic nature, this disease has high morbidity. It is a major cause of mortality in many parts of the developing world, and also its incidence is seeing an increasing trend even in developed nations as of 2010 because of higher rates of HIV infections.

  1. Sites of Occurrence

    • Tuberculosis can affect almost any part of the body. Most common among them is the lungs. Other sites of tuberculosis can be the abdomen, lymph nodes, genitourinary system, skin, brain and skeletal system.

    Tuberculosis of Skull

    • Tuberculosis of the bones is not an uncommon condition, but tuberculosis of flat bones such as the skull occurs much less as compared with the other bones. Tuberculosis of the skull is seen in around 1 percent of cases of bone tuberculosis. There are several case reports of occurrence of skull tuberculosis in literature, and these reports show that skull tuberculosis presents itself in different ways.

    Occurrence

    • The occurrence of tuberculosis in the skull bones is considered to be secondary in nature, with the presence of primary infection at other sites--commonly the lungs and neck lymph nodes. Because of the occurrence of symptoms over many weeks to months, and the rarity of infection of the skull as compared with other bones, this disease is always least suspected during initial presentation of the patient to the doctor. In the majority of cases, infection first occurs in the inner table of the skull, then spreads to the outer table and finally perforation occurs, which may or may not lead to decaying and sequestration of the skull bones.

    Effects/Complications

    • Cold abscess or fistula formation may occur in the skull bones.The lesions may occur singly or may be multiple. It may affect the frontal, ethmoidal or sphenoid bone of skull. Presentation of tuberculosis as osteolytic (lytic lesion of bone) lesion has also been reported. The infection may spread to intracranial regions, such as the meninges and brain, which may increase the seriousness of the illness further.

    Risk Factors

    • In many cases, bone tuberculosis was reported after some time in patients who had suffered a head injury. More cases of skull tuberculosis have been reported in males. Skull tuberculosis has been reported in patients with disseminated (military) tuberculosis also. Patients with conditions that decrease immunity, such as chronic dialysis, corticosteroid therapy or HIV infection, have greater chances of manifesting tuberculosis, including of the skull bones.

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