Tuberculosis and leprosy in perspective

Two of humankind's most socially and psychologically devastating diseases, tuberculosis and leprosy, have been the subject of intensive paleopathological research due to their antiquity, a presumed association with human settlement and subsistence patterns, and their propensity to leave characteristic lesions on skeletal and mummified remains. Despite a long history of medical research and the development of effective chemotherapy, these diseases remain global health threats even in the 21st century, and as such, their causative agents Mycobacterium tuberculosis and M. leprae, respectively, have recently been the subject of molecular genetics research. The new genome-level data for several mycobacterial species have informed extensive phylogenetic analyses that call into question previously accepted theories concerning the origins and antiquity of these diseases. Of special note is the fact that all new models are in broad agreement that human TB predated that in other animals, including cattle and other domesticates, and that this disease originated at least 35,000 years ago and probably closer to 2.6 million years ago. In this work, we review current phylogenetic and biogeographic models derived from molecular biology and explore their implications for the global development of TB and leprosy, past and present. In so doing, we also briefly review the skeletal evidence for TB and leprosy, explore the current status of these pathogens, critically consider current methods for identifying ancient mycobacterial DNA, and evaluate coevolutionary models.

Prevalence of Maxillary Sinusitis in Leprous Individuals from a Medieval Leprosy Hospital

The maxillary sinuses of 133 skeletons from the medieval hospital of St. James and St. Mary Magdalene, Chichester, England, were analyzed for evidence of sinusitis. Of the sample, 16 individuals were considered to have suffered from lepromatous leprosy and 13 from tuberculoid leprosy. The most common bone change seen within the sinuses was the presence of new bone formation followed by pitting. Bone change was seen in 56.3% (9 of 16) of the individuals with lepromatous leprosy and 54.8% (57 of 104) of nonleprous individuals. These results are not statistically significant. Clinical evidence suggests that one should see a higher frequency in the lepromatous group. Possible explanations of this include environmental factors promoting the spread of droplet infection in an immunosuppressed community, in addition to which the small sample of leprous skeletons may bias the result

Inflammatory Bone Changes in Leprous Skeletons from the Medieval Hospital of St. James and St. Mary Magdalene, Chichester, England

Resumo: The extent and location of an inflammatory bone lesion, periostitis, were examined in 50 leprous skeletons from the Chichester cemetery of the Hospital of St. James and St. Mary Magdalene in Sussex, England. Although the presence of periostitis is not pathognomonic of leprosy, it predominantly indicates dermal and neuropathic changes that the patient would have presented in life. The spread of inflammation across the knee joint and the ossification of the interosseous membrane due to inflammation are also suggested