A very rare case of possible actinomycosis of the mandible from the Middle Ages.

OBJECTIVE: Documented cases of actinomycosis in archaeological skeletons are very rare, especially from Central Europe. Our contribution will help facilitate the differential diagnosis of this disease for other paleopathologists. MATERIAL: This paper describes a pathological finding of the skeleton of a 40-year-old male from a burial ground in Sady-Spitálky (Czech Republic) dated to the 10th-12th century. METHODS: The affected skeleton was evaluated as a probable case of actinomycosis on the basis of a detailed macroscopic, X-ray and histological examination. The osteolytic foci examined were compared with similar changes caused by tuberculosis, syphilis and mycoses. RESULTS: The character and location of the defect on the mandible is indicative of organ actinomycosis and is also reflected by the lytic lesion observed on a lumbar vertebra. CONCLUSIONS: The described case can be considered one of the very rare paleopathological findings of possible actinomycosis in humans in Central Europe. SIGNIFICANCE: Good evidence of bone actinomycosis findings may be beneficial for further paleopathological and epidemiological studies, especially for research focused on the diachronic development of actinomycosis in Europe. In doing so, all available factors, such as hygiene habits, nutrition, social structure and overall health of the population that could be causally related to its origin, course and treatment, can be taken into account. LIMITATIONS: The mandible of the studied individual was damaged, especially in the area affected by the lesion, so the paleopathological analysis was difficult to perform. SUGGESTION FOR THE FUTURE RESEARCH: In future, actinomycosis in this skeleton may be confirmed by bio-molecular analysis.

Microstructural analysis of bony alterations in a historic case of actinomycosis.

OBJECTIVE: Actinomycosis infection of bone is rare and its diagnosis challenging. Here, we aim to identify and verify its microstructural features and the potential value for differential diagnosis. MATERIALS: We investigated the dry preparation of the lumbar vertebrae and pelvic ring of a purported case of actinomycosis documented by a post-mortem examination in 1891. METHODS: Macroscopic inspection, conventional radiology, µCT, 3D reconstruction, and histological examination were employed. RESULTS: All approaches revealed new periosteal bone deposition with increased vascularisation of the os coxa, vertebrae, and sacrum. The µCT revealed cortical loss underneath the new bone formation; the 3D reconstruction and histological examination revealed plexiform bone and granular structures. CONCLUSIONS: The plexiform bone is the result of reactive rapid growth and remodelling processes, and is consistent with pathomorphological findings summarised in the autopsy report (soft tissue abscesses and formation of fistulas caused by "Actinomycosis intestine et ossis ilei sin."). SIGNIFICANCE: This is the first case of a historically documented case of actinomycosis infection investigated by µCT and histology. Different degrees of tissue damage and inflammatory reaction in form of plexiform bone, which has not been reported previously, was identified. LIMITATIONS: The noted bone tissue modifications are not solely pathognomic of actinomycosis; they characterise other diseases, as well. Histological evaluation is not appropriate for identifying the aetiology of the granular structures observed here; but clinically such aggregations appear in tissue affected by actinomycosis. SUGGESTIONS FOR FURTHER RESEARCH: Histochemical and molecular-genetic analyses are obligatory to affirm the diagnosis based on micromorphological features.

Differential diagnosis of rib lesions: a case study from Middle Woodland southern Ontario circa 230 A.D.

The right ribs of an adult male (#18) from the LeVesconte Burial Mound in southern Ontario show extensive osteolytic and/or osteobastic lesions, some with bone thickening, interpreted herein as evidence of a chronic actinomycotic infection. In the alveolus, the presence of periapical abscesses and periodonitis with secondary inflammation may be associated with the pathogenesis of this bacterial disease by providing the normally commensurate Actinomyces israelii with the necessary conditions for their reproduction. This presumptive diagnosis, if correct, appears to represent the first case of actinomycosis in human palaeopathology. Recent literature reviews suggest that actinomycosis was not uncommon in preantibiotic populations, and that it has a high predilection for bone. Though actinomycosis can be associated with any subsistence strategy, such as, in this case, hunting and gathering, hypothetically it is most likely to occur in agricultural populations where general disease stress and age-adjusted dental pathology are highest. It is argued that in the differential diagnosis of archaeological specimens, as much attention should be given to the documentation of the natural range of variation of lesions produced by less well-known diseases, such as actinomycosis, since the disease ecology of pre-western populations differed significantly from our own.