Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection

Spekker, Olga; Hunt, David; Paja, László; Molnár, Erika; Paragh, György; Schultz, Michael

doi:10.1371/journal.pone.0230418

Cited by 26 publications

(46 citation statements)

References 71 publications

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“…Nonetheless, some autopsy studies revealed that a large number of individuals who died of pulmonary TB without developing neurological signs and symptoms exhibited tubercles in the CNS. The results of our recently published study [34], also conducted on the Terry Collection, fit in with those of the aforementioned autopsy studies. Although the vast majority of the individuals in our TB group were identified to have died of pulmonary TB (S1 Table), about one-third of them exhibited GIs that can be considered as pathognomonic features of TBM.…”

Section: Plos Onesupporting

confidence: 86%

“…Control (NTB) group, composed of 193 individuals (106 males and 87 females) identified to have died of causes other than TB, with age at death ranging from 20 to 90 years ( S2 Table ) [ 34 ].…”

Section: Methodsmentioning

confidence: 99%

“…• TB group, consisting of 234 individuals (169 males and 65 females) recorded to have died of TB, with age at death ranging from 16 to 81 years (S1 Table) [34]; and…”

Section: Plos Onementioning

confidence: 99%

“…• Control (NTB) group, composed of 193 individuals (106 males and 87 females) identified to have died of causes other than TB, with age at death ranging from 20 to 90 years (S2 Table) [34]. T786, T789, T795, T799, T809R, T820R, T822, T823, T828, T833R, T834R, T844, T846, T863, T876, T891, T892, T895, T896RR, T897, T902, T903R, T907, T914, T915, T919, T930R, T932, T933R, T934, T936, T938, T941, T946, T948, T950, T952, T955, T957, T957R, T964, T968, T973, T975, T987, T1002, T1005, T1013, T1018, T1020, T1023, T1027, T1029R, T1030, T1031, T1033, T1034, T1036, T1043, T1045, T1046, T1047, T1048, T1050, T1057, T1058, T1060, T1066R, T1070, T1071R, T1072, T1076, T1086, T1093, T1095, T1096R, T1098, T1100RR, T1102R, T1105, T1106, T1107, T1113, T1122, T1124R, T1129, T1130R, T1132, T1133RR, T1134R, T1137R, T1138R, T1140, T1147R, T1156, T1157, T1159, T1163, T1165, T1169, T1173, T1182R, T1183, T1185, T1186, T1187, T1190, T1192, T1204R, T1205, T1210, T1215, T1219, T1222, T1224, T1226, T1228, T1229, T1230, T1232, T1236, T1243R, T1247, T1249R, T1252, T1255, T1263R, T1264, T1266R, T1267, T1271, T1275, T1277, T1278, T1282, T1285, T1287, T1291, T1299R, T1300, T1304R, T1309, T1310, T1313, T1315, T1318, T1319, T1322, T1331, T1337RR, T1342, T1343, T1346, T1347R, T1352, T1353R, T1359, T1362, T1367, T1368, T1369, T1375R, T1376, T1377, T1378, T1379, T1387, T1388, T1397, T1398, T1401, T1405, T1406, T1407, T1411R, T1416, T1417R, T1419, T1422R, T1428R, T1434R, T1435, T1439R, T1444, T1451, T1453R, T1455, T1458, T1467, T1476, T1495, T1502R, T1503, T1505R, T1507, T1514, T1519, T1521, T1531, T1533, T1534, T1536, T1539, T1543, T1544, T1549, T1551, T1552, T1553, T1554, T1555, T1562, T1567, T1568, T1572, T1576, T1581, T1592, T1599, T1604, T1614, T1627, and T1629.…”

Section: Plos Onementioning

confidence: 99%

“…Paleopathological diagnosis of TB principally relies on the identification of macroscopic lesions in the human skeleton that have been found to be related to different manifestations of the disease (e.g., skeletal TB, pulmonary TB and/or TB pleurisy, and TB meningitis (TBM)) through clinical study [20][21]. Since the late 20 th century, a number of studies [e.g., 19,[22][23][24][25][26][27][28][29][30][31][32][33][34] were performed on osteoarchaeological series and documented skeletal collections that have revealed a positive association between TBM and a few endocranial alteration types, i.e., granular impressions (GIs), abnormally pronounced digital impressions (APDIs), abnormal blood vessel impressions (ABVIs), and periosteal appositions (PAs).…”

Section: Introductionmentioning

confidence: 99%

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Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

et al. 2020

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Although endocranial abnormal blood vessel impressions (ABVIs) and periosteal appositions (PAs) have been considered as paleopathological diagnostic criteria for tuberculous meningitis (TBM) based on findings of previous studies, they are not pathognomonic for tuberculosis (TB). Therefore, their utilization in the paleopathological practice can be questioned, especially in consideration that most of the previous studies were not performed on identified skeletal collections but on osteoarchaeological material and did not include statistical data analysis. To fill the aforementioned research gap, for the first time, a macroscopic investigation was conducted on identified pre-antibiotic era skeletons from the Terry Collection. A sample set of 234 individuals who died of TB (TB group) and 193 individuals who died of non-tuberculous causes (NTB group) were examined. The frequency of ABVIs and PAs, as well as other probable TB-related lesions was recorded. To determine the significance of difference (if any) in the frequencies of ABVIs and PAs between the two groups, χ 2 testing of our data was performed. We found that ABVIs, PAs, and their co-occurrence with each other and with other probable TB-related lesions were more common in the TB group than in the NTB group. In addition, the χ 2 comparative frequencies of ABVIs and PAs revealed a statistically significant difference between individuals who died of TB and individuals who died of NTB causes. Our findings strengthen those of previous studies that ABVIs and PAs are not specific to TBM but can be of tuberculous origin. Therefore, they do have a diagnostic value in the identification of TB in human osteoarchaeological material, especially when they simultaneously occur with other probable TB-related lesions. Their prudent utilization provides paleopathologists with a stronger basis for diagnosing TB and consequently, a more sensitive means of assessing TB frequency in past human populations.

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Section: Plos Onesupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

“…• TB group, consisting of 234 individuals (169 males and 65 females) recorded to have died of TB, with age at death ranging from 16 to 81 years (S1 Table) [34]; and…”

Section: Plos Onementioning

confidence: 99%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

et al. 2020

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Insights into the diagnostic efficacy and macroscopic appearance of endocranial bony changes indicative of tuberculous meningitis: Three example cases from the Robert J. Terry Anatomical Skeletal Collection

Spekker

Hunt

Berthon

et al. 2022

Intl J of Osteoarchaeology

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Recently, the combined macroscopic and statistical evaluation of 427 identified pre‐antibiotic era skeletons from the Terry Collection (Washington, DC, USA) revealed that there is a positive association between tuberculous meningitis (TBM) and four endocranial alteration types, namely, granular impressions (GIs), abnormal blood vessel impressions (ABVIs), periosteal appositions (PAs), and abnormally pronounced digital impressions (APDIs). Although all the four lesion types can be used as diagnostic criteria for TBM in the paleopathological practice, they do not have the same diagnostic value. The first aim of the current paper is to further highlight the diagnostic value of GIs, ABVIs, PAs, and APDIs by calculating and discussing their diagnostic sensitivity and specificity estimate values, as well as their association with each other from the 427 identified pre‐antibiotic era skeletons of the Terry Collection. The second aim is to demonstrate three example cases from the Terry Collection, who exhibit bony changes on the inner skull surface that are representative of the macromorphological appearance and co‐occurrence of GIs, ABVIs, PAs, and APDIs (in different combinations). Based on the generated sensitivity and specificity estimate values, GIs are sufficient enough on their own to make a definitive diagnosis of TBM, whereas ABVIs, PAs, and APDIs are not specific to the disease but can be of tuberculous origin. The χ2 test results regarding the association of ABVIs, PAs, and APDIs revealed that their co‐occurrence with each other (in any possible combination) is significantly more common in individuals who died of TB than in those who died of non‐TB causes—it implies that the chance of them being tuberculous in origin is higher when they simultaneously occur with each other. The three cases demonstrated in detail in the paper provide paleopathologists with a stronger basis for identifying TBM in ancient human remains that reveal endocranial alterations resembling that of the presented cases.

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New insights in the investigation of trepanations from the Carpathian Basin

Király

Váradi

Kis

et al. 2022

Archaeol Anthropol Sci

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The aim of this study is to describe four new cases of trepanation from the Great Hungarian Plain and complement two other previously published cases with new results from the 9th to 16th c. CE. Sex determination and age-at-death estimation were performed using classical macromorphological methods. In certain cases, radiographic imaging, 3D scanning, and radiocarbon dating were also performed. Our cases fit the formerly established understanding of trepanations, with a male majority and signs of trauma as accompanying symptoms. The cause of intervention was mostly therapeutic, i.e., trauma, in most cases. In order to simplify the currently confusing nomenclature in trepanation categories (complete–incomplete vs. surgical–symbolic), we propose the use of “trepanation” exclusively to all forms of intentional, non-violent removals of all three layers of the cranial vault. On the other hand, the phenomena widely known in Eastern Europe as symbolic trepanations should be designated as “cranioglyphs,” referring to all forms of superficial interventions administered to the cranial vault that do not penetrate all three layers of the bone. In case the data are insufficient to properly categorize the phenomenon at hand, one should refrain from it, and simply describe the lesion as intentional cranial intervention. In order to bring spotlight to the wide range of cranial interventions in the early medieval Carpathian Basin, our team is conducting several research projects, in order to contribute to a better understanding of these traditions in the future.

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Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection

Cited by 26 publications

References 71 publications

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

Tracking down the White Plague. Chapter two: The role of endocranial abnormal blood vessel impressions and periosteal appositions in the paleopathological diagnosis of tuberculous meningitis

Insights into the diagnostic efficacy and macroscopic appearance of endocranial bony changes indicative of tuberculous meningitis: Three example cases from the Robert J. Terry Anatomical Skeletal Collection

New insights in the investigation of trepanations from the Carpathian Basin

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