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

Abstract

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.

Tracking down the White Plague. Chapter three: Revision of endocranial abnormally pronounced digital impressions as paleopathological diagnostic criteria for tuberculous meningitis

“…Similar to the results of our two previously published studies that were also performed on skeletons from the Terry Collection [ 23 , 24 ], the findings of our current paper may draw physicians’ attention to the rather high prevalence of meningeal involvement in TB patients. Although the vast majority of individuals from the TB group were recorded to have died of pulmonary TB ( S1 Table ), more than two-thirds of them exhibited at least one out of the four examined endocranial alteration types probably related to TBM–about one-third of them displayed GIs that can be considered as specific signs of the disease [ 23 ].…”

“…These individuals were divided into two main groups on the basis of their causes of death. The TB group was composed of 234 individuals identified to have died of TB (169 males and 65 females), with age at death ranging from 16 to 81 years ( S1 Table ) [ 23 , 24 ]; whereas the control or non-TB (NTB) group consisted of 193 individuals recorded to have died of causes other than TB (106 males and 87 females), with age at death ranging from 20 to 90 years ( S2 Table ) [ 23 , 24 ].…”

“…In the second evaluation round, individuals showing APDIs on the endocranial surface were compared to the three reference cases and further classified based on the prominence of APDIs (i.e., very slight, slight or pronounced) ( Table 1 ). During the macromorphological assessment of the 427 selected skeletons, the co-occurrence of APDIs with other pathological bony changes likely related to different forms of TB (e.g., pulmonary TB/TB pleurisy [e.g., 4 – 8 , 18 , 19 , 51 – 54 ], skeletal TB [e.g., 9 , 10 , 19 , 20 , 56 – 59 ], and TBM [e.g., 12 – 15 , 19 , 21 , 23 , 24 ]) was also recorded ( Table 2 ).…”

“…What would be more helpful would be to identify further macromorphological diagnostic criteria for TB to provide a more relevant disease frequency in past human populations. To contribute to the establishment of a more reliable and accurate paleopathological diagnosis of TB, numerous studies [e.g., 4 – 24 ] were performed on osteoarchaeological series and documented skeletal collections since the 1980s. As a result of these investigations, a positive association between TB and several pathological bony changes, including endocranial abnormally pronounced digital impressions (APDIs), has been recognized.…”

Lipid biomarker-based verification of TB infection in mother’s and daughter’s mummified human remains (Vác Mummy Collection, 18th century, CE, Hungary)

“…2A), and abnormal blood vessel impressions (Fig. 2B) (Schultz 1993(Schultz , 1999(Schultz , 2001(Schultz , 2003Aufderheide and Rodríguez-Martín 1998;Marcsik et al, 1999;Pálfi and Marcsik 1999;Hershkovitz et al 2002;Maczel 2003;Ortner 2003;Pálfi and Molnár 2009;Pálfi et al 2012Pálfi et al , 2015Spekker et al 2012;Kajdocsi Lovász 2015;Masson et al 2015;Molnár et al 2015;Paja et al 2015;Schultz and Schmidt-Schultz 2015;Spekker 2018;Spekker et al 2020aSpekker et al , 2020b. Moreover, new bone formation on the long bones and on the visceral surface of ribs are used as TB-related markers (Roberts et al 1994;Marcsik et al 2009;Roberts 2001, 2006;Hershkovitz et al 2002;Maczel 2003;Matos and Santos 2006;Pálfi and Molnár 2009;Pálfi et al 2012Pálfi et al , 2015Kajdocsi Lovász 2015;Masson et al 2015;Molnár et al 2015).…”