Chagas' disease in Peruvian Inca mummy

Advances in paleopathology in context: A focus on soft tissue paleopathology

Skeletal and mummified remains from South America have had a significant impact on the progress of paleopathological research. In 1997, John Verano synthesized the state of paleopathological research, identifying trends and highlighting future potentials. The goal of this contribution is to consider Verano's observations on advances in soft tissue paleopathology within the context of the development of the field of mummy studies. As his article was published near the midpoint between the present and the early 1970s, when the modern form of mummy studies began to form, considering his observations in this context allows researchers the opportunity to consider how the field has progressed since the late 1990s.

An introduction to advances in Andean South American paleopathology

In the 20 years since the publication of John Verano's foundational paper "Advances in Paleopathology of Andean South America," paleopathological and bioarchaeological investigations of human skeletal remains in the region have increased dramatically. Today, primary foci have grown to span the identification of disease, detailed reconstructions of biocultural interactions, embodied social experiences, and ancient living worlds. In this special issue, more than a dozen scholars reflect on the state of developments in the scientific analyses of ancient disease, life, and society across the region. For this introductory article, we frame the current state of Andean paleopathology by reviewing key historical contributions beginning in the last century. More recent trends since 1997 are defined via a meta-analysis of the literature. We then highlight current innovations and consider future directions of study. We then close with an overview of the papers comprising this special issue. Each article explores major theoretical, topical, and methodological advances that have transpired since 1997 and charts the course for the next two decades of work - with implications and insights that transcend the Andes and speak to key paleopathological issues around the world.

Chagas disease in Italy: the study's contribution of Italian researchers

Chagas disease (CD) is an emerging infection in Italy as the consequence of the huge immigration from Latin American countries observed during the last ten-fifteen years. However, the interest of Italian researchers on CD dates back to the '80-90s of the last century with studies conducted in collaboration with Brazilian and Argentinian colleagues by Italian cardiologists and pathologists. Moreover, the first demonstration of the existence in the pre-Columbian America of Chagas disease in a Peruvian mummy was made by a group of Italian paleopathologists. Seroprevalence studies performed between 2010-2014 in Negrar (Verona), Bergamo, Milan, Florence and Rome shows Trypanosoma cruzi infection ranging from 3.9% to 17.1% with people coming from Bolivia as the most affected. As observed in Latin America about 30% of screened subjects in Italy are affected by cardiac or digestive forms of CD. More than 20% of subjects treated with benznidazole discontinued it permanently due to adverse events.

Gut Microbiome and Putative Resistome of Inca and Italian Nobility Mummies

Little is still known about the microbiome resulting from the process of mummification of the human gut. In the present study, the gut microbiota, genes associated with metabolism, and putative resistome of Inca and Italian nobility mummies were characterized by using high-throughput sequencing. The Italian nobility mummies exhibited a higher bacterial diversity as compared to the Inca mummies when using 16S ribosomal (rRNA) gene amplicon sequencing, but both groups showed bacterial and fungal taxa when using shotgun metagenomic sequencing that may resemble both the thanatomicrobiome and extant human gut microbiomes. Identification of sequences associated with plants, animals, and carbohydrate-active enzymes (CAZymes) may provide further insights into the dietary habits of Inca and Italian nobility mummies. Putative antibiotic-resistance genes in the Inca and Italian nobility mummies support a human gut resistome prior to the antibiotic therapy era. The higher proportion of putative antibiotic-resistance genes in the Inca compared to Italian nobility mummies may support the hypotheses that a greater exposure to the environment may result in a greater acquisition of antibiotic-resistance genes. The present study adds knowledge of the microbiome resulting from the process of mummification of the human gut, insights of ancient dietary habits, and the preserved putative human gut resistome prior the antibiotic therapy era.

Evidence of neurofibromatosis type 1 in a multi-morbid Inca child mummy: A paleoradiological investigation using computed tomography

Objective

In this study, an Inca bundle was examined using computed tomography (CT). The primary aim was to determine the preservation status of bony and soft tissues, the sex, the age at the time of death, possible indicators for disease or even the cause of death, as well as the kind of mummification. A secondary aim was to obtain a brief overview of the wrapping in order to gain additional information on the cultural background.

Materials and methods

The bundle belongs to the Museum of Cultures in Basel, Switzerland, and was bought in Munich, Germany, in 1921. Radiocarbon dating of the superficial textile yielded a calibrated age between 1480 and 1650 AD. The mummy was investigated using multi-slice CT with slice thickness of 0.75 mm and 110 kilovolt. For standardized assessment of soft tissue preservation, a recently developed checklist was applied.

Results

CT revealed the mummy of a seven to nine year old boy with superior preservation of bony and soft tissues allowing detailed assessment. Indicators of neurofibromatosis type 1 (paravertebral and cutaneous neurofibromas, a breast neurofibroma, sphenoid wing dysplasia), Chagas disease (dilatation of the esophagus, stomach, rectum, and large amounts of feces), and lung infection (pleural adherence, calcifications), probably due to tuberculosis, were found. Furthermore, signs of peri-mortem violence (transection of the chest and a defect in the abdominal wall) were detected. CT images revealed a carefully performed wrapping.

Conclusion

CT examination of the Inca bundle proved to be an important non-destructive examination method. Standardized assessment, especially of the soft tissue structures, allowed for diagnoses of several diseases, indicating a multi-morbid child at the time of death. The careful wrapping pointed to a ceremonial burial. Within the cultural background, the signs of fatal violence were discussed as a possible result of war, murder, accident, or human sacrifice.

The Paleoparasitology in Brazil and Findings in Human Remains from South America: A Review

The review article presents some of the history of how paleoparasitology started in Brazil, making highlight the great responsible Dr. Luiz Fernando Ferreira and Dr. Adauto Araújo, the trajectory of paleoparasitology in Brazil since 1978 and its performance in science to the present day. In sequence, it is made a presentation of parasitological findings on human remains found in archaeological sites in South America, highlighting Brazil, Argentina, Chile, and Peru, where major discoveries have occurred. Many of the parasites found in archaeological material and mentioned in this review went out of Africa with the peopling of Europe and from there they dispersed around the world, where climatic conditions allow the transmission. However, humans have acquired other parasites of animals, since humans invaded new habitats or creating new habits adopting new technologies, thus expanding its range of influence on the environment. Thus, this review article is finalized with information that explain the importance of these findings in the interaction between parasites, human host, and ambient.

Assessing the Archaeoparasitological Potential of Quids As a Source Material for Immunodiagnostic Analyses

In the present study, quids from La Cueva de los Muertos Chiquitos (CMC) were subjected to ELISA tests for 2 protozoan parasites, Toxoplasma gondii (n=45) and Trypanosoma cruzi (n=43). The people who occupied CMC, the Loma San Gabriel, lived throughout much of present-day Durango and Zacatecas in Mexico. The known pathoecology of these people puts them into at-risk categories for the transmission of T. gondii and T. cruzi. Human antibodies created in response to these 2 parasites can be detected in modern saliva using ELISA kits intended for use with human serum. For these reasons, quids were reconstituted and subjected to ELISA testing. All test wells yielded negative results. These results could be a factor of improper methods because there is no precedence for this work in the existing literature. The results could equally be a simple matter of parasite absence among those people who occupied CMC. A final consideration is the taphonomy of human antibodies and whether or not ELISA is a sufficient method for recovering antibodies from archaeological contexts. An additional ELISA test targeting secretory IgA (sIgA) was conducted to further examine the failure to detect parasite-induced antibodies from quids. Herein, the methods used for quid preparation and ELISA procedures are described so that they can be further developed by future researchers. The results are discussed in light of the potential future of quid analysis.

Paleopathology of cardiovascular diseases in South American mummies

BACKGROUND

Cardiovascular disease has emerged as the world's leading cause of death in the last century. An epidemiological focus of this disease that extends not only beyond the developed world but also far back into antiquity asks new questions about associated risk factors. Ancient mummies found in the Atacama desert are well preserved and show signs of cardiovascular disease as early as 1000B.C. in Peru and Chile.

METHOD AND RESULTS

Gross and histopathological examination of specimens shows atherosclerosis, cardiomegaly, endocarditis, and myocardial fibrosis.

CONCLUSION

In comparison to other ancient populations, less atherosclerosis has been noted in South American mummies. The chewing of coca leaves, a habitual cultural practice unique to the region, supports evidence of reduced cardiovascular risk among ancient people living in South America.

Gut Microbiome of an 11th Century A.D. Pre-Columbian Andean Mummy

The process of natural mummification is a rare and unique process from which little is known about the resulting microbial community structure. In the present study, we characterized the microbiome of paleofeces, and ascending, transverse and descending colon of an 11^th century A.D. pre-Columbian Andean mummy by 16S rRNA gene high-throughput sequencing and metagenomics. Firmicutes were the most abundant bacterial group, with Clostridium spp. comprising up to 96.2% of the mummified gut, while Turicibacter spp. represented 89.2% of the bacteria identified in the paleofeces. Microbiome profile of the paleofeces was unique when compared to previously characterized coprolites that did not undergo natural mummification. We identified DNA sequences homologous to Clostridium botulinum, Trypanosoma cruzi and human papillomaviruses (HPVs). Unexpectedly, putative antibiotic-resistance genes including beta-lactamases, penicillin-binding proteins, resistance to fosfomycin, chloramphenicol, aminoglycosides, macrolides, sulfa, quinolones, tetracycline and vancomycin, and multi-drug transporters, were also identified. The presence of putative antibiotic-resistance genes suggests that resistance may not necessarily be associated with a selective pressure of antibiotics or contact with European cultures. Identification of pathogens and antibiotic-resistance genes in ancient human specimens will aid in the understanding of the evolution of pathogens as a way to treat and prevent diseases caused by bacteria, microbial eukaryotes and viruses.

Palaeoparasitology - Human Parasites in Ancient Material

Parasite finds in ancient material launched a new field of science: palaeoparasitology. Ever since the pioneering studies, parasites were identified in archaeological and palaeontological remains, some preserved for millions of years by fossilization. However, the palaeoparasitological record consists mainly of parasites found specifically in human archaeological material, preserved in ancient occupation sites, from prehistory until closer to 2015. The results include some helminth intestinal parasites still commonly found in 2015, such as Ascaris lumbricoides, Trichuris trichiura and hookworms, besides others such as Amoebidae and Giardia intestinalis, as well as viruses, bacteria, fungi and arthropods. These parasites as a whole provide important data on health, diet, climate and living conditions among ancient populations. This chapter describes the principal findings and their importance for knowledge on the origin and dispersal of infectious diseases.

Studies on protozoa in ancient remains--a review

Paleoparasitological research has made important contributions to the understanding of parasite evolution and ecology. Although parasitic protozoa exhibit a worldwide distribution, recovering these organisms from an archaeological context is still exceptional and relies on the availability and distribution of evidence, the ecology of infectious diseases and adequate detection techniques. Here, we present a review of the findings related to protozoa in ancient remains, with an emphasis on their geographical distribution in the past and the methodologies used for their retrieval. The development of more sensitive detection methods has increased the number of identified parasitic species, promising interesting insights from research in the future.

Chagas disease in prehistory

The classical hypothesis proposes that Chagas disease has been originated in the Andean region among prehistoric people when they started domesticating animals, changing to sedentary habits, and adopting agriculture. These changes in their way of life happened nearly 6,000 years ago. However, paleoparasitological data based on molecular tools showed that Trypanosoma cruzi infection and Chagas disease were commonly found both in South and North American prehistoric populations long before that time, suggesting that Chagas disease may be as old as the human presence in the American continent. The study of the origin and dispersion of Trypanosoma cruzi infection among prehistoric human populations may help in the comprehension of the clinical and epidemiological questions on Chagas disease that still remain unanswered.

[Chagas disease in the Americas: an ecohealth perspective]

The historical processes involved in Chagas disease transmission relate to the patterns and conditions of human settlements, especially in rural areas, due to proximity to forest areas, where both vectors and Trypanosoma cruzi can occur, combined with precarious housing conditions and underlying poverty. However, seasonal and permanent rural-urban migration has played a major role in re-mobilizing vectors, T. cruzi, and Chagas-infected individuals. A new agricultural frontier in the Amazon has led to a new transmission pattern, especially with palm trees located close to houses. Improved blood bank surveillance has decreased transmission by blood transfusions. International migration also plays a role in Chagas disease epidemiology. The United States and Spain, where specific health services for Chagas disease diagnosis and treatment are largely absent, harbor an unknown number of individuals with Chagas, probably infected decades ago. The article discusses major strides in Chagas disease knowledge and control, besides identifying persistent gaps, such as the need for housing improvements, especially in poor rural areas in the Americas.

Environment, interactions between Trypanosoma cruzi and its host, and health

An epidemiological chain involving Trypanosoma cruzi is discussed at the environmental level, and in terms of fine molecular interactions in invertebrate and vertebrate hosts dwelling in different ecosystems. This protozoan has a complex, genetically controlled plasticity, which confers adaptation to approximately 40 blood-sucking triatomine species and to over 1,000 mammalian species, fulfilling diverse metabolic requirements in its complex life-cycle. The Tr. cruzi infections are deeply embedded in countless ecotypes, where they are difficult to defeat using the control methods that are currently available. Many more field and laboratory studies are required to obtain data and information that may be used for the control and prevention of Tr. cruzi infections and their various disease manifestations. Emphasis should be placed on those sensitive interactions at cellular and environmental levels that could become selected targets for disease prevention. In the short term, new technologies for social mobilization should be used by people and organizations working for justice and equality through health information and promotion. A mass media directed program could deliver education, information and communication to protect the inhabitants at risk of contracting Tr. cruzi infections.

Mummies

Mummies are human remains with preservation of nonbony tissue. Mummification by natural influences results in so-called natural mummies, whereas mummification induced by active (human) intervention results in so-called artificial mummies, although many cultures practiced burial rites, which to some degree involved both natural and artificial mummification. Since they are so uniquely well-preserved, mummies may give many insights into mortuary practices and burial rites. Specifically, the presence of soft tissues may expand the scope of paleopathological studies. Many recent mummy studies focus on the development and application of nondestructive methods for examining mummies, including radiography, CT-scanning with advanced three-dimensional visualizations, and endoscopic techniques, as well as minimally-destructive chemical, physical, and biological methods for, e.g., stable isotopes, trace metals, and DNA. This article discusses mummification and gives a presentation of various key mummy finds and a brief history of mummy studies. A description of the extant key technologies of natural and medical science that are applied in mummy studies is given; along with a discussion of some of the major results in terms of paleopathology. It is also shown how mummy studies have contributed much to the knowledge of the cultural habits and everyday life of past populations. Finally the impact of mummy studies on analyses of mortuary practices and cultural history is discussed.

Evolution and pathology in chagas disease--a review

Trypanosoma cruzi acute infections often go unperceived, but one third of chronically infected individuals die of Chagas disease, showing diverse manifestations affecting the heart, intestines, and nervous systems. A common denominator of pathology in Chagas disease is the minimal rejection unit, whereby parasite-free target host cells are destroyed by immune system mononuclear effectors cells infiltrates. Another key feature stemming from T. cruzi infection is the integration of kDNA minicircles into the vertebrate host genome; horizontal transfer of the parasite DNA can undergo vertical transmission to the progeny of mammals and birds. kDNA integration-induced mutations can enter multiple loci in diverse chromosomes, generating new genes, pseudo genes and knock-outs, and resulting in genomic shuffling and remodeling over time. As a result of the juxtaposition of kDNA insertions with host open reading frames, novel chimeric products may be generated. Germ line transmission of kDNA-mutations determined the appearance of lesions in birds that are indistinguishable from those seen in Chagas disease patients. The production of tissue lesions showing typical minimal rejection units in birds' refractory to T. cruzi infection is consistent with the hypothesis that autoimmunity, likely triggered by integration-induced phenotypic alterations, plays a major role in the pathogenesis of Chagas disease.

Trypanosoma cruzi: experimental parasitism of bone and cartilage

Trypanosoma cruzi causes Chagas' disease, a systemic infection that affects cells of meso-, endo-, and ectodermic origin. However, as far as we know, the presence of T. cruzi stages in bone has not been reported previously, and it has scarcely been investigated in cartilage. We inoculated 7- and 20-day-old (8 and 15 g) NMRI albino mice i.p. with metacyclic trypomastigotes from Rhodnius prolixus used for xenodiagnosis of mice previously infected with mammalian, human, and triatomines isolates, characterized by randomly amplified polymorphic DNA as zymodeme 1 (equivalent to T. cruzi I). Tissular parasitism (quantified according to the number of pseudocysts/50 fields 400x) showed amastigotes, intermediate forms, or trypomastigotes in sternum chondroblasts, osteoblasts, macrophages, and fibroblasts; chondrocyte and osteocyte invasion was rare. All isolates parasitized bone marrow macrophages, with few amastigotes. We observed marked associated myotropism, with or without inflammatory infiltration; there were small numbers of intensely parasitized mononuclear cells in perichondrium and periosteum. We discuss the results in relation to the marked differences of the T. cruzi tropism toward the different types of sternum cells, and, additionally, we outline the possibility of transmitting parasitized bone marrow through transplants. The fact of finding parasite stages in sternum bone and cartilage may be considered important due to the studies on Chagas' disease paleoparasitology that are based on histological and molecular analysis.

Molecular characterization of a pre-Columbian mummy and in situ coprolite

The history of Homo sapiens dispersal around the world and inherent interpopulation contacts and conflicts has given rise to several transitions in his relationships with the natural world, with the final result of changes in the patterns of infectious disease (McMichael [2001] Ecosystem Health 7:107-115). Of particular interest, in this context, is the contact between Amerindians and Europeans that started at the end of the 15th century, and the resulting exchange of microbes. We successfully recovered ancient DNA from a pre-Columbian mummy from Cuzco (Peru), radiocarbon-dated to 980-1170 AD, for which consistent mtDNA amplifications and sequences were obtained. The analysis of mtDNA revealed that the mummy's haplogroup was characteristic of Native American populations. We also investigated a sample of feces directly isolated from the intestines of the mummy, using a polymerase chain reaction system designed to detect the broadest spectrum of bacterial DNAs. The analysis of results, following a criterion of "paleoecological consistency" (Rollo and Marota [1998] Philos. Trans. R. Soc. Lond. [Biol.] 354: 111-119), demonstrated that some vestiges of the original microbial flora of the feces were preserved. In particular, we were able to identify the DNA of Haemophylus parainfluenzae, thus suggesting that this recently recognized pathogen was present in precontact Native Americans.

Paleodermatoses: lessons learned from mummies

Mummies, the preserved remains of living beings from former times, bear witness across millennia to the maladies plaguing humankind. Disease, older than humanity, is better understood when examined in the context of history. Paleopathology, literally meaning "ancient suffering", is the study of disease through evaluation of ancient remains. This area of increasing medical interest offers insights into the management of public health issues and disease epidemiology. This article provides an introduction and overview to paleodermatology, the branch of dermatology concerned with the evaluation of diseases associated with the integument by examination of ancient human remains. Mummy sources, how they were made and used throughout history, and the multidisciplinary approach used to study skin diseases found in mummies is briefly described. Despite pervasive pseudopathology, a remarkable array of diseases are well substantiated in the paleorecord, including infectious, heritable, nutritional, hormonal, acquired, iatrogenic, and neoplastic disorders. Legitimate ethical concerns have been raised in the use of human remains for any purpose, with the lack of informed consent eliciting accusations of exploitation. While these studies are undertaken with certain risks, such as the acquisition of potentially dangerous or extinct infections, paleodermatology offers a unique and historical perspective on the afflictions of the skin and the way of all flesh.

Parasitism, the diversity of life, and paleoparasitology

The parasite-host-environment system is dynamic, with several points of equilibrium. This makes it difficult to trace the thresholds between benefit and damage, and therefore, the definitions of commensalism, mutualism, and symbiosis become worthless. Therefore, the same concept of parasitism may encompass commensalism, mutualism, and symbiosis. Parasitism is essential for life. Life emerged as a consequence of parasitism at the molecular level, and intracellular parasitism created evolutive events that allowed species to diversify. An ecological and evolutive approach to the study of parasitism is presented here. Studies of the origin and evolution of parasitism have new perspectives with the development of molecular paleoparasitology, by which ancient parasite and host genomes can be recovered from disappeared populations. Molecular paleoparasitology points to host-parasite co-evolutive mechanisms of evolution traceable through genome retrospective studies.

History of human parasitology

Humans are hosts to nearly 300 species of parasitic worms and over 70 species of protozoa, some derived from our primate ancestors and some acquired from the animals we have domesticated or come in contact with during our relatively short history on Earth. Our knowledge of parasitic infections extends into antiquity, and descriptions of parasites and parasitic infections are found in the earliest writings and have been confirmed by the finding of parasites in archaeological material. The systematic study of parasites began with the rejection of the theory of spontaneous generation and the promulgation of the germ theory. Thereafter, the history of human parasitology proceeded along two lines, the discovery of a parasite and its subsequent association with disease and the recognition of a disease and the subsequent discovery that it was caused by a parasite. This review is concerned with the major helminth and protozoan infections of humans: ascariasis, trichinosis, strongyloidiasis, dracunculiasis, lymphatic filariasis, loasis, onchocerciasis, schistosomiasis, cestodiasis, paragonimiasis, clonorchiasis, opisthorchiasis, amoebiasis, giardiasis, African trypanosomiasis, South American trypanosomiasis, leishmaniasis, malaria, toxoplasmosis, cryptosporidiosis, cyclosporiasis, and microsporidiosis.

Paleo-parasitology and the antiquity of human host-parasite relationships

Paleo-parasitology may be developed as a new tool to parasite evolution studies. DNA sequences dated thousand years ago, recovered from archaeological material, means the possibility to study parasite-host relationship coevolution through time. Together with tracing parasite-host dispersion throughout the continents, paleo-parasitology points to the interesting field of evolution at the molecular level. In this paper a brief history of paleo-parasitology is traced, pointing to the new perspectives opened by the recent techniques introduced.

Chagas disease and human migration

Human Chagas disease is a purely accidental occurrence. As humans came into contact with the natural foci of infection might then have become infected as a single addition to the already extensive host range of Trypanosoma cruzi that includes other primates. Thus began a process of adaptation and domiciliation to human habitations through which the vectors had direct access to abundant food as well as protection from climatic changes and predators. Our work deals with the extraction and specific amplification by polymerase chain reaction of T. cruzi DNA obtained from mummified human tissues and the positive diagnosis of Chagas disease in a series of 4, 000-year-old Pre-Hispanic human mummies from the northern coast of Chile. The area has been inhabited at least for 7,000 years, first by hunters, fishers and gatherers, and then gradually by more permanent settlements. The studied specimens belonged to the Chinchorro culture, a people inhabiting the area now occupied by the modern city of Arica. These were essentially fishers with a complex religious ideology, which accounts for the preservation of their dead in the way of mummified bodies, further enhanced by the extremely dry conditions of the desert. Chinchorro mummies are, perhaps, the oldest preserved bodies known to date.

Paleoparasitology of Chagas disease revaled by infected tissues from Chilean mummies

Mummified tissues were sampled from bodies stored at the Museo Arqueologico de San Pedro de Atacama, northern Chile, dated from 2000 years BP-1400 AD, and Trypanosoma cruzi DNA was recovered using polymerase chain reaction (PCR) methodology. Amplification of the conserved region of the minicircle molecule of T. cruzi was achieved in four of the six samples tested. Amplified products corresponding to genetic fragments of the parasite were tested by hybridization experiments with positive results for T. cruzi specific molecular probe. The origin and dispersion of T. cruzi human infection is discussed as well as the molecular paleoparasitological approach, and what it may represent in an evolutionary perspective.

Isolation of Trypanosoma cruzi DNA in 4,000-year-old mummified human tissue from northern Chile

A segment of DNA unique to the kinetoplast of Trypanosoma cruzi was isolated from spontaneously mummified human remains from the coastal area of northern Chile at sites dated from 2000 BC to about AD 1400. Following rehydration of the desiccated human tissue samples of heart, esophagus, or colon, the samples were extracted and primers employed to bind to a 330 bp kinetoplast minicircle DNA sequence present in T. cruzi. This segment was then amplified using the polymerase chain reaction (PCR), and the target segment was visualized by gel electrophoresis. This method enables the identification of Chagas' disease in an ancient body in the absence of recognizable anatomic pathological changes.

Paleoparasitology: perspectives with new techniques

Paleoparasitology is the study of parasites found in archaeological material. The development of this field of research began with histological identification of helminth eggs in mummy tissues, analysis of coprolites, and recently through molecular biology. An approach to the history of paleoparasitology is reviewed in this paper, with special reference to the studies of ancient DNA identified in archaeological material.