Treponematosis and anthropology

The Depiction of Smallpox and Other Dermatologic Lesions on the Surfaces of Ancient Terracotta Statues from Mali, West Africa

Between 1100 A.D. and 1700 A.D., terracotta statues were created in the Interior Delta of the Niger River in what is now the Republic of Mali. They are known as Djenné-Jeno terracottas because of their geographic proximity to an ancient town of that name. Some of these statues possess surface excrescences that have long perplexed archaeologists, art historians, curators, and others. This study of these surface excrescences employed clinical, diagnostic, and epidemiological methodologies to elucidate their possible meanings. It has not been possible to ascribe these excrescences to a single cause. However, examination of all the evidence permitted consideration of several possibilities. These include diseases such as smallpox, onchocerciasis, and the secondary stage of venereal syphilis. On certain statues, the anatomic placement of excrescences possibly symbolizes intentional cicatrization that resulted in keloid formation which may have been a form of beautification.

Syphilis in an Italian medieval jewish community: A bioarchaeological and cultural perspective

OBJECTIVES

We aim to discuss the presence of treponemal infections in three individuals belonging to a large (∼400 individuals) Late Medieval cemetery (14th -16th century) that archaeological and documentary sources place within a Jewish context, and to discuss the role of these diseases in a biocultural perspective.

MATERIALS AND METHODS

An anthropological and paleopathological study was conducted on skeletal remains of three individuals, though macroscopic and tomographic examination.

RESULTS

Cranial lesions in which simultaneous destructive and proliferative processes (caries sicca) are noted. Long bones also present osseous alterations with increased bone density and non-uniform thickening.

CONCLUSIONS

Skeletal lesions are consistent with treponemal infections (possibly either endemic or acquired syphilis). Historical documentation could help the interpretation of our cases, recording a syphilis outbreak in Bologna in 1496, possibly coeval to the Late Medieval Jewish cemetery.

SIGNIFICANCE

These cases of treponematosis are unique, documenting the presence of the disease within the Jewish Medieval community in Italy, as they frame the effects and consequence of the infection in shaping social and cultural contexts of the medieval Italian and European communities. They offer material evidence to elaborate on the historical documents on the hostility Jewish community suffered.

LIMITATIONS

Radiocarbon dating have not been performed directly on skeletal remains of the three pathological individuals. δ¹³C and δ¹⁵N isotope ratios should also be acquired to estimate the marine diet component, to account for possible marine reservoir effect on radiocarbon age calibration.

Epidemic of venereal treponematosis in wild monkeys: a paradigm for syphilis origin

Treponema pallidum infections have been primarily known as slightly contagious mucocutaneous infections called yaws (tropical Africa and America) and bejel (subtropical North Africa). T. pallidum emerged as a highly infectious venereal syphilis agent in South America, probably about 500 years ago, and because of its venereal transmission, it quickly caused a worldwide pandemic. The disease manifests as lesions, including a chancre; then antibodies become detectable when or slightly after the chancre appears, and before the development of a rash and other systemic manifestations. Venereal diseases are poorly known in monkeys. During fieldwork in Senegal, we discovered an epizootic outbreak of venereal disease that we explored. We detected a venereal form of T. pallidum subsp. pertenue infection in green monkeys (Chlorocebus sabaeus), then observed an epizootic outbreak in Senegal and its spread among baboons a year later. Comparative analysis of T. pallidum genomes from the monkeys' chancres and other Treponema genomes showed an acceleration of the number of single nucleotide polymorphisms, comparable to that observed in syphilis. Identified T. pallidum clones seem to be epizootic through the acceleration of their mutation rate, which is linked to their larger diffusion.

Presence of dental signs of congenital syphilis in pre-modern specimens

OBJECTIVE

Tooth morphology can vary due to genetic factors, infectious diseases and other environmental stresses. Congenital syphilis is known to interrupt tooth formation i.e. odontogenesis and amelogenesis, producing specific dental characteristics. Variation of those characteristics can occur, resulting in dental signs "not typical" of the disease, however, they are described in the 19th century literature. Past treatments of congenital syphilis with mercury also interrupted dental processes resulting in significantly different dental signs. The aim of this study is to examine the dentition of the oldest (pre 15th century) cases attributed to congenital syphilis to determine whether their dental processes have been affected by either congenital syphilis itself, its treatments (mercury) or a combination of both (syphilitic-mercurial).

DESIGN

Comparisons of dental signs of congenital syphilis and its mercuric treatments as described by Hutchinson, Moon and Fournier in the 1800s and in standardised methods as established by modern studies, are made with the dentition of specimens found in archaeological sites in Mexico, Italy, Turkey and Austria dating back to the Terminal Formative Period, Classical Antiquity, Byzantine times and Middle Ages.

RESULTS

The dentitions of a child from Oaxaca, Mexico, St. Pölten, Austria, and two juveniles from Classical Antiquity site Metaponto, Italy, show signs attributed to syphilis only. One adolescent from Byzantine site Nicaea, Turkey, shows dental signs characterised as syphilitic-mercurial.

CONCLUSIONS

Dental abnormalities observed in Mediterranean individuals match a range of signs attributable to congenital syphilis and its treatments, more so than the New World case. Therefore, it is likely that these individuals suffered from congenital syphilis.

Who acquires infection from whom and how? Disentangling multi-host and multi-mode transmission dynamics in the 'elimination' era

Multi-host infectious agents challenge our abilities to understand, predict and manage disease dynamics. Within this, many infectious agents are also able to use, simultaneously or sequentially, multiple modes of transmission. Furthermore, the relative importance of different host species and modes can itself be dynamic, with potential for switches and shifts in host range and/or transmission mode in response to changing selective pressures, such as those imposed by disease control interventions. The epidemiology of such multi-host, multi-mode infectious agents thereby can involve a multi-faceted community of definitive and intermediate/secondary hosts or vectors, often together with infectious stages in the environment, all of which may represent potential targets, as well as specific challenges, particularly where disease elimination is proposed. Here, we explore, focusing on examples from both human and animal pathogen systems, why and how we should aim to disentangle and quantify the relative importance of multi-host multi-mode infectious agent transmission dynamics under contrasting conditions, and ultimately, how this can be used to help achieve efficient and effective disease control.This article is part of the themed issue 'Opening the black box: re-examining the ecology and evolution of parasite transmission'.

The endemic treponematoses

The agents of human treponematoses include four closely related members of the genus Treponema: three subspecies of Treponema pallidum plus Treponema carateum. T. pallidum subsp. pallidum causes venereal syphilis, while T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively. All human treponematoses share remarkable similarities in pathogenesis and clinical manifestations, consistent with the high genetic and antigenic relatedness of their etiological agents. Distinctive features have been identified in terms of age of acquisition, most common mode of transmission, and capacity for invasion of the central nervous system and fetus, although the accuracy of these purported differences is debated among investigators and no biological basis for these differences has been identified to date. In 2012, the World Health Organization (WHO) officially set a goal for yaws eradication by 2020. This challenging but potentially feasible endeavor is favored by the adoption of oral azithromycin for mass treatment and the currently focused distribution of yaws and endemic treponematoses and has revived global interest in these fascinating diseases and their causative agents.

On the origin of the treponematoses: a phylogenetic approach

Background

Since the first recorded epidemic of syphilis in 1495, controversy has surrounded the origins of the bacterium Treponema pallidum subsp. pallidum and its relationship to the pathogens responsible for the other treponemal diseases: yaws, endemic syphilis, and pinta. Some researchers have argued that the syphilis-causing bacterium, or its progenitor, was brought from the New World to Europe by Christopher Columbus and his men, while others maintain that the treponematoses, including syphilis, have a much longer history on the European continent.

Methodology/Principal Findings

We applied phylogenetics to this problem, using data from 21 genetic regions examined in 26 geographically disparate strains of pathogenic Treponema. Of all the strains examined, the venereal syphilis-causing strains originated most recently and were more closely related to yaws-causing strains from South America than to other non-venereal strains. Old World yaws-causing strains occupied a basal position on the tree, indicating that they arose first in human history, and a simian strain of T. pallidum was found to be indistinguishable from them.

Conclusions/Significance

Our results lend support to the Columbian theory of syphilis's origin while suggesting that the non-sexually transmitted subspecies arose earlier in the Old World. This study represents the first attempt to address the problem of the origin of syphilis using molecular genetics, as well as the first source of information regarding the genetic make-up of non-venereal strains from the Western hemisphere.

For 500 years, controversy has raged around the origin of T. pallidum subsp. pallidum, the bacterium responsible for syphilis. Did Christopher Columbus and his men introduce this pathogen into Renaissance Europe, after contracting it during their voyage to the New World? Or does syphilis have a much older history in the Old World? This paper represents the first attempt to use a phylogenetic approach to solve this question. In addition, it clarifies the evolutionary relationships between the pathogen that causes syphilis and the other T. pallidum subspecies, which cause the neglected tropical diseases yaws and endemic syphilis. Using a collection of pathogenic Treponema strains that is unprecedented in size, we show that yaws appears to be an ancient infection in humans while venereal syphilis arose relatively recently in human history. In addition, the closest relatives of syphilis-causing strains identified in this study were found in South America, providing support for the Columbian theory of syphilis's origin.

Histological identification of syphilis in pre-Columbian England

Microscopic analyses served to complement the macroscopic identification of venereal syphilis in two of four pre-Columbian skeletons from the site Hull Magistrates Court in England. Diagnosis was based on parameters presented by Schultz ([1994] Origin of Syphilis in Europe, Toulon: Centre Archaeologique du Var, p. 63-67; [2001] Yrbk. Phys. Anthropol. 44:106-147; [2003] Identification of Pathological Conditions in Human Remains, New York: Academic Press, p. 73-109), which characterized venereal syphilis at a histological level. Observation of the microarchitecture of these samples allowed a more comprehensive approach to identification of the disease (processes). In most samples, Polsters and Grenzstreifen (or remnants of such structures) could be identified, suggesting the presence of a chronic, inflammatory disease such as venereal syphilis. Sinous lacunae were also observed in all histological samples, pointing to lytic activity (osteitis). The combination of both proliferative and destructive processes is pathognomonic for syphilis, and histological analyses provided a more accurate diagnosis of this infectious disease in these four individuals. As a result, the histological evidence suggests that venereal syphilis was present in England prior to 1492. This secondary form of evidence supports the macroscopic identification of the disease, and shows the power of a multimethodological approach to paleopathological diagnoses.

Regional, social, and evolutionary perspectives on treponemal infection in the Southeastern United States

The origin and geographic distribution of syphilis, a form of treponemal infection, have long been regarded as among the most important medical riddles of prehistoric and historic disease evolution. In this study, we expand on previous discussions of the origin, evolution, and relationship of treponemal infections as they occur in the prehistoric southeastern United States. Individuals from 25 skeletal series (n = 2,410 individuals) were examined for cranial and dental lesions characteristic of treponemal infection. They lived between the Archaic period (8000-1000 BC) and protohistoric period (AD 1500-1600), and in physiographic zones from the coast to the mountains of Alabama, Florida, North Carolina, and Tennessee. Radial cranial scars were found for 47 individuals, but none of the four cases of dental lesions could be attributed to congenital syphilis. Differences in frequency of cranial lesions by region were minimal, with the least number of cases found for the mountains, but the frequency of positive cases tended to increase through time. It is suggested that increasing population density and changing behaviors, rather than novel strains of the treponemal pathogen, are responsible for the chronological increase in the frequency of positive cases.

Syphilis in renaissance Europe: rapid evolution of an introduced sexually transmitted disease?

When syphilis first appeared in Europe in 1495, it was an acute and extremely unpleasant disease. After only a few years it was less severe than it once was, and it changed over the next 50 years into a milder, chronic disease. The severe early symptoms may have been the result of the disease being introduced into a new host population without any resistance mechanisms, but the change in virulence is most likely to have happened because of selection favouring milder strains of the pathogen. The symptoms of the virulent early disease were both debilitating and obvious to potential sexual partners of the infected, and strains that caused less obvious or painful symptoms would have enjoyed a higher transmission rate.

Syphilis 2001--a palaeopathological reappraisal

The origin and subsequent spread of the treponematoses, especially that of venereal syphilis, has been the subject of considerable scientific attention. Various theories were put forth and palaeopathological specimens were used for their validation in recent times. One influential contribution was the paper by Baker & Armelagos in 1988. Numerous new findings and results on both sides of the Atlantic call for a new evaluation of the available osseous material. A review of the recent literature leads to the suggestion of a worldwide distribution of non-venereal treponemal disease since the emergence of Homo and to a first epidemic outbreak of venereal syphilis in Europe of the late 15th and the early 16th century, which was a time of change and enormous sexual liberty. Old World specimens with pathological alterations attributed to venereal syphilis and dated to precolumbian times seem to invalidate the Columbian theory and call for a more differentiated analysis of the phenomenon of syphilis than a theory based on a single factor can provide. With the help of molecular methods which now allow a positive identification of Treponema pallidum pallidum, causative agent of venereal syphilis, in palaeopathological material, it seems possible to elucidate the matter of origin and spread of syphilis further and to evaluate previous diagnoses of treponemal disease.

Genital chlamydial infection: a role for social scientists

Potential sociomedical research contributions to the understanding of genital chlamydial infections are outlined in a six-part sociomedical 'checklist'. Sociomedical research focuses on human behavior and its social, economic, cultural, and psychological determinants. Thus, the author urges sociomedical researchers--primarily medical sociologists, medical anthropologists, social psychologists, and public health economists--to explore the cultural, socioeconomic, and behavioral factors contributing to the current 'epidemic' of genital chlamydial infection, a sexually transmitted disease (STD) that is found worldwide and has now supplanted gonorrhea as the most common STD in the industrialized nations. Control of this STD is particularly important because of its grave consequences for women's and maternal/child health; these include ectopic pregnancy, infertility, and neonatal morbidity. Before effective prevention and control programs can be realized, however, beliefs and behaviors surrounding such areas as sexuality, fertility, contraception, STDs, hygiene, and health care must be discerned for widely based populations in both industrialized and nonindustrialized nations.