A possible case of treponemal disease from England dating to the 11th–12th century AD

This short report describes a human skeleton from an archaeological site in England showing signs of treponemal disease. A radiocarbon determination indicates that it is firmly pre‐Columbian in date. The implications for recent debates concerning the origin of treponemal disease in Europe are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

A case study of possible differential diagnoses of a medieval skeleton from Denmark: leprosy,ergotism, treponematosis,sarcoidosis or smallpox?

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the skeleton of a young woman, 20–25 years of age, which triggered the Danish palaeopathologist Vilhelm Møller‐Christensen's interest in leprosy. The skeleton was incomplete, but the majority of bones of the upper body, as well as the skull, were present. The pathological changes consisted of medullary and cortical lytic foci, periosteal reaction and enhanced cortical density. The lesions were most extensive on the left side, especially around the elbow, wrist and scapula. Treponematosis, leprosy, smallpox, ergotism, rheumatoid arthritis, tuberculosis and sarcoidosis are all reviewed with regard to bone and joint pathology and their likelihood of being the correct diagnosis. We concluded that the most plausible diagnosis is treponematosis, but neither sarcoidosis nor smallpox can be completely excluded. Copyright © 2007 John Wiley & Sons, Ltd.     

Two cases of facial involvement in probable treponemal infection from late prehistoric coastal North Carolina

This paper describes two late prehistoric burials from coastal North Carolina with cranial and postcranial lesions characteristic of treponemal infection. Each case exhibits facial lesions consistent with clinical reports of treponemal infection, but which have not previously been documented in these populations. The suite of facial lesions in one case and a mandibular lesion in the other serve to illustrate the variability inherent in treponemal infections. © 1998 John Wiley & Sons, Ltd.     

A case of treponematosis from pre‐Columbian Chaco Canyon,New Mexico

Although numerous cases of treponemal infection have been identified in prehispanic New World skeletal remains, none has been reported from Chaco Canyon, New Mexico. Chaco Canyon was the epicentre of a broad culture system that spanned the Four Corners region of the pre‐Columbian Southwestern United States. A burial recovered from the central Great House of Chaco Canyon, Pueblo Bonito, exhibits lesions indicative of treponematosis. However, the pathological condition of this individual has heretofore been only tentatively diagnosed because the skeleton was collected from a commingled context and distributed across four separate catalogue numbers. Now reassociated, these remains exhibit a pattern of pathological changes strongly indicative of treponemal disease. This case not only adds to the growing body of literature on the clinical expression and geographic distribution of pre‐Columbian treponematosis, but also demonstrates the utility of painstaking reassociation of commingled human remains. Copyright © 2009 John Wiley & Sons, Ltd.     

Periostitis and osteolysis in a medieval skeleton from South‐West Hungary: (Leprosy,treponematosis, tuberculosis or hypertrophic osteoarthropathy) A diagnostic challenge!

This paper uses macroscopic and radiological examinations to provide differential diagnoses of pathological lesions in the well‐preserved skeleton of a young male from the medieval site of Zalavár in South‐West Hungary. Macroscopic inspection of the skeleton revealed conspicuous thickening of the tibiae and fibulae with ‘tree bark’ appearance of the cortex. Periosteal proliferations are also found on the calcanea and on the posterior part of the femora. The metatarsals showed bony proliferation and bone dissolution. No alteration of the axial skeleton or the skull was noted. Radiographs showed thickening of the cortex of tubular bones due to a multilayered type of periosteal apposition. The likelihood of these symptoms being the result of melorheostosis, hypervitaminosis A, fluorosis, thyroid acropachy, endosteal hyperostosis, tuberculosis (TB), hypertrophic osteoarthropathy (HOA), treponematosis and leprosy is reviewed. None completely explains the entire spectrum of pathological lesions in the current individual, but the individual may have suffered from two co‐existent diseases. As a clinical entity, the changes in the metatarsals are compatible with leprosy, whereas the periosteal proliferations of the lower limbs point to a diagnosis of HOA as a secondary syndrome. Thus, a combination of leprosy and TB is suggested as a potential diagnosis. Although not definitive, our differential diagnosis was able to exclude a number of conditions producing periosteal apposition. Copyright © 2011 John Wiley & Sons, Ltd.     

On problems of differential diagnosis in palaeopathology,as illustrated by a case from prehistoric Indiana

Because palaeopathology has to call on a limited range of evidence, compared with modern clinical diagnosis, it is important that a differential diagnosis should be broad‐based. A prehistoric case from Indiana is discussed in relation to this statement. Copyright © 2009 John Wiley & Sons, Ltd.     

Temporal and Spatial Distribution of Treponemal Infection in South Florida: An Epidemiological Approach

Bioarchaeological analysis of the MDM site (8DA11) in Miami, Florida (ad 400–1200) has identified human skeletal remains with lesions suggestive of and consistent with treponematosis. A population and epidemiological approach was utilised to compare the MDM site to geographically neighbouring skeletal samples from the Highland Beach mound (8PB11) (ad 600–1200) and Fort Center (8GL12) (ad 1–500/1000). These samples were then integrated with data from previous research on proliferative skeletal lesion prevalence on the Gulf Coast of Florida. Population comparisons suggest a higher prevalence of proliferative skeletal lesions in Atlantic coastal populations as opposed to the nearest sampled site from the interior (p < 0.00001), a trend seemingly different from Gulf Coast populations. This investigation details the presence of treponemal disease in the Everglades archaeological region likely as early as ad 400, and the southern terminus in the contiguous United States that treponematosis has been reported. Copyright © 2013 John Wiley & Sons, Ltd.     

A pre‐Columbian case of congenital syphilis from Anatolia (Nicaea, 13th century AD)

In this study, the skeleton of an approximately 15‐year‐old child, dating back to the Late Byzantine period (13th century AD) is examined with the aim of determining where this specimen fits in the continuing arguments on the origins of syphilis. It was unearthed during an excavation at an amphitheatre in Nicaea dating to the Roman period. The Nicaea specimen displays common symptoms found in the majority of people with congenital syphilis such as Hutchinson's incisor, mulberry molar, darkened enamel, radial scar on frontal bone, sabre tibia, syphilitic dactylitis, and gummatous and non‐gummatous osteomyelitis on almost every post‐cranial bone. Because of the sub‐periosteal new bone formation, the medullary spaces in some long bones are narrowed or completely obliterated. These lesions, which were observed via macroscopic and radiological examination, reflect the late stages of congenital syphilis. The specimen, when examined together with increasing numbers of other finds from the Old World, contributes to the argument that venereal syphilis did exist in the Old World before 1493, and brings forward the need to revise the Columbian hypothesis, which maintains that syphilis is a new disease carried to the Old World from the New World by Columbus' crew. Copyright © 2005 John Wiley & Sons, Ltd.     

Multiple Cases with Probable Treponemal Infection from 16th to 19th Centuries Romania

In this paper, we describe pathological lesions identified in seven skeletons discovered in the Saint Sava necropolis in Bucharest, Romania, dating to the Late Medieval/Early Modern period. The pathological changes observed in the skeletons were analysed using macroscopic examination. Additionally, computed tomography scanning was performed on two individuals displaying advanced lesions on the cranial surface. For the differential diagnosis, we took into consideration treponemal infection, tuberculosis, osteomyelitis, leprosy, fluorosis, melorheostosis, hypertrophic pulmonary osteoarthropathy, Paget's disease and mycotic infection, along with the possibility of multiple afflictions occurring simultaneously. The morphology and distribution of the lesions are suggestive of treponematosis, which, to our knowledge, makes this the first case of this disease on the Romanian territory in archaeological populations. Copyright © 2015 John Wiley & Sons, Ltd.