Abstract
The aim of our paper is to demonstrate a middle-aged male (KK61) from the 8th-century-CE cemetery of Kiskundorozsma-Kettőshatár I (Duna-Tisza Interfluve, Hungary), who appears to represent the lepromatous form of Hansen's disease. Leprosy has affected not only the rhinomaxillary region of his face but also his lower limbs, with severe deformation and disfigurement of the involved anatomical areas (saddle-nose and flat-foot deformity, respectively). Consequently, he would have experienced disability in performing the basic activities of daily living, such as eating, drinking, standing or walking; and thus, he would have required regular and substantial care from others to survive. Despite his very visible disease and associated debility, it seems that KK61 was accepted as a member of the community in death, since he has been buried within the cemetery boundaries, among others from his community. In addition, his grave has conformed to the mortuary practices characteristic of the Kiskundorozsma-Kettőshatár I cemetery (e.g., burial orientation, position of the body in the grave, and type and quantity of accompanying grave goods). Although distinction or segregation in life do not preclude normative treatment in death, the long-lasting survival of KK61 with Hansen's disease implies that he would not have been abandoned but cared for by others. KK61 is one of the few published historic cases with leprosy from the Avar Age of the Hungarian Duna-Tisza Interfluve. His case gives us a unique insight into the biological consequences of living with Hansen's disease and illustrates the social attitude toward leprosy sufferers in early mediaeval Hungary.
Highlights
Leprosy bacilli are most commonly transmitted from one person to another through respiratory droplets, with the nasal mucosa representing the main portal of entry and exit for the pathogens [1, 3, 4]
The rhinomaxillary region of KK61 exhibited a number of alterations that can presumably be attributed to leprosy (Fig 3)
The rhinomaxillary bony changes observed in KK61 (Figs 3 and 4) are compatible with RMS
Summary
Leprosy or Hansen’s disease (HD) is a chronic infection of mainly humans that is caused by two pathogenic bacterial species, Mycobacterium leprae and Mycobacterium lepromatosis [1, 2]. Leprosy bacilli are most commonly transmitted from one person to another through respiratory droplets, with the nasal mucosa representing the main portal of entry and exit for the pathogens [1, 3, 4]. Amongst the few individuals who do progress to symptomatic disease, leprosy is manifest over a broad clinical and histopathological spectrum from tuberculoid through borderline forms to lepromatous [1, 3, 6]. The presentation of the disease reflects the host’s immune response to leprosy bacilli–patients have decreasing levels of cell-mediated immunity and increasing levels of humoral immunity as they move from the tuberculoid form to the lepromatous one [6, 7]
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