Abstract
Abnormally pronounced digital impressions (APDIs) on the endocranial surface develop secondary to a prolonged rise in the intracranial pressure. This can result from a number of pathological conditions, including hydrocephalus due to tuberculous meningitis (TBM). APDIs have been described with relation to TBM not only in the modern medical literature but also in several paleopathological studies. However, APDIs are not pathognomonic for TBM and their diagnostic value for identifying TBM in past human populations has not been evaluated in identified pre-antibiotic era skeletons. To assess the diagnostic value of APDIs for the first time, a macroscopic investigation was performed on skeletons from the Terry Collection (Smithsonian Institution, Washington, DC, USA). Our material consisted of 234 skeletons with tuberculosis (TB) as the cause of death (TB group) and 193 skeletons with non-tuberculous (NTB) causes of death (NTB group). The macroscopic examination focused on the stage of the prominence and frequency of APDIs in the TB group and NTB group. To determine the significance of difference (if any) in the frequency of APDIs between the two groups, χ2 testing of our data was conducted. We found that APDIs were twice as common in the TB group than in the NTB group. The χ2 comparison of the frequencies of APDIs revealed a statistically significant difference between the two groups. In addition, APDIs with more pronounced stages were recorded more frequently in the TB group. Our results indicate that APDIs can be considered as diagnostic criteria for TBM in the paleopathological practice. With suitable circumspection, their utilization provides paleopathologists with a stronger basis for identifying TB and consequently, with a more sensitive means of assessing TB frequency in past human populations.
Highlights
Tuberculosis (TB) or the “White Plague” is one of the oldest known infectious diseases that has been affecting humanity for millennia [1,2,3]
From a total of 427 skeletons assessed in the Terry Collection, 216 (50.59%) displayed abnormally pronounced digital impressions (APDIs) on the endocranial surface (Table 3): 154 (65.81%) of 234 individuals identified to have died of TB (S1 Table) and 62 (32.12%) of 193 individuals recorded to have died of causes other than TB (S2 Table)
The generated sensitivity and specificity estimate values for APDIs were 65.81% and 67.88%, respectively (Table 4)
Summary
Tuberculosis (TB) or the “White Plague” is one of the oldest known infectious diseases that has been affecting humanity for millennia [1,2,3]. Skeletal TB can be identified in only about 3–5% of all the TB cases in past human populations; it is difficult to estimate the true TB frequency in human osteoarchaeological series if we consider only the aforementioned diagnostic criteria [4,5,9,10]. 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
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