Malaria detection in the field of paleopathology: a meta-analysis of the state of the art

Developing an archaeology of malaria. A critical review of current approaches and a discussion on ways forward

OBJECTIVE

This paper presents the current state of the art in the investigation of past malaria by providing an extensive review of previous studies and identifying research possibilities for the future.

MATERIALS

All previous research on the detection of malaria in human skeletal material using macroscopic and biomolecular approaches is considered.

METHODS

The approaches and methods used by scholars and the results they obtained are evaluated and the limitations discussed.

RESULTS

There is a link between malaria and porous lesions with significantly higher prevalence in malaria-endemic areas, however, they are not pathognomonic or specific for malaria. Malaria can be identified using biomolecular techniques, yet, to date there is no completely satisfactory method that is able to consistently diagnose the disease.

CONCLUSIONS

Using macroscopic and biomolecular techniques, malaria can be investigated in past populations and the impact of the disease studied. Yet, this is not a straightforward process and the use of multiple lines of evidence is necessary to obtain the best results.

SIGNIFICANCE

The extensive discussion on ways malaria can and cannot be identified in past populations and the suggestions for new approaches provide a steppingstone for future research into this debilitating, global disease.

LIMITATIONS

Malaria is a difficult disease to study archaeologically and successful identification depends on many intrinsic and extrinsic factors.

SUGGESTIONS FOR FURTHER RESEARCH

More large-scale spatial analyses of porous lesions as well as targeting different tissues or molecules for biomolecular identification may improve the archaeological understanding of malaria.

Tentative indicators of malaria in archaeological skeletal samples, a pilot study testing different methods

OBJECTIVE

This study attempts to integrate multiple methods to investigate the presence of malaria in human skeletal samples from an archaeological context.

MATERIALS

33 well preserved human remains originating from a 17th-century archaeological site in southeastern Romania.

METHODS

The human bone samples were analyzed using rapid diagnostic tests for malaria antigens and PCR amplification of Plasmodium falciparum apical membrane antigen 1. A preliminary test was performed to identify and briefly characterize the presence of hemozoin using a combination of TEM imaging and diffraction.

RESULTS

The rapid diagnostic tests indicated that more than half of the examined samples were positive for Plasmodium antigens, but no traces of the parasites' genetic material were detected despite repeated attempts. The TEM images indicated that hemozoin might be a promising diagnostic marker of malaria in ancient bones.

CONCLUSIONS

The indisputable identification of malaria in the analyzed archaeological population was not possible as none of the applied methodological strategies turned out to be straightforward.

SIGNIFICANCE

This study reinforces the intricacy and limitations of unequivocally identifying malaria in past populations and sets the stage for future studies on such life-threatening infectious disease in a geographical space, which is currently underrepresented in the bioarchaeological literature.

LIMITATIONS

The low sample size and the lack of consistency across all assays hindered understanding the role of malaria in the studied population.

SUGGESTIONS FOR FURTHER RESEARCH

Further thorough multidisciplinary approaches on malaria detection in ancient settlements would be appropriate to inform our knowledge of its origins, frequency, and pathogen changes over centuries.

The elusive parasite: comparing macroscopic, immunological, and genomic approaches to identifying malaria in human skeletal remains from Sayala, Egypt (third to sixth centuries AD)

Although malaria is one of the oldest and most widely distributed diseases affecting humans, identifying and characterizing its presence in ancient human remains continue to challenge researchers. We attempted to establish a reliable approach to detecting malaria in human skeletons using multiple avenues of analysis: macroscopic observations, rapid diagnostic tests, and shotgun-capture sequencing techniques, to identify pathological changes, Plasmodium antigens, and Plasmodium DNA, respectively. Bone and tooth samples from ten individuals who displayed skeletal lesions associated with anaemia, from a site in southern Egypt (third to sixth centuries AD), were selected. Plasmodium antigens were detected in five of the ten bone samples, and traces of Plasmodium aDNA were detected in six of the twenty bone and tooth samples. There was relatively good synchronicity between the biomolecular findings, despite not being able to authenticate the results. This study highlights the complexity and limitations in the conclusive identification of the Plasmodium parasite in ancient human skeletons. Limitations regarding antigen and aDNA preservation and the importance of sample selection are at the forefront of the search for malaria in the past. We confirm that, currently, palaeopathological changes such as cribra orbitalia are not enough to be certain of the presence of malaria. While biomolecular methods are likely the best chance for conclusive identification, we were unable to obtain results which correspond to the current authentication criteria of biomolecules. This study represents an important contribution in the refinement of biomolecular techniques used; also, it raises new insight regarding the consistency of combining several approaches in the identification of malaria in past populations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s12520-021-01350-z.

The people behind the samples: Biographical features of Past Hunter-Gatherers from KwaZulu-Natal who yielded aDNA

PURPOSE

Skeletons sampled for ancient human DNA analysis are sometimes complete enough to provide information about the lives of the people they represent. We focus on three Later Stone Age skeletons, ca. 2000 B.P., from coastal KwaZulu-Natal, South Africa, whose ancient genomes have been sequenced (Schlebusch et al., 2017).

METHODS

Bioarchaeological approaches are integrated with aDNA information.

RESULTS

All skeletons are male. Dental development shows that the boy, with prominent cribra orbitalia, died at age 6-7 years. Two men show cranial and spinal trauma, extensive tooth wear, plus mild cribra orbitalia in one.

CONCLUSIONS

Dental wear and trauma of the adults are consistent with hunter-gatherer lives. Even partial aDNA evidence contributes to sex determination. Parasitic infection such as schistosomiasis is the best-fit cause for the child's anemia in this case.

CONTRIBUTION TO KNOWLEDGE

The convergence of genomic and bioarchaeological approaches expands our knowledge of the past lives of a boy and two men whose lives as hunter-gatherers included episodes of trauma and disease.

LIMITATIONS

The skeletons are incomplete, in variable condition, and from poorly characterized local cultural contexts.

SUGGESTIONS FOR FURTHER RESEARCH

Thorough osteobiographic analysis should accompany paleogenomic investigations. Such disciplinary collaboration enriches our understanding of the human past.

Life and death at the "The Land of Three Lakes": Revisiting the non-adults from Roman Aventicum, Switzerland (1st-3rd century CE)

The study of Roman childhood has been the focus of research primarily using documentary and archaeological evidence, while relatively few non-adult skeletal assemblages have been analyzed. This paper presents the study of 93 non-adult individuals from four cemeteries in the Roman (1st-3rd c. CE) civitas capital of Aventicum (Avenches), Switzerland. The results of the analysis offer a new bioarchaeological perspective on mortality and disease patterns during childhood in Roman Switzerland, adding to the discussion regarding living conditions in the urban centers at the periphery of the Roman Empire. This study also highlights the importance of studying perinates in archaeological populations, since the current research inform us about the experiences of mothers and their offspring in Aventicum. The mortality and disease patterns of the perinates, representing 71% of the total non-adult sample (66/93), suggest that pregnancy and the time around birth were extremely challenging at Aventicum. It is argued that environmental constraints, e.g. the risk of infectious diseases such as malaria and natural phenomena such as recurring floods resulting in resources scarcity, could have considerably affected the mother-fetus pair in this urban settlement.

Paleopathological Considerations on Malaria Infection in Korea before the 20th Century

Malaria, one of the deadliest diseases in human history, still infects many people worldwide. Among the species of the genus Plasmodium, P. vivax is commonly found in temperate-zone countries including South Korea. In this article, we first review the history of malarial infection in Korea by means of studies on Joseon documents and the related scientific data on the evolutionary history of P. vivax in Asia. According to the historical records, malarial infection was not unusual in pre-20th-century Korean society. We also found that certain behaviors of the Joseon people might have affected the host-vector-pathogen relationship, which could explain why malarial infection prevalence was so high in Korea at that time. In our review of genetic studies on P. vivax, we identified substantial geographic differentiation among continents and even between neighboring countries. Based on these, we were able to formulate a strategy for future analysis of ancient Plasmodium strains in Korea.

The identification of malaria in paleopathology-An in-depth assessment of the strategies to detect malaria in ancient remains

The comprehensive analyses of human remains from various places and time periods, either by immunological or molecular approaches, provide circumstantial evidence that malaria tropica haunted humankind at least since dynastic ancient Egypt. Here we summarize the "actual state-of-the-art" of these bio-molecular investigations and offer a solid basis for the discussion of the paleopathology of malaria in human history.

The skeletal manifestation of malaria: An epidemiological approach using documented skeletal collections

OBJECTIVES

Recent studies in paleopathology have shown promise in associating some skeletal lesions with malarial infection. However, malaria's skeletal manifestation has never been confirmed using a large clinical reference sample from an endemic area for malaria with known individual causes of death.

MATERIALS AND METHODS

To pinpoint evidence of malaria infection on ancient skeletal remains, this study uses an epidemiological approach to compare skeletal lesions in a modern reference sample of 98 individuals from Uganda, where malaria is holoendemic, to a similar modern sample of 106 individuals from a malaria-free area.

RESULTS

Five porous skeletal lesions are identified that appear more frequently in the endemic area population, especially in anemic individuals. These appear on the cranium, vertebral column, and humeral and femoral necks. Periostitis also associates strongly with individuals in the endemic population; however, linear enamel hypoplasias show an inverse association. The identified lesions are tested for their association with each other, and then tested individually for their diagnostic power through measures of sensitivity and specificity. A diagnostic outcome algorithm is formed from the remaining skeletal lesions and their inter-lesion associations.

DISCUSSION

Several etiological explanations for the characteristic malarial skeletal lesions are explored, including severe malarial anemia, an imbalance in bone remodeling, and extramedullary erythropoiesis. The importance of careful differential diagnoses between other infectious and noninfectious causes of these lesions is discussed, including the potential for coinfection of malaria with other infectious diseases. The findings of this study are pivotal in establishing diagnostic criteria by which we can identify the prevalence and impact of malaria on past populations.