A rare case of calvarial tuberculosis from the Avar Age (8th century CE) cemetery of Kaba-Bitózug (Hajdú-Bihar county, Hungary) - Pathogenesis and differential diagnostic aspects

The aim of our paper is to present and discuss in detail the bony changes indicative of tuberculosis (TB) that were identified in a skeleton (KB67), unearthed from grave 67 of the 8th-century-CE cemetery of Kaba-Bitózug (Hungary). Furthermore, to provide the differential diagnoses of the observed alterations, with special attention to the cranial osteolytic lesions. During the macro- and micromorphological examinations of KB67, the skull revealed three small, well-circumscribed, punched-out osteolytic lesions accompanied by endocranial granular impressions, abnormal blood vessel impressions, periosteal appositions, and cortical erosion. The postcranial skeleton exhibited osteolytic lesions, cortical remodelling and erosion, and signs of hypervascularisation in the spine. Based on the differential diagnosis of the cranial osteolytic lesions and their co-occurrence with endocranial and vertebral bony changes indicative of TB, they most likely resulted from tuberculous involvement of the frontal and left parietal bones. The morphologically established diagnosis was confirmed by a PCR analysis that provided evidence for the presence of Mycobacterium tuberculosis DNA in KB67. KB67, the first reported archaeological case with calvarial TB from the present-day territory of Hungary, gives us a unique insight into the occurrence of a rare manifestation of TB in the Avar Age of the Great Plain.

Sacral preauricular extensions and notches as parts of a 'Pelvic Pattern' may provide information on past pregnancies and parturitions

During the analyses of several hundred prehistoric individuals from Austria, we observed that some women display a "Pelvic Pattern" at the innominate bones and the sacrum, i.e. specific combinations of pronounced expressions of pelvic features. We recorded classic pelvic features (dorsal pubic pitting, preauricular sulcus, extended pubic tubercle) as well as new ones (SPE: sacral preauricular extension, a ventrally pointing flat bone formation at the ventrosuperior margin of the ala ossis sacri; SPN: sacral preauricular notch, a loss of convexity at the same location; CF: corresponding facets at the ilium), and some less well-known features, i.e. the margo auricularis groove, ventral pubic exostoses and lesions. To quantify the assessed features, we developed a specific formula to calculate the 'Pelvic Pattern Index' (PPI). As pregnancies and/or parturitions are suspected to contribute to or be at least partly causative of the occurrence of pelvic features, we analyzed 48 well-preserved female individuals and 15 males from identified skeletal collections with obstetric information in Geneva and London. In these collections, we found a pelvic pattern of at least four out of ten distinctly expressed pelvic features only in multiparous females, but not in nulli- or primiparous females or in males. This pattern was found in 40.6% of the multiparous females and 29.2% of all females from the identified collections, compared to 56.1% of well-preserved prehistoric females with unknown parity status from Austria (n = 41). The mean PPI of the multiparae from the identified collections is 0.25, compared to a mean PPI of 0.19 for all women from the identified collections, and 0.28 for the prehistoric female individuals. We conclude from this that a high PPI (≥ 0.30), especially in cases where SPE or SPN are present, can give insights into past motherhood.

Anatomic basics and technical approaches: sacral preauricular extensions, preauricular sulci and dorsal pubic pits in modern anatomical specimens

The aim of this study is the evaluation of three selected osseous pelvic features in modern anatomical specimen - the sacral preauricular extension, the preauricular sulcus and pits on the dorsal side of the pubic bone laterally to the symphysis. The specificity and significance of these features are under debate and their genesis is largely unclear. Descriptive data of specific soft tissue structures surrounding the anterior sacroiliac joint gap and the pubic symphysis were generated by assessing 20 fresh pelves and 12 embalmed hemipelves from human body donors. Computed tomography (CT) was performed on all specimens and three-dimensional (3D) surface models were generated and analysed. Afterwards, all the specimens underwent anatomical dissection and finally maceration. During dissection, it became apparent that the anterior sacroiliac ligament, due to its position, shape and potential impact on the sacroiliac joint and adjacent osseous structures, requires a detailed analysis of its dimension. The most promising result, in terms of the sacral preauricular extension, was that the measurements of the triangular part of the anterior sacroiliac ligament were significantly longer in females than in males. Pelvic floor muscle fibres and fascial parts were directly connected to this ligament in some specimens, which is an important starting point for a larger in-depth study. The evaluation of the anatomic structures in connection to dorsal pitting refutes the assumption that the pelvic floor muscles or fasciae could exert influence on its formation. A histological evaluation of the ligaments of the pubic symphysis, especially the dorsal pubic ligament, would be expedient to clarify the etiology of this feature.

Challenging definitions and diagnostic approaches for ancient rare diseases: The case of poliomyelitis

OBJECTIVE

This paper aims to contribute to the definition of ancient rare diseases in skeletons displaying pathologies associated with paralysis. It uses a new suite of methods, which can be applied to challenging cases of possible paralysis in archaeologically-derived human skeletal material, specifically applied to the identification of poliomyelitis.

MATERIALS

An adult male skeleton from Roman Halbturn, Austria.

METHODS

Morphological and entheseal change analyses, CT scans, X-rays, cross-section morphology, and histology, alongside modern clinical, as well as historic, literature were used to discuss paralyses.

RESULTS

The results suggest a diagnosis of poliomyelitis; now considered a rare disease, but perhaps ubiquitous in antiquity, thus complicating the definition of 'rare disease'.

CONCLUSIONS

The integrated methodological procedures employed for this case constitutes a replicable and thorough approach to diagnosis, and explores the nature of ancient rare diseases. Due to the socio-environmental aspects of poliomyelitis transmission, it is likely that polio was likely not rare in the past. Therefore, the definition of 'rare diseases in the past' must include rarely occurring rarely diagnosed diseases due to biases and challenges within the archaeological and environmental record.

SIGNIFICANCE

The developed suite of methods has not been applied to establish a diagnosis of polio in the past.

LIMITATIONS

The individual considered in this study is fairly well-preserved; thus, this set of analyses may not be applicable to all remains where preservation is poor or highly fragmentary, and the discussion of rare diseases requires relatively secure diagnoses and context.

SUGGESTIONS FOR FURTHER RESEARCH

Large collections and series of skeletal human remains are recommended to develop definitive conclusions.

Child murder in the Early Bronze Age: proteomic sex identification of a cold case from Schleinbach, Austria

The identification of sex-specific peptides in human tooth enamel by nanoflow liquid chromatography-tandem mass spectrometry (nanoLC-MS/MS) represents a quantum leap for the study of childhood and social relations more generally. Determining sex-related differences in prehistoric child rearing and mortality has been hampered by the insufficient accuracy in determining the biological sex of juveniles. We conducted mass spectrometric analysis to identify sex-specific peptides in the dental enamel of a child from a settlement pit of the Early Bronze Age settlement of Schleinbach, Austria (c. 1950-1850 bc). Four perimortal impression fractures on the skull of a 5-6-year-old child indicate an intentional killing, with a co-buried loom weight as possible murder weapon. Proteomic analysis, conducted for the first time on prehistoric teeth in Austria, determined the child's sex as male. While we cannot conclusively determine whether the child was the victim of conflicts between village groups or was slain by members of his own community, we suggest that contextual evidence points to the latter. A possible trigger of violence was the follow-on effects of an uncontrolled middle ear infection revealed by an osteological analysis. The boy from Schleinbach highlights the potential for further investigation of gender-biased violence, infanticide and child murder based on the recently developed method of proteomic sex identification.