Title: The paleopathology and paleoepidemiology of Upper Paleolithic tuberculosis: Facts and theories

Author: Olivier Dutour^1,2

Affiliations: ¹École Pratique des Hautes Études, PSL University Paris, Paris, France; ²UMR 5199 PACEA (Université de Bordeaux-Centre National de la Recherche Scientifique), Pessac, France

Abstract: Paleopathology was defined in 1913 by Marc Armand Ruffer as the science of diseases that can be demonstrated on human and animal remains from ancient times. Tuberculosis is one of these diseases, because this infection leaves identifiable traces on ancient bones. In addition to these morphological lesions, various molecular methods developed over the last thirty years have provided paleopathology with new means for demonstrating the existence of tuberculosis in the past. Many paleopathological cases have thus benefited from this double demonstration, morphological and molecular. Tuberculosis was for a long time considered to be the result of the domestication of cattle and paleopathologists did not consider the existence of tuberculosis before the Neolithic period, but this paradigm was overturned by research on bacterial phylogenesis (Brosch et al, 2002) showing that M. tuberculosis was more ancestral than M. bovis and other related strains of MTB complex. Further phylogenetic researches (e.g. Wirth & al, 2008) have shown that this tuberculosis complex would have emerged around 40,000 years ago, contemporary with the Out of Africa expansion of Homo sapiens and evolved in two clades, one including animal-human strains and the other only the human strain (M. tuberculosis). Thus, human populations would have been infected with MTBC bacilli from the very beginning of the Upper Paleolithic in Eurasia. During this entire period, which spanned thirty millennia and provided a substantial number of human remains in Europe and Asia, paleopathology has been able to demonstrate the existence of tuberculosis in only two cases: an American bison of 17,000 years BP (Rothschild et al, 2001) and a human case from the Azilian period in France, at the very end of the Upper Paleolithic, 10,000 years ago (Coqueugniot et al, this conference). The purpose of this presentation is to discuss the reasons for this weakness in the paleopathological demonstration of TB for the Upper Paleolithic, a pivotal period according to phylogenetic models for the paleoepidemiology of TB.

References:

Brosch, R., Gordon, S. V., Marmiesse, M., Brodin, P., Buchrieser, C., Eiglmeier, K., Garnier, T., Gutierrez, C., Hewinson, G., Kremer, K., Parsons, L. M., Pym, A. S., Samper, S., van Soolingen, D., & Cole, S. T. (2002). A new evolutionary scenario for the Mycobacterium tuberculosis complex. Proceedings of the National Academy of Sciences, 99(6), 3684‑3689.

Rothschild, B. M., Martin, L. D., Lev, G., Bercovier, H., Bar‐Gal, G. K., Greenblatt, C., Donoghue, H., Spigelman, M., & Brittain, D. (2001). Mycobacterium tuberculosis Complex DNA from an extinct bison dated 17,000 years BP. Clinical Infectious Diseases, 33(3), 305‑311.

Wirth, T., Hildebrand, F., Allix-Béguec, C., Wölbeling, F., Kubica, T., Kremer, K., van Soolingen, D., Rüsch-Gerdes, S., Locht, C., Brisse, S., Meyer, A., Supply, P., & Niemann, S. (2008). Origin, Spread and Demography of the Mycobacterium tuberculosis Complex. PLoS Pathogens, 4(9), e1000160.