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1/13
"Paleomicrobiology" is an amazing way to look at hx of pathogens/disease: spinal TB or Pott disease is a perfect example! I was reviewing skeletal #TB for ddx on 1 of my pts, thought I'd share my trip down the rabbit hole of #IDHistory #MedicalHistory #IDTwitter #MedTwitter
"Paleomicrobiology" is an amazing way to look at hx of pathogens/disease: spinal TB or Pott disease is a perfect example! I was reviewing skeletal #TB for ddx on 1 of my pts, thought I'd share my trip down the rabbit hole of #IDHistory #MedicalHistory #IDTwitter #MedTwitter
2/13
#Paleomicrobiology uses ancient DNA (aDNA)+PCR to look at bugs thru hx. I learned that mycobacteria might be ideal orgs for aDNA bc:
proportion of guanine and cytosine DNA stability, may aid in survival over time
thick lipid-rich cell wall may also help protect
#Paleomicrobiology uses ancient DNA (aDNA)+PCR to look at bugs thru hx. I learned that mycobacteria might be ideal orgs for aDNA bc:
proportion of guanine and cytosine DNA stability, may aid in survival over timethick lipid-rich cell wall may also help protect
3/13
Ancient skeletal remains demonstrate skeletal TB dating back 1000s of years.
Egyptian mummies are some of the oldest with evidence of spinal TB and psoas abscesses
Human remains from 'tombs of nobles' from necropolis of Thebes West (~2100-1000 BC) and Abydos (3000BC)
Ancient skeletal remains demonstrate skeletal TB dating back 1000s of years.
Egyptian mummies are some of the oldest with evidence of spinal TB and psoas abscessesHuman remains from 'tombs of nobles' from necropolis of Thebes West (~2100-1000 BC) and Abydos (3000BC)
4/13
This is one of the most prosperous times in ancient Egyptian history. There were probably 10k people in Thebes-West with relatively good living conditions / upper class. Dense crowding was still likely though.
Ref: https://bit.ly/3g8Suz8
Image: https://bit.ly/3bTe1sb
This is one of the most prosperous times in ancient Egyptian history. There were probably 10k people in Thebes-West with relatively good living conditions / upper class. Dense crowding was still likely though.
Ref: https://bit.ly/3g8Suz8
Image: https://bit.ly/3bTe1sb
5/13
There's also evidence of vertebral TB in pre-Columbian, New World remains (aka before arrival of Europeans)
Andean mummies (from @AMNH in NYC), 140-1200 AD
Ref: https://bit.ly/2LOGGnF
Peruvian mummy lung tissue (1000-1300)
Ref: https://bit.ly/2znIAZZ
There's also evidence of vertebral TB in pre-Columbian, New World remains (aka before arrival of Europeans)
Andean mummies (from @AMNH in NYC), 140-1200 ADRef: https://bit.ly/2LOGGnF
Peruvian mummy lung tissue (1000-1300)Ref: https://bit.ly/2znIAZZ
6/13
PCR confirmed that this likely was Mycobacterium tuberculosis (vs Mycobacterium bovis, which some suspected)
Ref: https://bit.ly/2TsO5gB
PCR confirmed that this likely was Mycobacterium tuberculosis (vs Mycobacterium bovis, which some suspected)
Ref: https://bit.ly/2TsO5gB
7/13
Hippocrates is credited for describing TB of the spine (400-300BC) in ancient Greece. Even tried to correct kyphotic deformities with manual pressure, traction, mechanical appliances! but failed
Ref: https://bit.ly/2ytqxkI
Ref: https://bit.ly/2AUCSiN
Hippocrates is credited for describing TB of the spine (400-300BC) in ancient Greece. Even tried to correct kyphotic deformities with manual pressure, traction, mechanical appliances! but failed
Ref: https://bit.ly/2ytqxkI
Ref: https://bit.ly/2AUCSiN
8/13
Sir Percivall Pott described the presentation of TB vertebral osteo in 1779 in Chirugical Works of Percivall Pott.
"The occasion of the mistake is palpable; the pt is deprived of the use of his legs, and has a deformed incurvation of the Spine"
Ref: https://bit.ly/2zVDl3J
Sir Percivall Pott described the presentation of TB vertebral osteo in 1779 in Chirugical Works of Percivall Pott.
"The occasion of the mistake is palpable; the pt is deprived of the use of his legs, and has a deformed incurvation of the Spine"
Ref: https://bit.ly/2zVDl3J
9/13
In 1936, Compere and Garrison from @UChicago provided description of vertebral TB, comparing radiologic + path/autopsy findings. Also compared TB spondylitis to pyogenic infection, and they noted that anterior vertebral body was affected more
Ref: https://bit.ly/2ylJTbc
In 1936, Compere and Garrison from @UChicago provided description of vertebral TB, comparing radiologic + path/autopsy findings. Also compared TB spondylitis to pyogenic infection, and they noted that anterior vertebral body was affected more
Ref: https://bit.ly/2ylJTbc
10/13
Side note: what is that Gibbus deformity? #MedStudentTwitter
Infection/Inflam in anterior aspect of intervertebral jt
Spreads behind anterior ligament to involve adjacent vertebral body
With 2 adjacent vertebra affected, TB can enter intervertebral disc space
Side note: what is that Gibbus deformity? #MedStudentTwitter
Infection/Inflam in anterior aspect of intervertebral jtSpreads behind anterior ligament to involve adjacent vertebral bodyWith 2 adjacent vertebra affected, TB can enter intervertebral disc space
Although there's rich blood supply to vertebrae, no blood supply to disc
eventually that avascular disc tissue diesVertebral narrowing Collapse of vertebral end plateKyphotic deformity (Gibbus deformity)Photo courtesy of Hani Salam: https://bit.ly/3e6sZN5
11/13
12/13 Before anti-TB meds, possible Pott dz txs:
Herbal therapies in texts from ancient India
Hippocrates rudimentary bracing (above)
Sanatoria, immobilization/prolonged bed rest or body cast
Heliotherapy (phototherapy) and nutrition interventions
https://bit.ly/2WRThwB
Herbal therapies in texts from ancient IndiaHippocrates rudimentary bracing (above)Sanatoria, immobilization/prolonged bed rest or body castHeliotherapy (phototherapy) and nutrition interventionshttps://bit.ly/2WRThwB
13/13 but you can review more details about the fascinating evolution in management here: https://bit.ly/2TrL0O7
Thanks for reading and hope you learned something new about #tuberculosis!
Thanks for reading and hope you learned something new about #tuberculosis!
