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
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
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)
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 
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 
6/13
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 
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 
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 
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
⏬
🔷Although there's rich blood supply to vertebrae, no blood supply to disc➡️eventually that avascular disc tissue dies
🔷Vertebral narrowing ➡️ Collapse of vertebral end plate
⏬
🔷Kyphotic 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 
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!
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