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& #39;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:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🟢" title="Green circle" aria-label="Emoji: Green circle">https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow">proportion of guanine and cytosine https://abs.twimg.com/emoji/v2/... draggable="false" alt="⬆️" title="Upwards arrow" aria-label="Emoji: Upwards arrow">DNA stability, may aid in survival over time
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🟢" title="Green circle" aria-label="Emoji: Green circle">thick lipid-rich cell wall may also help protect

3/13
Ancient skeletal remains demonstrate skeletal TB dating back 1000s of years.
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦴" title="Bone" aria-label="Emoji: Bone">Egyptian mummies are some of the oldest with evidence of spinal TB and psoas abscesses
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦴" title="Bone" aria-label="Emoji: Bone">Human remains from & #39;tombs of nobles& #39; 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/3g8Suz8&q... https://bit.ly/3bTe1sb ">https://bit.ly/3bTe1sb&q...

5/13
There& #39;s also evidence of vertebral TB in pre-Columbian, New World remains (aka before arrival of Europeans)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦴" title="Bone" aria-label="Emoji: Bone">Andean mummies (from @AMNH in NYC), 140-1200 AD
Ref: https://bit.ly/2LOGGnF 
https://bit.ly/2LOGGnF&q... class="Emoji" style="height:16px;" src=" https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦴" title="Bone" aria-label="Emoji: Bone">Peruvian mummy lung tissue (1000-1300)
Ref: https://bit.ly/2znIAZZ ">https://bit.ly/2znIAZZ&q...

Andean mummies (from @AMNH in NYC), 140-1200 ADRef: https://bit.ly/2LOGGnF&q... class="Emoji" style="height:16px;" src=" " title="5/13There& #39;s also evidence of vertebral TB in pre-Columbian, New World remains (aka before arrival of Europeans)https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦴" title="Bone" aria-label="Emoji: Bone">Andean mummies (from @AMNH in NYC), 140-1200 ADRef: https://bit.ly/2LOGGnF&q... class="Emoji" style="height:16px;" src=" " class="img-responsive" style="max-width:100%;"/>

6/13
PCR confirmed that this likely was Mycobacterium tuberculosis (vs Mycobacterium bovis, which some suspected)
Ref: https://bit.ly/2TsO5gB ">https://bit.ly/2TsO5gB&q...

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/2ytqxkI&q... https://bit.ly/2AUCSiN ">https://bit.ly/2AUCSiN&q...

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 ">https://bit.ly/2zVDl3J&q...

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 ">https://bit.ly/2ylJTbc&q...

10/13
Side note: what is that Gibbus deformity? #MedStudentTwitter
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔷" title="Large blue diamond" aria-label="Emoji: Large blue diamond">Infection/Inflam in anterior aspect of intervertebral jt
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔷" title="Large blue diamond" aria-label="Emoji: Large blue diamond">Spreads behind anterior ligament to involve adjacent vertebral body
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔷" title="Large blue diamond" aria-label="Emoji: Large blue diamond">With 2 adjacent vertebra affected, TB can enter intervertebral disc space
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⏬" title="Down-pointing double triangle" aria-label="Emoji: Down-pointing double triangle">

https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔷" title="Large blue diamond" aria-label="Emoji: Large blue diamond">Although there& #39;s rich blood supply to vertebrae, no blood supply to dischttps://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow">eventually that avascular disc tissue dies
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔷" title="Large blue diamond" aria-label="Emoji: Large blue diamond">Vertebral narrowing https://abs.twimg.com/emoji/v2/... draggable="false" alt="➡️" title="Rightwards arrow" aria-label="Emoji: Rightwards arrow"> Collapse of vertebral end plate
https://abs.twimg.com/emoji/v2/... draggable="false" alt="⏬" title="Down-pointing double triangle" aria-label="Emoji: Down-pointing double triangle">
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🔷" title="Large blue diamond" aria-label="Emoji: Large blue diamond">Kyphotic deformity (Gibbus deformity)
Photo courtesy of Hani Salam: https://bit.ly/3e6sZN5 
11/13">https://bit.ly/3e6sZN5&q...

12/13 Before anti-TB meds, possible Pott dz txs:
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🌿" title="Herb" aria-label="Emoji: Herb">Herbal therapies in texts from ancient India
https://abs.twimg.com/emoji/v2/... draggable="false" alt="😟" title="Worried face" aria-label="Emoji: Worried face">Hippocrates rudimentary bracing (above)
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🏥" title="Hospital" aria-label="Emoji: Hospital">Sanatoria, immobilization/prolonged bed rest or body cast
https://abs.twimg.com/emoji/v2/... draggable="false" alt="☀️" title="Sun with rays" aria-label="Emoji: Sun with rays">Heliotherapy (phototherapy) and nutrition interventions
https://bit.ly/2WRThwB ">https://bit.ly/2WRThwB&q...

13/13 but you can review more details about the fascinating evolution in management here: https://bit.ly/2TrL0O7 

Thanks">https://bit.ly/2TrL0O7&q... for reading and hope you learned something new about #tuberculosis!