Here and Now, There and Then: Two Mycobacterial Diseases Still with Us Today

Leprosy and tuberculosis (TB) both affect humans and other animals. They are two of the very few infections identified in paleopathology where the specific causative organisms are known (as opposed to non-specific infections), and where bone changes can be linked to them. They are both diseases of poverty and can be transmitted between humans via the respiratory route; they have long and variable incubation periods; and they can have subclinical infection phases. In the 1980s, they were both declining in developing countries and becoming resistant to the drugs used for treatment (more so for TB). This contribution explores the current global challenges of these mycobacterial diseases and relevant clinical information, proceeding then to consider the ways in which leprosy and TB are diagnosed in the skeleton, and giving a brief overview of the extant evidence in skeletal remains, which reveals that overall normative burial for the time and place characterizes people who had these diseases in past times. Recent developments in their paleopathological study are then highlighted, including clinical and statistical approaches, synergistic studies (e.g. vitamin D and respiratory diseases), and biomolecular research using aDNA and proteins (including evolutionary studies) and dietary and mobility isotope analyses. A considerable amount of extant paleopathological research on these mycobacterial diseases has already been accomplished, but there is huge potential for future work.