Chapter 12 : Paleomicrobiology of Human Tuberculosis

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Tuberculosis remains one of the world’s deadliest communicable diseases. In 2014, tuberculosis developed in an estimated 9.6 million people, and 1.5 million died of the disease ( ). The principal causative organism is , an obligate pathogen that is a member of the complex (MTBC), a group of closely related organisms that primarily infect different animal hosts. Tuberculosis may involve every organ in the body, but the most common clinical presentation is pulmonary disease, in which transmission is via infectious aerosols released from the lungs of an infected person. In the alveolus of the lung, inhaled tubercle bacilli are ingested by macrophages and are normally contained by the host immune response. This leads to granuloma formation and eventually to calcified lesions. Swallowing infected sputum can cause intestinal tuberculosis. Transmission can occur via direct contact in cases of scrofula (skin tuberculosis). In addition, ingestion of milk or food from an infected animal can cause human infection with or other members of the MTBC. However, subsequent transmission of these animal MTBC lineages from person to person is rare. can survive and grow within macrophages, so that it is able to evade the host immune system. An active cell-mediated immune response is required to contain and kill the tubercle bacilli, so any underlying conditions that reduce its efficiency increase susceptibility to tuberculosis. One-third of the global population is estimated to have latent tuberculosis infection. These individuals do not have active disease but may develop it in the near or remote future, a process called tuberculosis reactivation. The lifetime risk for reactivation is estimated to be 5% to 10%, with tuberculosis developing in the majority of cases within the first 5 years after initial infection. However, the risk is considerably higher in the presence of predisposing factors ( ).

Citation: Donoghue H. 2016. Paleomicrobiology of Human Tuberculosis, p 113-130. In Drancourt M, Raoult D (ed), Paleomicrobiology of Humans. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.PoH-0003-2014
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Figure 1

Paleopathology diagnostic for skeletal tuberculosis: Pott’s disease, angular kyphosis in Th8–L2. Hungary: Zalavár-Vársziget-Kápolna, juvenile, grave No. 17/03. Paleopathology highly suggestive of tuberculosis: evidence of infection shown by fusion of vertebrae (Th6–8) with slight gibbus, cavities, and traces of cold abscess (chronic lytic lesion). Hungary: Zalavár-Vársziget-Kápolna, juvenile, grave No. 74/03. Paleopathology showing nonspecific changes consistent with a tuberculosis infection; disseminated, small, new bone formations can be observed on the costal groove and on the inner surface of the ribs. Romania: Peteni, grave No. 107. (Courtesy of Tamás Hadju, Department of Biological Anthropology, Eötvös Loránd University, Budapest, Hungary. Fig. 1A, B reprinted from [ ] with permission of the publisher. Fig. 1C reprinted from [ ] with permission of the publisher.)

Citation: Donoghue H. 2016. Paleomicrobiology of Human Tuberculosis, p 113-130. In Drancourt M, Raoult D (ed), Paleomicrobiology of Humans. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.PoH-0003-2014
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Figure 2

Evolutionary relationship between selected mycobacteria and members of the complex (MTBC). The MTBC was thought to arise as a clonal expansion from a smooth tubercle bacillus (STB) progenitor population. The animal-adapted ecotypes branch from a presumed human-adapted lineage of that is currently restricted to West Africa. Human-adapted strains are grouped into seven main lineages, each of which is primarily associated with a distinct geographical distribution. The dates of branching events are only crude estimates. (Courtesy of James E. Galaghan, Department of Biomedical Engineering, Bioinformatics Program and National Emerging Infectious Diseases Laboratory, Boston University, Boston, Massachusetts, USA, and Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA. Reprinted from [ ] with permission of the publisher.)

Citation: Donoghue H. 2016. Paleomicrobiology of Human Tuberculosis, p 113-130. In Drancourt M, Raoult D (ed), Paleomicrobiology of Humans. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.PoH-0003-2014
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Image of Figure 3
Figure 3

A possible timeline of evolutionary events and archaeological data; the location for archaeological evidence is indicated in each box. Boxes outlined in black indicate morphological evidence only, whereas boxes outlined in red denote both morphological and molecular evidence. (Courtesy of James E. Galaghan, Department of Biomedical Engineering, Bioinformatics Program and National Emerging Infectious Diseases Laboratory, Boston University, Boston, Massachusetts, USA, and Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Massachusetts, USA. Reprinted from [ ] with permission of the publisher.)

Citation: Donoghue H. 2016. Paleomicrobiology of Human Tuberculosis, p 113-130. In Drancourt M, Raoult D (ed), Paleomicrobiology of Humans. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.PoH-0003-2014
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Figure 4

Structures of selected lipid biomarkers. The main components of each mycolic acid class are shown; each class comprises a limited range of homologous components with different chain lengths. Mycolipenic and mycocerosic acids; for each component, the ions () monitored on negative ion-chemical ionization gas chromatography-mass spectrometry (NICI-GCMS) of pentafluorobenzyl esters of these acids are given. (Courtesy of David E. Minnikin, School of Biosciences, University of Birmingham, Edgbaston, Birmingham, UK.)

Citation: Donoghue H. 2016. Paleomicrobiology of Human Tuberculosis, p 113-130. In Drancourt M, Raoult D (ed), Paleomicrobiology of Humans. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.PoH-0003-2014
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