Thoracic aortic aneurysm in a pre-Columbian (210 BC) inhabitant of Northern Chile: Implications for the origins of syphilis

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Abstract

The aim of this work is to report a probable first case of a thoracic aortic aneurysm in the remains of a pre-Columbian individual from South America and to explore the relationship of this case to the only other paleopathological case previously described. We also consider the implications of both cases for the origins of syphilis. This study is based on the macroscopical analysis of human remains recovered during excavation of the Chiu Chiu 273 prehistoric cemetery, in the Antofagasta Region of Northern Chile. Ceramic sherds from the grave have a thermoluminescence date of 2160 ± 100 A.P. or 210 B.C. The skeletal remains of an adult individual display resorptive lesions in both the sternum and the first two thoracic vertebrae, which are suggestive of a thoracic aortic aneurysm. The lesions observed in the case described are clearly compatible with the development of an aneurysm of the thoracic aorta (ascending portion and arch). We suggest that this aneurysm has a syphilitic etiology, considering the vascular segments compromised, the type of lesions observed, and the prevalent etiology of this kind of cardiovascular pathology in pre-penicillin times. Since the only two cases of thoracic aortic aneurysms reported to date have been found in the Americas and are clearly pre-Columbian, it can be suggested that venereal syphilis was present in the Americas in times before European contact.

Introduction

Acute and chronic aortic diseases have been known for several centuries, with the earliest descriptions of these afflictions dating back to the time of Galen of Pergamon (Hartnett and Beatty, 1947, Ramanath et al., 2009). However, tangible evidence of their existence in bone and mummified remains of ancient populations has been elusive (Aufderheide and Rodríguez Martín 1998; Ortner, 2003), with only one possible case of a thoracic aortic aneurysm having been reported for a skeleton from Saskatchewan, Canada, radiocarbon dated at 2465 + 85 B.P. or 515 B.C. (Walker, 1983), and four additional cases of thoracic aortic aneurysms associated with bone erosion identified in individuals of the Hamann-Todd osteological collection (Kelley, 1979).

A thoracic aortic aneurysm is defined as a restricted dilation of the thoracic aorta (Agarwal et al., 2009). Anatomically, the thoracic aorta consists of three parts: (1) the ascending aorta, which commences at the left ventricle and ends near the sternal angle; (2) the aortic arch, which includes the segment between the sternal angle and the intervertebral disc located between T4 and T5; and (3) the descending aorta, which is the continuation of the arch (Woodbourne and Burkel 1994). The ascending aorta is 5 cm long, the arch 4.5 cm and the descending aorta 20 cm; its diameter is greater at its origin and diminishes gradually towards the distal end (Dotter and Steinberg, 1949; Posniak, 1990). From an epidemiological perspective, aneurysms that compromise the abdominal aorta are more common than those that affect the thoracic aorta (Lilienfeld et al., 1987, Perko et al., 1995).

Before the discovery of penicillin, venereal syphilis was probably the most frequent cause of thoracic aortic aneurysms, especially of the ascending aorta (Brindley and Stembridge, 1956, Heggtveit, 1964, Isselbacher, 2005, Isselbacher, 2007, Roberts et al., 2009). The second most common cause was atherosclerosis and cystic medial degeneration (Brindley and Stembridge, 1956, Heggtveit, 1964, Lilienfeld et al., 1987, Isselbacher, 2005). Other causes include Marfan's Syndrome, familial thoracic aortic aneurysm Syndrome, bicuspid aortic valve, Turner's syndrome, aortic arteritis, aortic dissection, and trauma (Hiratzka et al., 2010).

The aims of this work include presenting the probable first case of a thoracic aortic aneurysm in the remains of a pre-Columbian individual from South America and comparing this example to the case described for Saskatchewan, Canada, dated at 2465 + 85 B.P. or 515 B.C. (Walker, 1983). The differential diagnosis is discussed, as well as the implications of these two cases for the origins of Treponematosis, particularly venereal syphilis.

Section snippets

Materials

The human remains described in this work were recovered by archeologists Benavente and Thomas in 1995 during excavation of the Chiu Chiu 273 prehistoric cemetery (Thomas et al., 2002). The site is located 2.525 m above sea level, in the middle reaches of the Loa River in the Antofagasta Region of Northern Chile (Fig. 1). The cemetery is located within a large area where the bodies and grave goods are buried in circular or oval depressions. The recovered human remains are incomplete or

Sternal and vertebral lesions

The sternum displays resorptive lesions on both the manubrium and body (Fig. 2). The manubrium has a large lesion on the posterior surface associated with a perforation on the anterior aspect that partially compromises the right sternoclavicular joint, while the sternal body displays a circular cortical resorptive lesion (20 mm in diameter) on the left side of the upper third of the posterior surface. Additionally, the bodies of the first and second thoracic vertebrae display resorption,

Differential diagnosis

Given the magnitude and location of the sternal lesions; it is likely that a large mass in the anterior mediastinum compressed the posterior surface of the manubrium and the sternal body on the left side. This chronic compression would also have affected the bodies of the first two thoracic vertebrae. The location and depth of the lesions along with the age and sex of the individual suggests that the most likely cause was an aneurysm of the thoracic aorta affecting both the ascending portion

Conclusions

The sternal and vertebral lesions observed in the case described are clearly compatible with the development of an aneurysm of the thoracic aorta, both in the ascending portion and in the aortic arch. We argue that this aneurysm has a syphilitic etiology, considering the vascular segments compromised (ascending aorta and aortic arch), the type of lesions observed, and the prevalent etiology of this kind of vascular pathology in pre-penicillin times.

Acknowledgements

This article is dedicated to the memory of two wonderful friends Dr. Donald Ortner and Dr. Arthur Aufderheide for their immense contribution to paleopathological research and with whom we discussed this case. In addition, we want to thank Dr. Mary Lucas Powell, Dr. Della Collins-Cook and Dr. Jane Buikstra for their invaluable and enlightening comments on earlier versions of this manuscript. We are also indebted to Viviana Rivas and Manuel Araneda for the photographic work, and Joan Donaghey for

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