Thoracic aortic aneurysm in a pre-Columbian (210 BC) inhabitant of Northern Chile: Implications for the origins of syphilis
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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Treponematosis in a pre-Columbian hunter-gatherer male from Antofagasta (1830 ± 20 BP, Northern Coast of Chile)
2020, International Journal of PaleopathologyCitation Excerpt :However, Rogan and Lentz (1994) analysed ribosomal DNA of Treponema extracts of four of the 51 individuals examined by Standen and Arriaza and proposed the possible presence of venereal syphilis after finding Treponema pallidum as the closest genetic match of the spirochete sequence, hence suggesting that “ancient treponematosis in Chile may have been due to a spirochete similar, but not identical, to T. pallidum” (p., 172). Recently, the presence of venereal syphilis in Northern Chile has been re-assessed after the report of an adult male dated to 2160 + 100 BP recovered from a site near the city of Calama (Chiu Chiu 273), which has sternal and vertebral lesions compatible with the development of a thoracic aortic aneurysm of (venereal) syphilitic origin (Castro et al., 2016). It must be noted that the distance between Chiu Chiu and Antofagasta, where the case described here was recovered, is about 250 km, and several archaeological studies have demonstrated exchanges between coastal and highland groups in the Antofagasta area (Pimentel et al., 2011; Pestle et al., 2015) (see Appendix A).
Circulatory, reticuloendothelial, and hematopoietic disorders
2019, Ortner's Identification of Pathological Conditions in Human Skeletal RemainsAdvancing the understanding of treponemal disease in the past and present
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