Biology Reference
In-Depth Information
2002;
Pfeiffer and Crowder, 2004; Pinhasi et al., 2006
), it is only recently that osteomalacia (i.e.,
adult vitamin D deficiency) has (e.g., Brickley et al., 2005,
2007
).
Periostitis and Differential Diagnosis
Reactive bone indicative of infection, trauma, or inflammation can occur anywhere on the
skeleton. On the long bones it displays as shaft thickening, as rough striated exterior surface,
and/or new bone deposition (woven bone). It can also occur as discrete pitted lesions or
areas of pitting. Sometimes this reactive change is localized, that is, restricted to one bone.
Periostitis can also occur on multiple bones, often bilaterally. Most cases of periostitis are non-
diagnostic (meaning that a nonspecific infection is indicated). However, certain specific
diseases have predilections to certain bones and/or additionally display with pathogno-
monic or diagnostic features. These include diseases of bioarchaeological significance such
as tuberculosis, leprosy, treponemal disease, and brucellosis.
Tuberculosis
Tuberculosis is an infectious respiratory disease indigenous to both the Old and New
Worlds caused by a bacterium of the genus Mycobacterium. The paleopathological interest
in the disease stems from its association with concentrated aggregate living and poor
community health as well as its reputed high mortality and morbidity (
Roberts and Buikstra,
2003; Stone et al., 2009
). It also has an epidemiological history that includes an inexplicable
pre-antibiotics drop in prevalence in Europe after the nineteenth century (
Roberts and Buik-
stra, 2003
). Although a chronic respiratory disease, it disseminates via the bloodstream
throughout the body with a predilection for the visceral surface of the ribs, the broad ends
of long bones (i.e., metaphyses), certain joints (knee, hip, elbow), and bones of the hands
and feet.
For the most part, the reactive changes are nondiagnostic. However, the disease is most
characteristically evident in the spine. Cavitating (hole-forming) lesions on the anterior verte-
bral body are a precursor to the diagnostic sharply angled vertebral column collapse
(referred to as a kyphosis or gibbus) known as Pott's disease (Aufderheide and Rodr
´
guez-
Mart
´
n, 1998;
Ortner, 2003
). However, this same pattern of vertebral destruction occurs in
the fungal infections blastomycosis (North America) and actinomycosis (worldwide) except
that the former differentially displays cavitations on the dorsal surface and the latter differ-
entially involves more vertebral surfaces (articular facets, transverse and spinous processes)
(Kelly and Eisenberg, 1987;
Mann and Hunt, 2005
).
Brucellosis
An OldWorld disease with a predilection for vertebral bodies of bioarchaeological interest
is brucellosis. It is a disease associated with the consumption of dairy products or meat
(cattle, horses, sheep, goats) and has a considerable antiquity (Capasso, 1999; D'Anastasio
et al., 2011;
Mutolo et al., 2012
). Ideally it is distinguishable from tuberculosis by the lack
of vertebral collapse and cavitating lesions that exhibit reparative reactive bone (Zimmerman
and Kelly, 1982).
But, despite the existence of nuanced differences between these pathologies that predilect
the vertebrae, the perennial problem of poor preservation can prevent confident diagnosis
(e.g.,
Mays et al., 2001
), a frustration that all diagnosticians encounter. Fortunately, genetic
