title: A case of spinal tuberculosis from the middle ages in Transylvania (Romania).
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To characterize the paleopathology presented in the skeleton of a 45- to 50-year-old man indicative of tuberculous spondylitis and to confirm by the detection of ancient DNA.
  
  
  BACKGROUND
  Tuberculosis (TB) is an infectious disease prevalent in both present and ancient human populations. The disease is primarily located within the lungs; although characteristic bone lesions can lead to a clear diagnosis, skeletal TB occurs in only 5% to 6% of TB infections, even in historical cases. In addition, the visual appearance of human skeletal remains may be influenced by the environmental conditions at the burial site. However, it is important to recognize ancient skeletal TB because it can provide important data on the history of Mycobacterium tuberculosis and give a unique opportunity for physicians to observe the natural outcome of the infection of the preantibiotic era.
  
  
  METHODS
  Paleopathological analysis was carried out using careful visual observation supported by ancient DNA analysis. Approximately 60 mg of bone powder from rib fragments was examined and DNA from the M. tuberculosis complex was detected by polymerase chain reaction (PCR) targeting specific genetic loci of the IS6110 and IS1081 regions.
  
  
  RESULTS
  The skeleton is part of a human osteoarchaeological collection (n = 274) from the 12th- to 13th-century Transylvanian archaeological site of Peteni, in modern-day Romania. The individual, a 45- to 50-year-old man, showed gross pathology typical of tuberculous spondylitis. The paleopathological diagnosis was supported by analysis for M. tuberculosis complex ancient DNA.
  
  
  CONCLUSIONS
  This case demonstrates that TB was present in Transylvania (Romania) during the 12th and 13th centuries and adds to the growing body of knowledge on the history of this disease.
authors.affiliation: Department of Biological Anthropology, Institute of Biology, Faculty of Science, Eötvös Loránd University, Pázmány Péter sétány 1/C, H-1117 Budapest, Hungary. hajdut@elte.hu
authors.forename: Tamás
authors.initials: T
authors.lastname: Hajdu
authors.forename: Helen D
authors.initials: HD
authors.lastname: Donoghue
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Bernert
authors.forename: Erzsébet
authors.initials: E
authors.lastname: Fóthi
authors.forename: Ivett
authors.initials: I
authors.lastname: Kővári
authors.forename: Antónia
authors.initials: A
authors.lastname: Marcsik
mesh_terms: D000328:Adult; D001483:Base Sequence; D004269:DNA, Bacterial / Q000302:isolation & purification; D049691:History, Medieval; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009169:Mycobacterium tuberculosis / Q000235:genetics; D010164:Paleopathology; D016133:Polymerase Chain Reaction; D012383:Romania; D017422:Sequence Analysis, DNA; D013131:Spine / Q000382:microbiology / Q000473:pathology; D013166:Spondylitis / Q000175:diagnosis / Q000266:history* / Q000382:microbiology; D014399:Tuberculosis, Spinal / Q000150:complications / Q000175:diagnosis / Q000266:history* / Q000382:microbiology
chemical_list: D004269:DNA, Bacterial