Molecular Biomarkers for Ancient Tuberculosis

Tuberculosis is an ancient disease. It was recognised and described by Hippocratus (460–390 BCE) and Galen (2nd–3rd century CE) in the western Classical World (Xarchus & Bourandas, 2003), ancient Egypt, India and the Far East (Morse, 1961). The obvious symptoms that attracted attention were the late outcomes of skeletal tuberculosis, where collapsed vertebrae led to scoliosis and Pott's disease, plus the symptoms associated with pulmonary tuberculosis, such as fever, weight loss and haemoptysis (coughing up blood). In the UK, tubercular lesions of the lymph glands (cervical lymphadenitis) were formerly termed scrofula, or the King's evil, and tubercular skin lesions were described as Lupus vulgaris or tuberculous chancre. The palaeopathology of ancient skeletal remains, together with classical and historical reports, demonstrate that tuberculosis occurred in prehistory. However, tuberculosis is still the greatest cause of death from any single infectious disease in the world today, with over one third of the global population infected and an estimated 1.7 million deaths from the disease in 2009 (WHO, 2010). Therefore it is essential to understand the nature of tuberculosis in the past: its distribution, spread and relationship to human society.