1. A possible case of meningitis in a young child, from the medieval/modern necropolis in Santa Maria do Olival, Tomar (Portugal)
Cláudia Relvado1*, Teresa Fernandes2,3, Eugénia Cunha1,3
1Departamento de ciências da vida da Universidade de Coimbra
2Departamento de Biologia e Centro de Ciências e Tecnologias da Saúde, Universidade de Évora
3CIAS
Abstract:
This study reports a young child skeleton, exhumed from a medieval/modern necropolis of Santa Maria do Olival, Tomar (Portugal). This skeleton shows unusual blood vessel impressions on the endocranio, porosity and new bone formation in cranial and post-cranial skeleton. These intracranial marks are compatible with cases of meningitis. Changes in the meninges can occur due to various factors. Although it’s very challenging to determine the etiology of meningitis, when we analyzed the skeleton, we were able to exclude some diseases such as syphilis, scurvy and rickets. Leaving the most probable explanations as bacterial and viral infections.
Key-word: non-adult, endocranial lesions, infection, paleopathology
Introduction:
The study of non-adults is extremely important to understand the past living conditions, due to their sensitivity to environmental conditions. Unfortunately, the scarcity of non-adults in the archaeological record, their poor preservation and fast deaths during the acute phase of the disease hinders its paleopathological study. The acute meningitis is prevalent today and usually kills an individual too rapidly, but there are documentary evidences of children who survived many weeks with a meningeal infection(Lewis, 2006). The role of meningeal diseases in the mortality of infants and children in past populations was frequently underestimated (Lewis, 2007; Ortner, 2003)
Material and methods:
This study reports a young child skeleton exhumed from a medieval/modern necropolis (13th-18th centuries) of Santa Maria do Olival, Tomar (Portugal).
The age to death was determined through formation and eruption of tooth (AlQhatani et al., 2010). The preservation was calculated through the anatomical preservation index (Dutour 1989 in Bello et al, 2006). The skeleton was subjected to morphological and morphometric analysis.
Results and Discussion:
The age of death is approximately 1.5 years old and the anatomical preservation index is 27.9%, poorly preserved.
The skull :
The inner surface of the occipital (figure 1) and parietal bone (figure 2) show reactive new bone formation.
The pars basilaris was changed by
taphonomy but also has signs of an
inflammatory process revealed by mild
porosity in all bone.
The pars petrous had porosity too
(figure 3).
Post-cranial skeleton:
Porosity in three vertebrae, two ribs and the left ilium (figure 4).
New bone formation in the diaphysis of femurs and tibias (figure 5).
The hummers shows porosity in metaphysis, cribra humeralis.
The skeleton doesn’t show any changes in orbital and ectocranium. The others bones present (clavicle, scapula, scapula, right ilium, fibulas and the remaining ribs and vertebrae) are normal.
The diagnostic differential includes congenital syphilis, anemia, scurvy, rickets, meningitis.
Congenital syphilis:
Congenital syphilis can lead to an acute meningitis, the base of the skull is particularly affected and there can even occur new bone formation in cranial vault. Tibia, ulna and radio are frequently affected. They can show osteochondritis and periostitis. The dental defects as Hutchinson's teeth's and Moon's (Lewis, 2004; Ortner, 2003).
The skeleton shows new bone formation in the tibia but not registered dental defects or osteochondritis.
Scurvy:
Deficiency of vitamin C, affects the production of collagen fiber.
The changes in the bones result mainly from two factors: hemorrhage and production of new bone by the periosteum. The skull shows frequently porotic hyperostosis in cranial vault, also can occur in the orbital walls, the sphenoid, the maxilla and the jaw (Paredes et al., 2014; Ortner 2003). New bone deposition, can occur changes in the metaphysis of long bones, transverse fractures in the osteochondral junction of ribs and a subperiosteal hemorrhage in the pelvis and scapula (Ortner, 2003) can rarely occur.
the skeleton has some porosity corresponding to the lesions described in scurvy, but has no porous changes in ectocranium, orbital walls, jaw, and the metaphyses of long bones are not affected
Rickets:
Vitamin D deficiency, results inadequate mineralization of bone during growth.
Changes in osteocartilaginous junction of ribs, distal metaphysis of femur, radio and ulna and proximal metaphysis of hummers. The skull has a porous appearance, changes in facial bones can occur. In long bones can occur porosity, stress fractures and deposition of new bone. The ribs can suffer deformity and the vertebrae can occur compression and collapse (Ortner, 2003).
Porosity in some bones. The skeleton doesn’t shows any bone deformation.
Meningitis:
Meningitis is an acute inflammation of the meninges. The most common pathogens are: Haemophilus influenza type b (HIB), Streptococcus pneumonia and Neisseria meningitidis often resulting in meningococcal meningitis. Viruses and fungal agents have also been identified as causative agents and meningitis. In areas of the skull vault affected by a focus of relatively large meningeal inflammation, characteristic impressions of atypical blood vessels can occur (Lewis, 2004; Paredes et al, 2014). In specific meningitis (meningitis tuberculosis) occur the changes above, but also by a small granular impression, whose diameter varies between and mm, which may be filled at the bottom with lamellar bone ( Ortner 2003; Paredes et al, 2014)
The skeleton has signs of an inflammatory process, by macroscopic observation it is difficult observe the existence of granular impression or not.
Conclusions:
All the conditions described above can lead to a reaction in meninges. It’s very it’s very challenging to determine the etiology of meningitis. The lack of dental defects, porosity in ectocranium and deformed bones are some of the reasons that lead us to believe that the most likely diagnosis is of bacterial or viral meningitis. A DNA analysis could help clarify the ethology of these changes.
Bibliography:
AlQahtani, S. J.; Hector, M. P.; Liversidge, H. M Brief Communication: The London Atlas of Human Tooth Development and Eruption. American Journal of Physical Anthropology, 142:481–490.
Bello, S. M.; Thomman A.; Signoli, M.; Dutour, O.; Anderws P Age and sex bias in reconstruction of past populations structures. American Journal of Physical Anthropology, 129:24-38.
Lewis, M. E Endocranial Lesions in Non-adult Skeletons: Understanding their Aetiology. International Journal of Osteoarchaeology, 14: 82–97.
Lewis, M. E The bioarchaeology of children: Perspectives from biological and forensic anthropology. Cambridge. Cambridge University Press.
Ortner, D.J., (2003). Identification of Pathological Conditions in Human Skeletal Remains. 2ª Edition. San Diego. Academic Press.
Paredes, J.; Ferreira, M. T.; Wasterlain, S. N Early illness: a possible case of meningitis in a modern child from the
wheel of Santa Casa da Misericórdia(Faro, Portugal). Cadernos do GEEvH, 2 (2):
Figure 2: Endocranial lesions in Parietal Bone
Figure 1: Endocranial lesions in occipital bone
Figure 3: Porosity in pars petrous
Figure 5: Right tibia (posterior view)
Figure 4: Porosity in left ilium