Hydatid disease (<i>Echinococcosis granulosis)</i> diagnosis from skeletal osteolytic lesions in an early seventh‐millennium <scp>BP</scp> forager community from preagricultural northern Vietnam

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Weighted threshold diagnostic criteria approaches have emerged for diseases that involve skeletal/bony tissue that are readily diagnosed in the field of paleopathology such as Vitamin C deficiency (scurvy), Vitamin D deficiency (rickets) and treponemal disease. These criteria differ from traditional differential diagnosis in that they involve standardized inclusion criteria based on the lesion's specificity to the disease. Here I discuss the limitations and benefits of threshold criteria. I argue that while these criteria will benefit from further revision such as inclusion of lesion severity, and the incorporation of exclusion criteria, threshold diagnostic approaches have considerable value in the future of diagnosis in the field.

Section: Standardizing Terms In the Threshold Diagnostic Approachmentioning

confidence: 99%

Technical note: The use and misuse of threshold diagnostic criteria in paleopathology

Vlok

2023

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“…There were very little differences in the prevalence of non‐specific stress markers such as linear enamel hypoplasia and cribra orbitalia at Man Bac and Con Co Ngua (Oxenham et al, 2018; Oxenham & Domett, 2011). We now know that the inhabitants of Con Co Ngua greatly suffered high infectious disease burdens including malaria, hydatid disease, as well as genetic anemia (Vlok et al, 2021, 2022), which would have obscured the differing nutritional trends contributing to non‐specific stress, and now revealed through investigation for evidence of scurvy in the assemblages. That is, while the morbidity of general physiological stress was similar, the contribution of nutritional and infectious diseases to these stressors differed greatly between Con Co Ngua and Man Bac.…”

Section: Discussionmentioning

confidence: 99%

“…New research has questioned a simplified definition of ‘decline’ in health and revealed a level of epidemiological complexity only visible through the diagnosis of specific infectious diseases. For example, Vlok et al (2020) and (2022) demonstrated a shift from environmentally driven to human driven infectious diseases with the adoption of agriculture in northern Vietnam. This region is a geographical friction zone between forager groups from MSEA and farmers from modern day southern China, eventually leading to both demographic and technological change (Bellwood & Oxenham, 2008; Higham, Guangmao, & Qiang, 2011).…”

Section: Introductionmentioning

confidence: 99%

Scurvy in the tropics: Evidence for increasing non‐adult micronutrient deficiency with the transition to agriculture in northern Vietnam

Vlok

Oxenham

Domett

et al. 2023

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Objective Scurvy in non‐adults was assessed at the Pre‐Neolithic site of Con Co Ngua and the Neolithic site of Man Bac in northern Vietnam to investigate nutritional stress during the agricultural transition in Mainland Southeast Asia (MSEA). Materials One hundred and four human skeletons under the age of 20 years old were assessed. Methods Lesions were recorded macroscopically and radiographically. Differential diagnosis using prior established paleopathological diagnostic criteria for scurvy was conducted. Results There was no clear evidence for scurvy at Con Co Ngua and a high burden of scurvy was present at Man Bac (>79% diagnosed with probable scurvy). Scurvy levels were high across all non‐adult ages at Man Bac indicating significant burden throughout childhood and adolescence. Conclusions No scurvy at Con Co Ngua is consistent with widely available food sources at the peak of the Holocene thermal maximum. High levels of scurvy at Man Bac corresponds with decreased dietary diversity, high pathogen load, and increased population stress with the transition to agriculture around the time of the 4.2 ka desertification event. Significance This is the first systematic population‐level non‐adult investigation of specific nutritional disease in MSEA and demonstrates an increase in nutritional stress during the Neolithic transition in northern Vietnam. Limitations Subperiosteal new bone deposits can be due to normal growth in infants and young children, therefore, identification of scurvy in children under the age of 4 years needs to be considered critically. Suggestions for Further Research Further work in diagnosing specific nutritional disease in other non‐adult cohorts throughout MSEA is required.

“…Iron deficiency induced by parasites, including hookworm and roundworm, also contribute to high iron deficiency anemia morbidity in Southeast Asian children (Loukas et al, 2016). It should be noted that hydatid disease, caused by a parasitic tapeworm, was a significant burden at Con Co Ngua (Vlok et al, 2022); however, while anemia is commonly observed in infected individuals, it tends to be anemia of chronic disease/infection (Krige & Beckingham, 2001) which is not associated with the mechanisms that can lead to cribra orbitalia (Oxenham & Cavill, 2010).…”

Section: Discussionmentioning

confidence: 99%

Paleoepidemiology of cribra orbitalia: Insights from early seventh millennium BP Con Co Ngua, Vietnam

Wang

McFadden

Buckley

et al. 2023

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Objectives We test the hypothesis that the condition(s) leading to the development of cribra orbitalia at Con Co Ngua, an early seventh millennium sedentary foraging community in Vietnam, effectively reduced the resilience of the population to subsequent health/disease impacts. An assessment of both the implications and potential etiology of cribra orbitalia in this specific population is carried out. Methods The effective sample included 141 adults aged ≥15 years (53 females, 71 males, and 17 unknown sex) and 15 pre‐adults aged ≤14 years. Cribra orbitalia was identified by way of cortical bone porosity of the orbital roof initiated within the diplöic space, rather than initiated subperiosteally. The approach is also robust to the misidentification of various pseudo‐lesions. Resultant data was analyzed using Kaplan–Meier survival analysis. Results Median survival is higher in adults aged ≥15 years without cribra orbitalia than those with this lesion. For the pre‐adult cohort, the opposite pattern is seen where median survival is higher in those with cribra orbitalia than those without. Conclusion Adults displayed increased frailty and pre‐adults increased resilience with respect to cribra orbitalia. The differential diagnosis for a survival analysis of adults and pre‐adults with and without cribra orbitalia included iron deficiency anemia and B12/folate deficiency, parasitism (including hydatid disease and malaria) in addition to thalassemia. The most parsimonious explanation for observed results is for both thalassemia and malaria being the chief etiological agents, while appreciating these conditions interact with, and can cause, other forms such as hematinic deficiency anemias.