Three Possible Cases of Melioidosis in Metal Period in Tham Tau Cave, Northern Vietnam

TRẦN Thị Minh1,2*, PHẠM Thành Sơn2, NGUYỄN Anh Tuấn2, LƯU Văn Phú2, Melandri Vlok3, Kimberly A. Plomp1, and Thomas Higham4

Melioidosis is an infection caused by the bacillus Burkholderia pseudomallei. Often fatal, is widely distributed in contaminated soil and water, predominantly in Australia and Southeast Asia. The disease has a wide range of clinical manifestations involving many organs and tissues including the musculoskeletal system, with symptoms ranging from mild localized abscesses to invasive infections. Although it is common today, melioidosis has never been identified in archaeological human remains, and its antiquity remains entirely unknown. Here, we report three possible adult cases of melioidosis from the Metal period (~2800BP) found in Tham Tau cave, Northern Vietnam. All three individuals exhibit areas of abnormal new bone formation and diffuse lysis appearing as micro- and macroporosity on most non-articular surfaces of long bone epiphyses, as well as on their ribs and vertebrae. There are several clear cortical and medullary lytic lesions on the tibia and talus of one individual, and thick cortical new bone indicative of osteomyelitis. The third individual has evidence of severe “cyst-like” abscesses on the right navicular and cuneiforms with associated inflammatory subperiosteal reaction of the non-articular surfaces. We suggest that these three individuals present skeletal lesions most consistent with a melioidosis infection. Furthermore, the development of chronic forms of the condition may have been influenced by important comorbidities such as diabetes and thalassemia. It will have affected daily functioning and mobility of these individuals that required some level of family support, suggesting the presence of caregiving behaviour within their community.