The Evolution of Mycobacterial Disease in Human Populations: A Reevaluation [and Comments and Reply]

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Abstract
The historically documented high susceptibility of Amerindians to tuberculosis following contact with Europeans was long considered evidence that the Amerindians were "naive" with respect to tuberculosis. Since the discovery, in 1973, of acid-fast bacilli in Peruvian mummified tissue, most paleopathologists have accepted that tuberculosis was endemic in these prehistoric communities. In this article, this evidence is reviewed. In addition, skeletal evidence from a recently excavated 17th-century New England Indian cementery and historical reports from this area are presented. It is argued that the traditional concept of "innate" genetically determined resistance resulting from long periods of exposure to tuberculosis may be much less imortant than phenetic resistance resulting from cross-immunization by other mycobacterial species ("atypical" mycobacteria) present as animal pathogens or environmental saprophytes. Accordingly, the apparent high incidence of the disease in certain Amerindian populations may have been the result of enforced changes in ecological and environmental factors rather than of exposure to a new infectious disease.