Bioarchaeologists and palaeopathologists have recently turned their attention towards one critical aspect of the study of the history of disease: health-related caregiving. In response, an approach, the bioarchaeology of care, and, within it, the web-based Index of Care (IoC) have been developed to enable the identification and interpretation of past caregiving. Here, we apply the IoC to Burial 86, a young adult (18–25 years) female from the late Mississippian period, Dallas cultural phase Holliston Mills site (40HW11; ca. ad 1348–1535), TN. Burial 86 exhibits pathologies specific to treponematosis. They also exhibit a suite of pathologies indicative of physical impairment, including a varus angular deformity in the right tibia that is potentially the result of a malaligned pathological fracture. Following the IoC, we determine that Burial 86 probably experienced moderate clinical impacts on several domains (e.g., musculoskeletal system) with various functional impacts on essential activities of daily living. This means that Burial 86 likely had a disability and likely received caregiving, though it is impossible to determine if the care was efficacious. That care was provided likely reflected the community of Holliston Mills' more egalitarian socio-political structure, which was unusual for the late Mississippian. It may also reflect Burial 86's agency, the presence of adequate resources at the site, as indicated by high frequencies of high status mortuary artifacts, or a combination of these factors. The mortuary program for Burial 86 does not indicate that they were marked as being different—in status or other social categories—than other community members. This study highlights how bioarchaeological evidence can be used to explore the downstream effects of chronic infections, such as treponematosis, throughout the body and across the life course, and the opportunities for health-related caregiving in past societies that these processes can potentially create.

Foram testadas, com o teste não treponêmico VDRL e com o teste treponêmico imunoenzimático de competição, 23.531 amostras de soros, coletados em todas as regiões do Brasil, com o objetivo de verificar o comportamento do teste imunoenzimático treponêmico na triagem de amostras. A prevalência obtida foi de 0,63% com o VDRL e de 0,84% para o teste imunoenzimático. A análise dos dados foi feita comparando-se os resultados dos dois testes com os resultados do teste treponêmico de imunofluorescência indireta (FTA-ABS), considerado como teste de referência. No total, 1120 amostras foram submetidas ao teste FTA-ABS, incluindo todas as que foram reagentes em qualquer um dos testes de triagem e 872 amostras negativas. Amostras com resultados discordantes entre os testes foram submetidas a um teste imunoenzimático do tipo Western blot. Nas amostras por nós estudadas, o teste imunoenzimático apresentou sensibilidade de 89,95% e especificidade de 99,78%, muito superior aos 55,11% de sensibilidade e 97,43% de especificidade que encontramos para o VDRL. Os resultados dos testes detectaram positividade em amostras diferentes portanto, recomendamos utilizar a associação dos dois testes, como método de triagem, quando se trata de populações de baixa prevalência. Resultados preliminares do Western blot sugerem a participação doas proteínas de 43 kD, 17 kD e 15,5 kD na reação de ELISA treponêmico competitivo. / The VDRL, a non treponemal test, and a treponemal competitive ELISA were used to test 23,531 serum samples, collected from conscript men throughout Brazil, with the objective of assessing the performance of the competitive ELISA on the screening of serum samples. The VDRL showed a prevalence of 0.63% contrasting with a 0.84% prevalence showed by the competitive ELISA. The results obtained with the two tests were then compared to those obtained by fluorescent treponemal antibody absorption (FTA-ABS) test which is considered the gold standard method for detection of antibodies for syphilis. A total number of 1,120 samples, which included all that were reagent in at least one of the screening test plus 872 that were negative in both tests, were submitted to the FTA_ABS test. In addition, some of the samples that presented discrepant results between the two tests studied were also submitted to the Western blot test. The results of the screening tests showed an 89.95% sensitivity and a 99.78% specificity for the competitive ELISA, which are much higher than the 55.11% sensitivity and 97.43% specificity presented by the VDRL. Also, the tests detected positivity in different samples. In conclusion, we recommended the use in tandem of both tests as screening for syphilis antibodies in low prevalence populations. In addition, the results of the Western blot seemed to suggest the positivity of the ELISA becoming non reactive after treatment of the patient and that the 43 kD, 17 kD and 15 kD proteins are the main proteins involved in the ELISA competitive reaction.

Foram testadas, com o teste não treponêmico VDRL e com o teste treponêmico imunoenzimático de competição, 23.531 amostras de soros, coletados em todas as regiões do Brasil, com o objetivo de verificar o comportamento do teste imunoenzimático treponêmico na triagem de amostras. A prevalência obtida foi de 0,63% com o VDRL e de 0,84% para o teste imunoenzimático. A análise dos dados foi feita comparando-se os resultados dos dois testes com os resultados do teste treponêmico de imunofluorescência indireta (FTA-ABS), considerado como teste de referência. No total, 1120 amostras foram submetidas ao teste FTA-ABS, incluindo todas as que foram reagentes em qualquer um dos testes de triagem e 872 amostras negativas. Amostras com resultados discordantes entre os testes foram submetidas a um teste imunoenzimático do tipo Western blot. Nas amostras por nós estudadas, o teste imunoenzimático apresentou sensibilidade de 89,95% e especificidade de 99,78%, muito superior aos 55,11% de sensibilidade e 97,43% de especificidade que encontramos para o VDRL. Os resultados dos testes detectaram positividade em amostras diferentes portanto, recomendamos utilizar a associação dos dois testes, como método de triagem, quando se trata de populações de baixa prevalência. Resultados preliminares do Western blot sugerem a participação doas proteínas de 43 kD, 17 kD e 15,5 kD na reação de ELISA treponêmico competitivo. / The VDRL, a non treponemal test, and a treponemal competitive ELISA were used to test 23,531 serum samples, collected from conscript men throughout Brazil, with the objective of assessing the performance of the competitive ELISA on the screening of serum samples. The VDRL showed a prevalence of 0.63% contrasting with a 0.84% prevalence showed by the competitive ELISA. The results obtained with the two tests were then compared to those obtained by fluorescent treponemal antibody absorption (FTA-ABS) test which is considered the gold standard method for detection of antibodies for syphilis. A total number of 1,120 samples, which included all that were reagent in at least one of the screening test plus 872 that were negative in both tests, were submitted to the FTA_ABS test. In addition, some of the samples that presented discrepant results between the two tests studied were also submitted to the Western blot test. The results of the screening tests showed an 89.95% sensitivity and a 99.78% specificity for the competitive ELISA, which are much higher than the 55.11% sensitivity and 97.43% specificity presented by the VDRL. Also, the tests detected positivity in different samples. In conclusion, we recommended the use in tandem of both tests as screening for syphilis antibodies in low prevalence populations. In addition, the results of the Western blot seemed to suggest the positivity of the ELISA becoming non reactive after treatment of the patient and that the 43 kD, 17 kD and 15 kD proteins are the main proteins involved in the ELISA competitive reaction.

Treponema pallidum (T. pallidum) is the bacteria that causes syphilis, which is a sexually transmitted disease that might give the carrier a multisystemic infection. A combination of serological tests is needed to put a diagnosis of T. pallidum infection, because the bacteria cannot be cultured in vitro. Serological tests categorize intro nontreponemal test and treponemal test, which both are needed for a correct diagnosis. The principle of a nontreponemal test is the measure of antibodies directed towards lipoid antigens, whereas the principle of a treponemal test is the measure of antibodies directed towards specific T. pallidum antigens. One kind of a treponemal test that are used are treponemal antibody test which is a manual agglutination test. At Sundsvall County hospital TP-PA was used for detection of antibodies, this kit is no longer available for purchase which means that a new kit must be validated to take its place. The purpose of this study was to evaluate the possible replacing kit, TP-HA. To validate TP-HA, ten positive serum samples were analyzed and compared with the two kits. A positive kit-control were also used to confirm the results of this study. The results showed that TP-PA was more sensitive than TP-HA according to a Wilxocon ranking test (p<0.05). Because TP-PA has to be replaced due to stricter in vitro diagnostic regulation (IVD-R laws), TP-HA will be taking its place even though it differs in sensitivity. This might effect tests with a lower titre, they might give a negative result even though the test has a low concentration of antibodies which needs to be further evaluated.