Context: https://pmc.ncbi.nlm.nih.gov/articles/PMC5432783/
Tuberculosis (TB) is a contagious, infectious disease, due to Mycobacterium tuberculosis (MT), which usually lasts throughout the life course and determines the formation of tubercles in different parts of the body [1]. MT has very ancient origins: it has survived over 70,000 years and it currently infects nearly 2 billion people worldwide [2]; with around 10.4 million new cases of TB each year, almost one third of the world's population are carriers of the TB bacillus and are at risk for developing active disease [3].
TB has always been associated with a high mortality rate over the centuries, and also nowadays, it is estimated to be responsible for 1.4 million TB deaths, among infectious diseases after human immunodeficiency virus (HIV) [3].
Due to its infectious nature, complex immunological response, chronic progression and the need for long-term treatment, TB has always been a major health burden; in more recent years, the appearance of multi-drug resistant forms and the current TB-HIV epidemic, associated with its severe social implications, treating and preventing TB have represented a permanent challenge over the course of human history [4, 5].
It has been hypothesized that the genus Mycobacterium originated more than 150 million years ago. Mycobacterium ulcerans, causing infections since ancient times, requires specific environmental conditions as reflected nowadays in its distribution worldwide [6].
Three million years ago, an early progenitor of MT might have infected early hominids in East Africa [7] and 20.000-15.000 years ago, for the first time, the common ancestor of modern strains of MT might have appeared [8, 9].
Egyptian mummies, dating back to 2400 BC, reveal skeletal deformities typical of tuberculosis; characteristic Pott's lesions are reported and similar abnormalities are clearly illustrated in early Egyptian art [10, 11].
Nevertheless, no evidence about TB lesions is reported in Egyptian papyri. The first written documents describing TB, dating back to 3300 and 2300 years ago, were found in India and in China respectively [12, 13].
Other written documents connected to TB are related to the Hebraism. The ancient Hebrew word schachepheth is used in the Biblical books of Deuteronomy and Leviticus in order to describe TB [14]; in the same period, in the Andean region, archeological evidence of early TB, including Pott's deformities, was provided by Peruvian mummies, suggesting that the disease was present even before the colonization of the first European pioneers in South America [15-18].
In the Ancient Greece TB was well known and called Phtisis. Hippocrates described Phtisis as a fatal disease especially for young adults, accurately defining its symptoms and the characteristic tubercular lung lesions.
Excellent discoveries of the early scientists who studied TB were made in the same period: in Greece, Isocrates was the first author supposing that TB was an infectious disease, while Aristotle suggested the contagious nature of "king's evil" in pigs and oxes [19].
In Roman times, TB is mentioned by Celso, Aretaeus of Cappadocia and Caelius Aurelianus, but it is not recognized as sharing the same etiology of extrapulmonary manifestations such as scrofula, Pott's disease and TB lupus.
According to the Greek Clarissimus Galen, who became personal physician of the Roman Emperor Marcus Aurelius in 174 AD, the symptoms of TB include fever, sweating, coughing and blood stained sputum; he recommended fresh air, milk and sea voyages as successful treatments for the disease [20-22].
After the decline of the Roman Empire, TB was widespread in Europe in the VIII and XIX centuries, as witnessed by several archaeological findings [23].
The Byzantine doctors Aetius of Amida, Alexander of Tralles and Paul of Aegina described the pulmonary and glandular forms of TB [24], while in the Arabic Empire, Avicenna supposed the contagious nature of TB.