Malaria and the Boy Pharaoh

Tut receiving flowers. Note the staff he in his hand. (Wikipedia Commons)

An international team led by Egyptologist Zhai Hawass published the most comprehensive molecular and pathological analysis of a set of Egyptian mummies to date this week. The central figure of the investigation is the boy Pharaoh Tutankhamun.

The molecular analysis produced the most new and intriguing evidence. DNA extraction and PCR analysis was successful on 11 royal mummies believed to be relatives of Tut and five control mummies. From the analysis a 5 generation family tree was constructed that runs from Tut’s great grandparents to two of his own stillborn daughters. Tut was the product of a brother-sister marriage and his children are also products of brother-sister marriage. This inbreeding may have contributed to the end of dynasty with Tut’s early death at about age 19 and his only known children, two stillborn daughters.

The most important discovery made was that four of the 16 mummies tested had Plasmodium falciparum, tropical malaria, infections. Following up on a skin blemish of Tut’s cheek, the mummies were tested for plague, malaria, tuberculosis, leprosy, and leishmaniasis. The only infection detected was malaria. Hawass et al had a second laboratory confirm these results with different biopsies. They were able to amplify alleles from three malarial genes: STEVOR, AMA1 and MSP1. Polymorphisms indicated that Tut and his great-grandfather Yuya had multiple infections; this is common in a majority of modern infections as well. Hawass et al note that it is impossible to tell if malaria was epidemic or endemic in ancient Egypt. It also can not be concluded the role malaria may have played in the deaths of these four people; Tut’s infected great-grandparents were over 50 at their deaths. If malaria was endemic, then the most susceptible to it would likely die young.

The malaria results are significant for two reasons: first, at 3300-3400 years old, this is the oldest datable malaria DNA ever detected, and second, there is no evidence of malaria (signs and symptoms or medical treatment) in Egyptian texts from the period. However, there is some evidence of mosquitoes in Lower Egypt, and the marshes of the Nile delta and its flood plain are good breeding grounds for the Anopheles mosquito.

Pathological analysis revealed some skeletal deformities including a cleft palate in Tut and his father Alkhenaten, and clubfoot in Tut, his grandfather Amenhotep III, and two of Tut’s sisters but not Marfan’s syndrome or evidence of feminizing disorders as has been speculated. It is unclear how much of an impact Tut’s mild cleft palate would have had on his life. Not all mild cleft palates like Tut’s affect speech, but it would have made him more prone to sinus infections.  Tut also had active bone disease (aseptic bone necrosis) in his non-clubfoot at the time of his death suggesting that he had been disabled for sometime, consistent with the many canes and staffs in his tomb. Some of the 130 canes and staves in his tomb show wear, suggesting that at least some of them were used in his lifetime.

The ultimate cause of death is unclear. His unhealed broken leg is probably the main contributing factor in his death. Between the clubfoot on one leg and the other broken leg, he may not have been able to walk for some time. Malaria would have significantly weakened him, probably producing chronic anemia. When malaria is involved, it is usually a contributing or secondary factor rather than the primary cause of death. Immobility would have left him susceptible for more common infectious diseases like pneumonia that would not have left traces on his remains.

Hawass et al (2010, p. 646) summarize Tut’s medical condition in the following way:

“Tutankhamun had multiple disorders, and some of them might have reached a cumulative character of an inflammatory, immune-suppressive– thus weakening — syndrome (Table 3). He might be envisioned as a young but frail king who needed canes to walk because of the bone-necrotic and sometimes painful Kohler disease II, plus oligodactyly (hypophalangism) in the right foot and clubfoot on the left. A sudden leg fracture possibly introduced by a fall might have resulted in a life-threatening condition when a malaria infection occurred. Seeds, fruits, and leaves found in the tomb, and possibly used as medical treatment, support this diagnosis (eAppendix, eFigures 3D and 3E).

Considering that he had multiple malarial infections, I would suggest that the malaria probably pre-dated the fall. Indeed, with his crippled condition a malarial fever could have contributed to his fall.

This study advances what is possible for molecular archaeology. Beyond what this type of work can tell us about the individuals studied, it broadens our ability to study the evolution of infectious disease. Not only can we confirm the existence of a pathogen in the past but we may be able to recover extinct DNA sequences that shed light on the evolution of the organism.

References:

ResearchBlogging.org

Hawass Z, Gad YZ, Ismail S, Khairat R, Fathalla D, Hasan N, Ahmed A, Elleithy H, Ball M, Gaballah F, Wasef S, Fateen M, Amer H, Gostner P, Selim A, Zink A, & Pusch CM (2010). Ancestry and pathology in King Tutankhamun’s family. JAMA : the journal of the American Medical Association, 303 (7), 638-47 PMID: 20159872

These discoveries will be the focus of a Discovery Channel special “King Tut Unwrapped” that premieres tonight,  February 21, 2010.

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