Section 4 -

Viral and Fungal Diseases in South America Before Columbus Marvin J. Allison and Enrique Gerszten Virginia Commonwealth University Medical College of Virginia Campus Richmond, Virginia, USA

The liver is the largest solid organ to survive in Andean natural, dried mummies; it is also associated with most blood borne organisms since they must pass through the liver. The livers of numerous Andean mummies also demonstrate cirrhosis when examined microscopically. Therefore the liver is a good organ for the study of possible "persister" viruses and their association with disease in pre-Columbian native populations. Such viruses and some fungi are chronically infective and remain in the human host for the duration of his or her life. They may initially enter the host subclinically or in a mild clinical state, becoming latent, and later after months or years produce a long-term cumulative clinical disease. These organisms are rarely initially lethal (ex. Hepatitis B or Herpes simplex), and readily become well adapted in community life. Method: We have reviewed the livers of 3 populations of Andean populations dating from 1,650 – 500 B.P. looking for the "persister" viruses Hepatitis B and C, Herpes I and II, Cytomegalo virus and Epstein-Barr virus. They were tested using Biogenex monoclonal antibodies and their Super Sensitive Immunodetection system for Streptavidin-Biotin-Alkaline phosphatase-Fast Red to produce color of in-situ antigen detection. Modern positive and negative controls were used, and the presence of DNA in the tissue was demonstrated with an ALU probe. Results: DNA was found in all livers tested in fragments of 200-400 base pairs. Viruses found in in-situ hybridization of liver sections were as follows compared with Black's modern Amazon Indian studies performed in Brazil in 1970: Mummies Modern Amazon Indians HCV 23.03 % HCV was first described in 1989 HBV 19.35 % 56.0% HSVI 54.84 % No antibody available at that time HSV II 96.77 % 95.0 % CMV 16.13% 54.0% EBV 58.0 % 97.0% Currently, HBV and HCV are common among the modern Amazon tribes. The disease is contracted early in childhood with a pre-mature death before the age of 30. A survey of 670 Indians in 37 Amazon communities for HBV found 59% positive with 1.8% active. Males account for 83%. Children under 10 years old were 44.26 % positive, and the chronic carrier rate in children under 5 years old was 14.9%. This is an old disease among the pre-Columbian children where pediatric children's mummified livers were positive in 45.8%, almost identical with Black's modern figure of 44.26 % of children. Infectious diseases with a fungal etiology have been scarce among the Andean mummies, but the following cases have been found: Cases 1 -The mummy of a 56-year-old woman who was found in the Arica area of Northern Chile was autopsied at the University of Chile in Santiago. The lung in her thoracic cavity on the right side was firmly adherent to the costal pleura. A large cavity containing blackish material from a large hemorrhage was present in the upper lobe. The tracheobroncheal lymph nodes were 2 cm. Initially, it was thought to be another case of tuberculosis but Kenyoun stains were negative repeatedly for acid-fast organisms. The lung and lymph nodes were both positive for the yeast form Paracoccidiodes brasiiliensis with numerous "Mickey Mouse" figures and "municioneras" or cartridge belt forms. The disease of South American Blastomycosis in South America has more cases than the few hundred reported annually. This disease is found in rural areas where good medical attention is lacking and is probably diagnosed as tuberculosis based on an X-ray and skin test, which will be positive in 95% of the adult population. Case 2 – An adult woman who died of pneumonia in 1610 (Colonial Period) had lung sections stained with H &E and Gram's stain. Her sections were positive for yeast like organisms with typical pseudohyphae of Candida albicans. This infection today is generally associated with immunological or endocrine diseases. Case 3 – A 25-year-old woman who died 1,200 years ago, underwent a chest X-ray of her mummy bundle that showed calcified tracheobroncheal lymph nodes that could have been part of a Ghon complex, but no primary lesion was present. When she was unwrapped she was found to have extensive nodular lesions of her right breast with a few nodules in her left breast. She was autopsied and found to have just delivered a baby and bled to death from the delivery. Sections of the breast lesion had numerous spheroides and endospores of Coccidiodes immitis. A review of her information suggests that the calcified lung lymph nodes were due to a primary pneumonia of coccidioidomycosis, which was self-healing, only to be reactivated due to her pregnancy. The disease spread to the active tissues of her breast as a result of her pregnancy and the coccidioidomycosis may have caused spontaneous abortion, resulting in her death. This case is the first such case in Peru although there are scatterings of cases in Argentina since the first case was reported there in 1892. There are a few cases reported from other South American countries, but the disease is much more frequent in the United States where in some geographic locations 1:3 people are skin positive. Why are so few cases found in South America when much of the geographic area is similar to California where the fungus is a common soil organism? 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