Diagnóstico imagiológico de um caso provável de osteomielite em uma criança de 9 meses do Brasil pré-histórico: uma breve história sobre cuidados de saúde na antiguidade
DOI:
https://doi.org/10.24215/18536387e099Palavras-chave:
formação de osso novo periosteal, doença infecciosa, paleopatologia de não-adultosResumo
O Indivíduo 9 (9 ± 3 meses) do sítio Toca do Enoque, Holoceno médio (6650-6170 anos AP), Piauí (Brasil), mostrou mudanças ósseas patológicas significativas e recebeu um tratamento mortuário excecional. Estudos prévios inferiram cuidados de saúde especiais, embora o diagnóstico diferencial manteve-se indefinido. Este estudo reexamina esse diagnóstico patológico utilizando radiografias, tomografias e reconstruções 3D de 10 ossos longos. As mudanças patológicas incluíram crescimentos ósseos endocranianos e formações bilaterais e assimétricas de osso novo subperiosteal, que afetaram os ossos longos e as costelas. A tíbia direita mostrou deformidade ânteromedial e perfurações centrífugas com rebordos dentados e rebarbas. A imagiologia revelou Linhas de Harris no úmero esquerdo, proliferação óssea endosteal nas tíbias, úmeros e rádio direito, assim como perda de densidade cortical na tíbia direita. Conexões entre os espaços medular, subperiosteal e externo sugerem caraterísticas de cloaca ou abscessos. As manifestações tibiais sugerem a formação de involucrum sem sinais de sequestra, sendo consistente com uma osteomielite (OM) neonatal/infantil aguda hematogênica. Embora seja extremamente raro, as cloacas podem surgir em idades precoces sob circunstâncias específicas, tais como a OM crônica neonatal/infantil. Atrasos na evacuação do pus, aliados à amamentação, resiliência e cuidados de saúde, podem ter prolongado tanto a vida do Indivíduo 9, quanto a duração da infeção. Este possível caso de OM neonatal/infantil é raro e valioso, podendo ser o mais jovem documentado em Paleopatologia e o primeiro no continente americano. No entanto, lesões inespecíficas nas costelas e na superfície endocraniana não excluem a presença de comorbilidades. A ampliação do conjunto de estudos de caso é essencial para aprimorar os diagnósticos na investigação bioarqueológica e paleopatológica.
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