In 2008, during an archaeological excavation on the medieval site of Montecorvino (Foggia, Puglia, Italy), ten individuals were found buried near the principal church. The tombs were dated to the 13th-14th centuries AD, except for one attributable to the 11th century AD. The individual from tomb MCV2 shows some bone changes in the rhinomaxillary area. The most probable diagnosis is that she suffered from a type of near-multibacillary leprosy. Although leprosy has been documented in Italy from the first millennium BC and well described in the first millennium AD, its presence seems to be confined to Northern and Central Italy. This is the first case of leprosy in southeastern Italy and the second in Southern Italy overall. At the moment, the interesting datum is that leprosy seems to appear in Southern Italy only after the first millennium AD. All this could be because of the First Crusade with the opening of new trade and pilgrimage routes to the Near East or simply because other cases of leprosy have still not been found in osteoarchaeological context.

Leprosy was rare in Europe during the Roman period, yet its prevalence increased dramatically in medieval times. We examined human remains, with paleopathological lesions indicative of leprosy, dated to the 6th-11th century AD, from Central and Eastern Europe and Byzantine Anatolia. Analysis of ancient DNA and bacterial cell wall lipid biomarkers revealed Mycobacterium leprae in skeletal remains from 6th-8th century Northern Italy, 7th-11th century Hungary, 8th-9th century Austria, the Slavic Greater Moravian Empire of the 9th-10th century and 8th-10th century Byzantine samples from Northern Anatolia. These data were analyzed alongside findings published by others. M. leprae is an obligate human pathogen that has undergone an evolutionary bottleneck followed by clonal expansion. Therefore M. leprae genotypes and sub-genotypes give information about the human populations they have infected and their migration. Although data are limited, genotyping demonstrates that historical M. lepr...

a b s t r a c t 48 Leprosy was rare in Europe during the Roman period, yet its prevalence increased dramatically in medi-49 eval times. We examined human remains, with paleopathological lesions indicative of leprosy, dated to 50 the 6th-11th century AD, from Central and Eastern Europe and Byzantine Anatolia. Analysis of ancient 51 DNA and bacterial cell wall lipid biomarkers revealed Mycobacterium leprae in skeletal remains from 52 6th-8th century Northern Italy, 7th-11th century Hungary, 8th-9th century Austria, the Slavic Greater 53 Moravian Empire of the 9th-10th century and 8th-10th century Byzantine samples from Northern Ana-54 tolia. These data were analyzed alongside findings published by others. M. leprae is an obligate human 55 pathogen that has undergone an evolutionary bottleneck followed by clonal expansion. Therefore M. lep-56 rae genotypes and sub-genotypes give information about the human populations they have infected and 57 their migration. Although data are limited, genotyping demonstrates that historical M. leprae from Byzan-58 tine Anatolia, Eastern and Central Europe resembles modern strains in Asia Minor rather than the recently 59 characterized historical strains from North West Europe. The westward migration of peoples from Central 60 Asia in the first millennium may have introduced different M. leprae strains into medieval Europe and cer-61 tainly would have facilitated the spread of any existing leprosy. The subsequent decline of M. leprae in Eur-62

Introduction: Plague has been responsible for two major historic pandemics (6th–8th century CE; 14th–19th century CE) and a modern one. The recent Malagasy plague outbreaks raised new concerns on the deadly potential of the plague-causing bacteria Yersinia pestis. Between September 2014 and April 2015, outbreaks of bubonic and pneumonic plague hit the Malagasy population. Two hundred and sixty-three cases, including 71 deaths, have been reported in 16 different districts with a case fatality rate of 27%. The scope of our study was to ascertain whether the risk factors for health in modern-day populations exposed to plague and in ancient populations that faced the two historic pandemics varied or remained substantially unaltered. Methodology: The risk of mortality of the Malagasy population with those obtained from the reconstruction of three samples of European populations exposed to the historic pandemics was contrasted. Results: The evidence shows that the risks of death are not uniform across age neither in modern nor in historic populations exposed to plague and shows precise concentrations in specific age groups (children between five and nine years of age and young adults). Conclusions: Although in the post-antibiotic era, the fatality rates have drastically reduced, both modern and historic populations were exposed to the same risk factors that are essentially represented by a low standard of environmental hygiene, poor nutrition, and weak health systems.