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Whilst archaeological evidence for many aspects of life in ancient China is well studied, there has been much less interest in ancient infectious diseases, such as intestinal parasites in past Chinese populations. Here, we bring to- gether evidence from mummies, ancient latrines, and pelvic soil from burials, dating from the Neolithic Period to the Qing Dynasty, in order to better understand the health of the past inhabitants of China and the diseases endemic in the region. Seven species of intestinal parasite have been identified, namely roundworm, whipworm, Chinese liver fluke, oriental schistosome, pinworm, Taenia sp. tapeworm, and the intestinal fluke Fasciolopsis buski. It was found that in the past, roundworm, whipworm, and Chinese liver fluke appear to have been much more common than the other species. While roundworm and whipworm remained common into the late 20th century, Chinese liver fluke seems to have undergone a marked decline in its prevalence over time. The iconic transport route known as the Silk Road has been shown to have acted as a vector for the transmission of ancient diseases, highlighted by the discovery of Chinese liver fluke in a 2,000 year-old relay station in northwest China, 1,500 km outside its endemic range.
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565
INTRODUCTION
The aim of this paper is to discuss the evidence for intestinal
parasites in past human populations of Chinese ethnicity in
order to better understand which species were most common
and how infection might have varied throughout history. This
is an important area of investigation, as such an approach
could potentially identify changes in parasitism between hunt-
er-gatherers, farmers cultivating rice or sorghum, the inhabit-
ants of early small towns, and later large cities [1]. There may
have been differences in species infecting those people living
in the lush, well-watered regions of eastern and southern Chi-
na compared with the more arid regions of central, northern,
and western China. We could even identify the spread of para-
sites along the Silk Road and other trade routes [2].
Some of the publications describing ancient parasites are
not widely known outside China as they have been published
in regional Chinese journals that may not be easily read or ac-
cessed by the international community. Paleoparasitology is a
relatively recent field of research in ethnically Chinese regions,
compared to the century long tradition in Western countries
[3]. In the past, parasite evidence from China has often been
obtained from naturally preserved mummies that were ana-
lyzed by anatomists or physicians (Table 1). Other methods
for sourcing ancient fecal samples, such as the pelvic soil from
burials, latrine sediments, and coprolites from rubbish tips
have not been widely used. In this paper, we will examine the
evidence for parasites dating from the Neolithic period to the
end of the Qing Dynasty (7,000 BCE to CE 1911/1912) (Table
2). This will start to shed light on when, how, and where the
ancient communities of the area became infected by the range
of parasite species now known in the region [4].
THE EVIDENCE FOR PARASITES IN CHINA
THROUGH THE AGES
Neolithic (7,000-2,000 BCE)
The earliest proposed evidence for parasites in China dates
from the Neolithic period. Three distinct phases of the period
have been categorized: the Early Neolithic (7,000-5,000 BCE),
the Middle Neolithic (5,000-3,000 BCE), and the Late Neo-
lithic (3,000-2,000 BCE) [5]. Within the first phase, the Jiahu
site, located in Henan Province and dated to 7,000 BCE to
5,700 BCE, is significant with findings of many artefacts, in-
ISSN (Print) 0023-4001
ISSN (Online) 1738-0006
Korean J Parasitol Vol. 54, No. 5: 565-572, October 2016
https://doi.org/10.3347/kjp.2016.54.5.565
󱒱 MINI-REVIEW
Received 22 August 2016, revised 28 September 2016, accepted 1 October 2016.
*Corresponding author (pdm39@cam.ac.uk)
© 2016, Korean Society for Parasitology and Tropical Medicine
This is an Open Access article distributed under the terms of the Creative Commons
Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0)
which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
Ancient Human Parasites in Ethnic Chinese Populations
Hui-Yuan Yeh1,2, Piers D. Mitchell1,
*
1
Department of Archaeology and Anthropology, University of Cambridge, The Henry Wellcome Building, Cambridge CB2 1QH, UK;
2
School of
Humanities and Social Sciences, Nanyang Technological University, 637332, Singapore
Abstract:
Whilst archaeological evidence for many aspects of life in ancient China is well studied, there has been much
less interest in ancient infectious diseases, such as intestinal parasites in past Chinese populations. Here, we bring to-
gether evidence from mummies, ancient latrines, and pelvic soil from burials, dating from the Neolithic Period to the Qing
Dynasty, in order to better understand the health of the past inhabitants of China and the diseases endemic in the region.
Seven species of intestinal parasite have been identified, namely roundworm, whipworm, Chinese liver fluke, oriental
schistosome, pinworm, Taenia sp. tapeworm, and the intestinal fluke Fasciolopsis buski. It was found that in the past,
roundworm, whipworm, and Chinese liver fluke appear to have been much more common than the other species. While
roundworm and whipworm remained common into the late 20th century, Chinese liver fluke seems to have undergone a
marked decline in its prevalence over time. The iconic transport route known as the Silk Road has been shown to have
acted as a vector for the transmission of ancient diseases, highlighted by the discovery of Chinese liver fluke in a 2,000
year-old relay station in northwest China, 1,500 km outside its endemic range.
Key words:
Clonorchis sinensis, Schistosoma japonicum, archaeology, helminth, mummy, paleoparasitology, parasite, Silk Road, China
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cluding the oldest known musical instruments [6]. With re-
gard to parasite evidence, Zhang and colleagues [6] reported
that abdominal soil samples were collected from 4 burials at
the Jiahu site. On microscopy, they reported finding structures
which they believed represent the eggs of roundworm (Ascaris
lumbricoides), whipworm (Tr ic hu ri s tr ic hi ur a), and tapeworm
Ta bl e 1 . Summary of Chinese mummies with published parasite studies, adapted from Li (1984)
Location Parasite Sex Age Time period & dynasty Social status Reference
Jiangling, Hubei Province Clonorchis sinensis,
Tri c hu ri s tr ic hi ur a,
Ascaris lumbricoides
Funknown Warring St ate s p eri od unknown [16]
Changsha, Huibei Province Schistosoma japonicum,
T. t r ic h i ur a , E nt e r ob i us v er m ic u l ar i s
F50 Han Dynasty Wealthy [16]
Phoenix Hill, Huibei Province S. japonicum, C. sinenisis,
Tae n ia s p. , T. tr ic hi ur a
M55 Han Dynasty Wealthy [15,16]
Jintan, Jiangsu Province A. lumbricoides, T. trichiura M28-40 Song Dynasty unknown [16]
Hengyang, Hunan Province C. sinensis M50 Song Dynasty unknown [16]
Guangzhou, Guangdong Province A. lumbricoides M84 Ming Dynasty Wealthy [16]
Guangzhou, Guangdong Province T. t ri c hi u r a, C. si n e ni s is ,
Fasciolopsis buski
F80 Ming Dynasty Wealthy [16]
Yan g zh ou , Ji an gs u Pr ov in ce A. lumbricoides, T. trichiura Munknown Ming Dynasty Wealthy [16]
Yan g zh ou , Ji an gs u Pr ov in ce A. lumbricoides, T. trichiura F60 Ming Dynasty Wealthy [16]
Fuqing, Fujian Province C. sinenisis, F. buski,
T. t r ic h i ur a , A . l u mb r ic o i de s
M50 Ming Dynasty unknown [16]
Shaowu, Fujian Province A. lumbricoides M41 Ming Dynasty Wealthy [16]
Longyan, Fujian Province T. tr i c hi u ra , A . lu m br i c oi d es F74 Ming Dynasty Wealthy [16]
Fuzhou, Fujian Province C. sinenisis, T. trichiura F50-60 Ming Dynasty Wealthy [16]
Ta bl e 2 . Time periods and dynasties in China
Neolithic (7000 BCE-2000 BCE)
Formation of Early States: Erlitou and Erligang (1900/1800 BCE -1250 BCE)
Shang dynasty (c. 1766/1600/1556 BCE - c.1122/1046 BCE)[1]
Zhou dynasty Western Zhou 11th century BCE-771 BCE
Eastern Zhou Spring and Autumn c.770/771 BCE -c.475/476 BCE/403 BCE
Warring St ate s 5th century BCE-221 BCE
Qin dynasty 221 BCE-207/206 BCE
Han dynasty Western/Former Han 206/202 BCE-CE 9
Xin dynasty CE 9-CE 23
Eastern/Later Han CE 25-CE 220
Three Kingdoms CE 220-CE 280
Jin dynasty Western Jin (CE 265/266-CE 316) CE 265/266-CE 420
Eastern Jin (CE 317-CE 420) Sixteen Kingdoms
(CE 304-CE 439)
Northern and Southern dynasties CE 420-CE 589
Sui dynasty CE 581-CE 618
Ta ng dy n a st i es CE 618-CE 907
Five Dynasties and Ten Kingdoms Liao dynasty
(CE 907/916-CE 1125 )
CE 907-CE 960/979
Song dynasty Northern Song (CE 960-CE 1127) Wester n Xia (CE 1038-CE 1227) CE 960-CE 1279
Southern Song
(CE 1127-CE 1279)
Jin dynasty (CE 1115-CE1234)
Yua n dyn ast y CE 1271-CE 1368
Ming dynasty CE 1368-CE 1644
Qing dynasty CE 1644-CE 1911/1912
According to the Xia–Shang–Zhou Chronology Project, the Shang dynasty was dated from c. 1600 to c. 1046 BCE. However, the chronology has
been disputed by many scholars.
Yeh a nd Mitc hell: Ancient human parasites in China 567
(Tae n ia sp.) [7]. However, in our opinion, the illustrations of
the proposed eggs published in the paper do not provide
strong evidence to confirm such identification. For example,
the structure proposed to be a human roundworm egg had the
dimensions of 122 by 83 μm, which is too large to be a hu-
man roundworm egg. Standard dimensions quoted in the lit-
erature for human roundworm eggs are in the range of 45-75
μm in length by 35-50 μm in breadth for fertilized eggs, and
85-95 μm by 43-47 μm for unfertilized eggs [8]. The proposed
whipworm and tapeworm eggs have an appearance more
compatible with plant material than parasite eggs.
Ancient China (Early States-Warring States period)
(1,900/1,800 BCE-221 BCE)
The formation of early states, known as Erlitou and Erligang,
took place around 1,900/1,800 BCE to 1,250 BCE in the Cen-
tral Plain in mainland China [5]. During the period from
1,900 BCE to 221 BCE, examples of ancient parasites have
been reported [9]. Wei et al. [9] examined pelvic soil from 20
inhumation burials at Zhengzhou, Henan Province, dated to
the Spring and Autumn period (770/771 BCE- 476/403 BCE).
Five of these burials (25%) were positive for roundworm eggs
(A. lumbricoides). A total of 34 eggs were identified (18 fertil-
ized and 16 unfertilized roundworm eggs), but they did not
specify the number from each of the 5 individuals.
Later, during the Warring States period (5th century BCE-
221 BCE), a female mummy from Jiangling, Hubei Province
was found to contain the eggs of Chinese liver fluke (Clonorchis
sinensis), whipworm, and roundworm [10,11]. Similarly, a fe-
male mummy from Jingmen, Hubei Province was found to
have Chinese liver fluke as well as whipworm [12].
Imperial China (Qin dynasty-Qing dynasty) (221 BCE-CE
1911/1912)
A greater number of cases of ancient parasites have been re-
covered in the period dating from Imperial China. A latrine
has been identified in the Xuanquanzhi relay station at Dun-
huang in Gansu Province, northwest China. The relay station
was built in 111 BCE and used until CE 109 (during the Han
dynasty). Xuanquanzhi was positioned on the Silk Road, pro-
viding accommodation to travellers and a change of horses for
government officials and the postal service. When the latrine
Fig. 1. Personal hygiene sticks from a latrine at Xuanquanzhi Re-
lay Station at Dunhuang on the Silk Road, dating from 111 BCE-
CE 109.
Fig. 2. Whipworm egg (Tr i ch ur is t ri ch iu ra ) from the Xuanquanzhi
latrine. Dimensions 53 x 27 μm. Black scale bar indicates 20 μm.
Fig. 3. Ta e n i a sp. tapeworm egg from the Xuanquanzhi latrine. It
is most likely to be Ta en ia as ia ti c a or Tae n i a solium, and less likely
to be Ta e n i a saginata. Dimensions 36x32 μm. Black scale bar in-
dicates 20 μm.
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was excavated, it was found to contain a significant number of
personal hygiene sticks used for wiping after defecation. These
wooden sticks had cloth wrapped around one end, and some
well-preserved sticks had dried feces still in situ (Fig. 1). When
analyzed, the eggs of whipworm (Fig. 2), roundworm, Ta e n i a
sp. tapeworm (Fig. 3), and Chinese liver fluke were identified
[13].
A study carried out on a female mummy from the Mawang-
tui tomb in Changsha, Han Dynasty (206/202 BCE-CE 220),
found oriental schistosomiasis (Schistosoma japonicum), whip-
worm, and pinworm (Enterobius vermicularis) eggs in the fecal
material extracted from the intestines [14]. A similar study of a
Han dynasty mummy from Phoenix Hill in Huibei Province
showed the presence of oriental schistosomiasis, Chinese liver
fluke, whipworm, and Taeni a sp. tapeworm [15].
In addition to this, the human mummies of several individ-
uals who died in the Ming and Song dynasties have displayed
evidence of infection with roundworm, Chinese liver fluke,
whipworm, and the giant intestinal fluke Fasciolopsis buski [16]
(Table 3). A map showing the location of all the examples dis-
cussed in this paper is given as Fig. 4.
DISCUSSION
Having brought together all the available evidence, we can
start to investigate which parasites may have been more com-
mon than others, if geographical location affected likelihood
of infection, and if there seem to be changes in infection over
time. However, we do need to be cautious and realistic in how
we use this data. A total of 33 individuals and 1 latrine from
Ta bl e 3 . Species of parasites found in samples from China
Parasite Species Location Ty pe of s am p le s No. of individuals affected
Ascaris lumbricoides Zhengzhou, Henan Province Pelvic soil 5
Xuanquanzhi, Gansu Province Latrine
Jiangling, Hubei Province Mummy 8
Jintan, Jiangsu Province
Guangzhou, Guangdong Province
Yan g zh ou , Ji an gs u Pr ov in ce
Fuqing, Fujian Province
Shaowu, Fujian Province
Longyan, Fujian Province
Clonorchis sinensis Xuanquanzhi, Gansu Province Latrine
Guangzhou, Guangdong Province Mummy 6
Hengyang, Hunan Province
Jiangling, Hubei Province
Phoenix Hill, Huibei Province
Fuqing, Fujian Province
Fuzhou, Fujian Province
Enterobius vermicularis Changsha, Huibei Province Mummy 1
Fasciolopsis buski Guangzhou, Guangdong Province Mummy 2
Fuqing, Fujian Province
Schistosoma japonicum Phoenix Hill, Huibei Province Mummy 2
Changsha, Huibei Province
Tae n ia sp. Phoenix Hill, Huibei Province Mummy 1
Xuanquanzhi, Gansu Province Latrine
Tri c hu ri s tr ic hi ur a Changsha, Huibei Province Mummy 10
Phoenix Hill, Huibei Province
Jintan, Jiangsu Province
Guangzhou, Guangdong Province
Jiangling, Hubei Province
Yan g zh ou , Ji an gs u Pr ov in ce
Fuqing, Fujian Province
Longyan, Fujian Province
Fuzhou, Fujian Province
Xuanquanzhi, Gansu Province Latrine
Yeh a nd Mitc hell: Ancient human parasites in China 569
the whole of ancient China have been analyzed for the eggs of
intestinal parasites. These 33 individuals are represented by 13
mummies and 20 skeletonized burials. The time period over
which these individuals lived and died is very large, over 3,000
years. Therefore, we cannot determine past prevalence of dis-
eases in the way we might with much larger samples. Further-
more, many of the samples came from mummies in sophisti-
cated tombs that would suggest they were the burials of
wealthy people. This means the findings from the mummy ev-
idence may not necessary apply to those of poor members of
the population.
The most common parasites found were those of whip-
worm, roundworm, and Chinese liver fluke. Whipworm was
found in 77% of the mummies (n=10 / 13 ) a s w e ll a s o n t he
personal hygiene sticks excavated from the latrine at Xuan-
quanzhi in Gansu Province (111 BCE-CE 109). Roundworm
was found in the pelvic soil of 25% of burials (n =5/20) dat-
ing from the Spring and Autumn period from Zhengzhou in
Henan Province. It was also identified on the Xuanquanzhi la-
trine sticks, and in 62% (n =8/13) mummies from across all
times periods. Chinese liver fluke eggs were recovered from
46% of the mummies (n=6/13) and the Xuanquanzhi latrine.
As whipworm and roundworm are spread by fecal contamina-
tion of food, possible explanations for their widespread pres-
ence are that in ancient China hands were not washed regular-
ly, that drinking water was contaminated by human feces, or
that human feces were being used a crop fertilizer [17,18].
Other species of intestinal parasites seem to have been
much less common. Both the flukes F. b u sk i and S. japonicum
were found in just 15% of mummies (n=2/13), while pin-
worm (E. vermicularis) and Taenia sp. tapeworm were found in
just 8% of mummies (n =1/13). Taen i a sp. was also found on
the personal hygiene sticks from the latrine at Xuanquanzhi. If
the limited sample we have in this study is in any way repre-
sentative of the wider population, this would suggest that far
fewer people in ancient China might have suffered with these
helminths than was the case for whipworm, roundworm, and
Chinese liver fluke.
Geographical variation is more of a challenge to assess, as
the locations where parasites have been studied are not evenly
spread across ancient China. As we can see from our map (Fig.
4), the vast majority of samples came from eastern and south-
ern China. Only 1 sample, the Xuanquanzhi latrine, was in
northwest China. This leaves the northeast, north, center, west,
and southwest of this huge region devoid of evidence.
It is interesting that 46% of the 13 mummies were infected
with Chinese liver fluke. All the mummies were recovered
from regions of China that are lush and well-watered by the
Fig. 4. Map of China showing the location of each site where parasites were found in archaeological material. Round circle indicates a
mummy, triangle indicates pelvic soil from burials, and square indicates a latrine.
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Korean J Parasitol
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Yel lo w, Ya ngt ze , and Pe arl R iv er net wo rk s. C hi ne se li ve r flu ke
is found today just in eastern and southern China and Korea,
where the life cycle of the parasite can be completed in the lo-
cal water snails and freshwater fish. It is contracted if a person
eats raw infected freshwater fish [19,20]. The mummies were
almost all from the areas of eastern and southern China where
we would expect to find the Chinese liver fluke.
In the 20th century, it was found that the region of China
with the highest prevalence of Chinese liver fluke was Guang-
dong Province, with a prevalence of just 1.82% between 1988-
1992, and 0.365% for the whole country [21]. Since 46% of
the ancient mummies were infected, this would suggest either
that these mummies were not representative of the population
in which they lived, or that there has been a dramatic fall in
the prevalence of Chinese liver fluke over this time. If there has
been a genuine drop in liver fluke infection, we should ask
ourselves if this might be due to advances in medical treat-
ments, hygiene, toilets, and health education over this time.
However, in the same 20th century survey, the prevalence of
roundworm was 47% in China [21]. This is not that dissimilar
to the 62% of ancient mummies infected by roundworm. This
data suggests that while roundworm remained common in
China for many centuries up to and including the late 20th
century, Chinese liver fluke may have been much more com-
mon over the last 2,000 years than it was in the late 20th cen-
tury. It seems unlikely that this change in Chinese liver fluke
infection was due to advances in medicine and sanitation, as
we would expect roundworm to have become rarer as well if
that was the case. More likely explanations for this apparent
change in prevalence for the liver fluke, but not roundworm,
could be that this indicates either a change in the way freshwa-
ter fish was processed or eaten by Chinese people in the late
20th century compared with the previous 2,000 years, or that
modern pollution in Chinese rivers has affected the intermedi-
ate hosts, such as water snails that are required for the trans-
mission of this flatworm to humans.
The DNA of the Chinese liver fluke from the Phoenix Hill
mummy (167 BCE) has been the focus of research. Samples
from the gall bladder underwent genomic analysis, and the in-
ternal transcribed spacers 1 and 2 (ITS1 and ITS2) in ribosom-
al genes were sequenced. It was found that while ITS2 se-
quences were identical to modern strains of Chinese liver
fluke, the ITS2 sequence differed by 15 nucleotides. It was pro-
posed that this indicates the parasite has evolved over the last
2,000 years [22].
Taenia sp. tapeworm eggs of different species appear very
similar on microscopy, so without DNA analysis, it is not pos-
sible to distinguish Ta en ia s a gi na ta contracted from eating beef,
from Ta en ia sol iu m and Ta eni a a si ati ca contracted from eating
pork. However, written records from ancient China show that
pork was widely eaten, and that beef was rare in the diet as
cattle were used for their strength pulling farm machinery
[23,24]. This might suggest that the infections noted were like-
ly to have been due to either T. as i at ic a or T. s ol iu m, and not T.
saginata. Texts written on Han Dynasty bamboo slips have de-
scribed how it was common for pigs to be reared in captive
environments where they would not be able to violate laws by
disrupting crops [25]. Pig-shaped burial goods from a tomb
dating from the Han Dynasty serves as an indication of the ex-
tent to which the pig was an important resource as a food
product and as part of daily life in the period [26].
Chinese communities started to consume animal viscera in
the period from the 11th century BCE to 221 BCE, in the Zhou
Dynasty. The Book of Rites, a compilation of written accounts
relating to aspects of conduct in society and to the ceremonial
rights of the Zhou Dynasty, recorded that the roasted liver of a
dog was considered to be a delicacy [27]. A noteworthy discov-
ery was made the excavation of Mawangdui in central China.
This excavation explored the burial places of elites dating from
the Han Dynasty, and it gained widespread fame as a result of
the recovery of an excellently preserved mummified female
body. Numerous burial items of considerable value included
models of animal viscera, including liver, stomach, lungs, and
spleen [28,29]. The Book of Han (dating from CE 32-92) also
referred to the consumption of sliced liver, bacon, incomplete-
ly cooked and roasted animal products, and dog and pig vis-
cera [23,30]. These references are an indication of the wide-
spread nature of these dietary habits over this period. In light
of this, the identification of Ta e n i a sp. tapeworm eggs in the
Xuanquanzhi latrine and a Han dynasty mummy potentially
reflect the well documented dietary practices of consuming
raw pig viscera.
The Silk Road was a well-known long distance transport route
that came to prominence during the Han dynasty (206/202
BCE-CE 220). It connected eastern China with central Asia,
the Middle East, and Europe, and in its entirety was about
7,000 km in length [2,31]. It has been proposed to have acted
as a route via which diseases, such as bubonic plague, anthrax,
and leprosy might have spread between Asia and Europe [32-
34]. However, the evidence supporting this hypothesis is based
Yeh a nd Mitc hell: Ancient human parasites in China 571
upon genetic similarity between bacterial strains in East Asia
and Europe [35,36]. It remained unknown whether transmis-
sion was along the Silk Road itself, or to the north via Mongo-
lia and Russia, or to the south via India. Past research using
parasites as markers of migration to and from Asia include
movement between Europe and the Middle East in the 15th
century AD, and between China and America in the 19th cen-
tury [37,38]. A study of the latrine at Xuanquanzhi relay sta-
tion has for the first time allowed an investigation of an ar-
chaeological site on the Silk Road that was built for travellers.
The presence of Chinese liver fluke on the personal hygiene
sticks in the latrine is an important finding. This relay station
at Dunhuang is located in an arid region of northwest China,
at the eastern end of the Tamrin Basin. This basin contains the
Tak lamak an Des ert , a nd is far to o dr y a re gio n f or the Ch ine se
liver fluke to be able to complete its life cycle. Indeed, Dun-
huang is 1,500 km away from any region where the Chinese
liver fluke was endemic in the 20th century [21]. This suggests
that a traveller from the well-watered areas of eastern or south-
ern China contracted the parasite there, and travelled a huge
distance along the Silk Road before using the latrine at Xuan-
quanzhi relay station. This provides the first archaeological ev-
idence from along the Silk Road to show that ancient travellers
were moving with their infectious diseases [13].
CONCLUSION
Here we have brought together the available evidence for in-
testinal parasites in ancient China and used this to better un-
derstand the consequences of infection for the people living in
the region. We have been cautious in our interpretation due to
the limited sample size and the long period over which the ar-
chaeological evidence originates. However, we have been able
to draw some fascinating conclusions. Seven species of intesti-
nal parasites have been identified in ancient China, but it was
found that whipworm, roundworm, and Chinese liver fluke
seem to have been by far the most common. Indeed, around a
half to 3/4 of Chinese mummies so far studied have been in-
fected by these parasites. While whipworm and roundworm
remained common in Chinese people in the late 20th century,
Chinese liver fluke had become much less common by then.
This might suggest a reduction in the amount of raw freshwa-
ter fish eaten over time, or pollution in modern Chinese rivers.
We hav e al so seen evi den ce for the migr ati on of pe ople al ong
the Silk Road with their parasites 2,000 years ago, with the dis-
covery of Chinese liver fluke in a latrine in northwest China
1,500 km outside its endemic area. It is hoped that in the fu-
ture Chinese archaeologists will start to sample the contents of
latrines at the time of their excavation, so that we can increase
our evidence base and enable us to create a much more reli-
able interpretation of intestinal parasite infection in past Chi-
nese populations.
CONFLICT OF INTEREST
We have no c onf lict of inter est rela ted t o t his s tud y.
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... Parasitic worms have been a part of human history since time immemorial, with the first direct evidence from 8000 BC, but it is suspected that parasitic worms have been in humans for 50 thousand years or more (7). Parasitic worms have been found in Ancient Roman latrines, in Egyptian mummies, and Ancient Chinese burials and are still found around the world in modern humans (8)(9)(10)(11). There are 277 species of helminths and 66 species of protozoa where humans act as the main host or an incidental host (12). ...
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The Silk Road has often been blamed for the spread of infectious diseases in the past between East Asia, the Middle East and Europe. While such a hypothesis seems plausible, there is actually very little concrete evidence to prove that diseases were transmitted by early travellers moving along its various branches. The aim of this study is to look for ancient parasite eggs on personal hygiene sticks in a latrine at a large relay station on the Silk Road at Xuanquanzhi (111 BCE–CE 109), at the eastern margin of the Tarim Basin in north-western China. We isolated eggs of four species of parasitic intestinal worms: Chinese liver fluke ($\textit{Clonorchis sinensis}$), $\textit{Taenia}$ sp. tapeworm (likely $\textit{Taenia asiatica, Taenia solium}$T or $\textit{Taenia saginata}$), roundworm ($\textit{Ascaris lumbricoides}$) and whipworm ($\textit{Trichuris trichiura}$). The Chinese liver fluke requires wet marshy areas to sustain its life cycle and could not have been endemic to this arid region. The presence of this species suggests that people from well-watered areas of eastern or southern China travelled with their parasites to this relay station along the Silk Road, either for trade or on government business. This appears to be the earliest archaeological evidence for travel with infectious diseases along the Silk Road.
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On Aug 21, 1875, James McConnell published in The Lancet his findings from a post-mortem examination of a 20-year-old Chinese man-undertaken at the Medical College Hospital in Calcutta, India-in whom he found Clonorchis sinensis in the bile ducts. Now, exactly 140 years later, we have a sound understanding of the lifecycle of this liver fluke, including key clinical, diagnostic, and epidemiological features. Developments in the so-called -omics sciences have not only advanced our knowledge of the biology and pathology of the parasite, but also led to the discovery of new diagnostic, drug, and vaccine targets. C sinensis infection is primarily related to liver and biliary disorders, especially cholangiocarcinoma. Clonorchiasis mainly occurs in east Asia, as a result of the region's social-ecological systems and deeply rooted cultural habit of consuming raw freshwater fish. The Kato-Katz technique, applied on fresh stool samples, is the most widely used diagnostic approach. Praziquantel is the treatment of choice and has been considered for preventive chemotherapy. Tribendimidine showed good safety and therapeutic profiles in phase 2 trials and warrants further investigation. Still today, the precise distribution, the exact number of infected people, subtle morbidities and pathogenesis, and the global burden of clonorchiasis are unknown. Integrated control strategies, consisting of preventive chemotherapy; information, education, and communication; environmental management; and capacity building through intersectoral collaboration should be advocated. Copyright © 2015 Elsevier Ltd. All rights reserved.