Tuberculosis (TB) is a major global health threat, infecting one-third of the world's population. Despite this prominence, the age, origin and spread of the disease have been topics of contentious debate. Molecular studies suggest that Mycobacterium tuberculosis ‘sensu stricto’, the most common strain of TB infecting humans today, originated in Africa and from there spread into Europe and Asia. The M. tuberculosis strains most commonly found across the Pacific and the Americas today are most closely related to European strains, supporting a hypothesis that the disease only reached these regions relatively recently via European sailors or settlers. However, this hypothesis is inconsistent with palaeopathological evidence of TB-like lesions in human remains from across the Pacific that predate European contact. Similarly, genetic evidence from pre-European South American mummies challenges the notion of a European introduction of the disease into the Pacific. Here, we review the complex evidence for the age and origin of TB in the Pacific, and discuss key gaps in our knowledge and how these may be addressed.

This article is part of the theme issue ‘Insights into health and disease from ancient biomolecules’.

结核病 (TB) 是一种主要的全球健康威胁，感染了世界三分之一的人口。尽管如此突出，该疾病的年龄、起源和传播一直是有争议的话题。分子研究表明，结核分枝杆菌是当今感染人类最常见的结核菌株，起源于非洲，并从那里传播到欧洲和亚洲。在结核分枝杆菌今天在太平洋和美洲最常见的菌株与欧洲菌株的关系最密切，这支持了一种假设，即该疾病仅通过欧洲水手或定居者相对较晚才到达这些地区。然而，这一假设与欧洲人接触之前来自太平洋彼岸的人类遗骸中的结核样病变的古病理学证据不一致。同样，来自前欧洲南美木乃伊的遗传证据挑战了欧洲将该疾病引入太平洋的观点。在这里，我们回顾了太平洋地区结核病年龄和起源的复杂证据，并讨论了我们知识中的主要差距以及如何解决这些问题。

这篇文章是主题问题“从古代生物分子洞察健康和疾病”的一部分。