Eleonora of Toledo (1522–1562): Evidence for tuberculosis and leishmaniasis co-infection in Renaissance Italy

Clinical reports for Eleonora of Toledo (1522–1562), the wife of Cosimo I de’ Medici, imply that during her 28th year she developed pulmonary tuberculosis, which was complicated by an attack of pernicious malaria, killing her at age 40. Eleonora's autopsy indicated that she had severe lung lesions consistent with chronic pulmonary infection. To clarify her disease status, we performed paleomolecular investigations. Our results identified ancient DNA from the Mycobacterium tuberculosis complex (MTB), along with Leishmania infantum (VL). Our data are of particular interest since in Tuscany the endemic foci of L. infantum are widely distributed and overlapped with those of malaria prior to its eradication. Although we can only speculate about Eleonora's true state of health, this clear evidence of long-term co-infection with MTB and VL is of major medical and biological interest since the co-evolution of the two pathogens and host–pathogen interactions in co-infected individuals are still not fully understood.

► Paleomolecular investigations were carried out on Eleonora of Toledo (1522–1562).
► Evidence for MTB complex/Leishmania infantum co-infection in Renaissance was provided.
► Biological data were compared to medical and autopsy reports.
► The consequence of those diseases on her living conditions was discussed.