Central Florida is a hotspot for leprosy, report says

[Spartan]

When a 54-year-old landscaper came into an Orlando dermatology clinic with a splotchy, painful rash, Dr. Rajiv Nathoo took five or six biopsies. The rash was spreading from the man’s limbs to his face, but previous doctors had been stumped by what was causing it.

The biopsy results confirmed Nathoo’s hunch, a diagnosis he described as something “you read in your textbooks”: leprosy.

However, the man didn’t have the obvious risk factors that most doctors would expect with the hard-to-catch infection. So after noticing a cluster of other cases in the area, Nathoo, a dermatologist and complex clinic director for Advanced Dermatology and Cosmetic Surgery Clinics in Orlando, began to suspect that Central Florida could be an unexpected leprosy hotbed.

Now, his team is cautioning other health care providers to be on the lookout for similar cases in the area.

According a research letter published by Nathoo and his colleagues in the journal Emerging Infectious Diseases, Central Florida has reported among the highest rates of leprosy in the United States.

In 2020, 159 cases were reported nationwide, compared with 200,000 new cases each year around the world, according to the World Health Organization. The new letter says Central Florida accounted for 81% of cases in Florida and nearly 1 out of 5 leprosy cases nationwide.

Also known as Hansen’s disease, leprosy is caused by the bacteria Mycobacterium leprae, which attacks nerves under the skin. Scientists aren’t completely sure of how it spreads, but most believe that it’s transmitted via droplets when an infected person coughs and sneezes. Its telltale symptoms include lesions and rashes that are numb or lack sensation because of the involvement of nerves.

Nine-banded armadillos in the Southeastern United States can also carry the bacteria, and gene studies have linked human infections to the leprosy strains carried by armadillos, although it’s not always clear how humans encounter armadillo-carried bacteria. Many patients can’t recall ever having contact with the animals.

The disease is not transmitted through casual contact like shaking hands or sitting next to an infected person. Instead, spread requires prolonged close contact with someone who has untreated leprosy over many months, according to the US Centers for Disease Control and Prevention. Roughly 95% of people aren’t susceptible to the infection because their immune systems are genetically programmed to resist it.

As a result, leprosy is a rare disease in the United States. Historically, most cases of leprosy in the US affect people who travel to countries with high rates of disease or who are exposed to armadillos that carry the disease.

But there are cases in which doctors never know how a person was exposed.

“In certain states, we see more cases than others. Florida is one of them,” said Dr. Linda Adams, chief of the laboratory research branch at the National Hansen’s Disease Program, a federal program that coordinates treatment for Americans who are diagnosed. “In all of these areas, we do see cases that we cannot explain. There’s been no foreign travel, for example, or no contact with armadillos.”

The 54-year-old man in the new report told his doctors that he had never left the state of Florida and had no exposure to armadillos and no extended interaction with people from countries with high rates of leprosy, though he did spend a lot of time outdoors.

About 34% of new cases between 2015 and 2020 didn’t have those traditional risk factors, according to the research letter. Instead, the people appear to have been infected locally, a finding that suggests that leprosy has become endemic in Florida, the letter says.