Is leprosy spreading in Florida?

Campos Krauer plans to test the armadillo for leprosy, an ancient disease also known as Hansen’s disease that can cause nerve damage and disfigurement in humans. He and other scientists are trying to solve a medical mystery: why central Florida has become a hot spot for the centuries-old bacteria that causes it.

Leprosy remains rare in the United States. But Florida, which often reports the highest number of cases of any state, has seen a surge in patients. The epicenter is east of Orlando. Brevard County reported 13% of the nation’s 159 leprosy cases in 2020, according to a Tampa Bay Times analysis of state and federal data.

Many questions about the phenomenon remain unanswered. But leprosy experts believe armadillos play a role in spreading the disease to humans. To better understand who is at risk and prevent infections, a dozen scientists teamed up last year to investigate. The group includes researchers from the University of Florida, Colorado State University and Emory University in Atlanta.

“We really don’t know how this transmission occurs,” said Ramanuj Lahiri, head of the laboratory research department of the National Hansen’s Disease Program, which studies the bacteria involved and treats leprosy patients across the country.

“Nothing Added Up”

Leprosy is believed to be the oldest human infection in history. It’s probably been making people sick for at least 100,000 years. The disease is heavily stigmatized: in the Bible, it is described as a punishment for sin. In more modern times, patients were isolated in “colonies” around the world, including Hawaii and Louisiana.

In mild cases, slow-growing bacteria cause some lesions. If left untreated, they can paralyze the hands and feet.

But it’s actually difficult to get leprosy because the infection is not very contagious. Antibiotics can cure the disease within a year or two. They are available free from the federal government and the World Health Organization, which launched a campaign in the 1990s to eliminate leprosy as a public health problem.

In 2000, reported cases in the United States fell to their lowest level in decades, with 77 infections. But then they increased, reaching an average of about 180 per year between 2011 and 2020, according to data from the National Hansen’s Disease Program.

Around this time, a curious trend emerged in Florida.

In the first decade of the 21st century, the state recorded 67 cases. Miami-Dade County recorded 20 infections, the most of any county in Florida. The vast majority of its cases were acquired outside the United States, according to a Times analysis of Florida Department of Health data.

But over the next 10 years, recorded cases in the state more than doubled to 176 as Brevard County took center stage.

Credit: (Douglas R. Clifford/Tampa Bay T

Credit: (Douglas R. Clifford/Tampa Bay T

The county, whose population is about a fifth of Miami-Dade’s, has recorded 85 infections during that period — by far the most of any county in the state and nearly half of all cases from Florida. In the previous decade, Brevard noted only five cases.

Remarkably, at least a quarter of Brevard infections were acquired within the state, not when the individuals were overseas. India, Brazil and Indonesia diagnose more cases of leprosy than anywhere else, reporting more than 135,000 infections combined in 2022 alone. People were getting sick even if they had not traveled to such areas or had not been in close contact with existing lepers, said Barry Inman, a former Brevard Health Department epidemiologist who investigated the cases and retired in 2021.

“Nothing was adding up,” Inman said.

Some patients remember touching armadillos, which are known to carry the bacteria. But most didn’t, he said. Many spent a lot of time outdoors, especially gardeners and avid gardeners. Cases were generally mild.

It is difficult to determine where people are contracting the disease, he added. Because the bacteria grows so slowly, it can take anywhere from nine months to 20 years for symptoms to appear.

Amoeba or culprit insect?

Increased awareness of leprosy may play a role in the surge of cases reported by Brevard.

Doctors must report leprosy to the health service. Still, Inman said many in the county didn’t know, so he tried to educate them after noticing cases in the late 2000s.

But that’s not the only factor at play, Inman said.

“I don’t think there’s any doubt in my mind that something new is happening,” he said.

Other areas of Central Florida have also seen more infections. From 2011 to 2020, Polk County recorded 12 cases, tripling its number from the previous 10 years. Volusia County noted 10 cases. He reported none in the previous decade.

Scientists are focusing on armadillos. They suspect that burrowing creatures may indirectly cause infections through soil contamination.

Armadillos, which are protected by hard shells, serve as good hosts for bacteria, which do not like heat and can thrive in animals with body temperatures ranging from 86 to 95 degrees.

Credit: (Douglas R. Clifford/Tampa Bay T

Credit: (Douglas R. Clifford/Tampa Bay T

Colonists likely introduced the disease to the New World hundreds of years ago, and somehow the armadillos became infected, said Lahiri, a scientist with the National Hansen’s Disease Program . Nocturnal mammals can develop lesions from the disease, just like humans. More than a million armadillos occupy Florida, estimated Campos Krauer, an assistant professor in the Department of Large Animal Clinical Sciences at the University of Florida.

It is not known exactly how many people have leprosy. A study published in 2015 of more than 600 armadillos in Alabama, Florida, Georgia and Mississippi found that about 16 percent showed signs of infection. Public health experts believe leprosy was previously confined to armadillos west of the Mississippi River and then spread east.

Creature handling is a known danger. Laboratory research shows that single-celled amoebae, which live in soil, can also carry the bacteria.

Armadillos love to dig up and eat earthworms, which frustrates homeowners whose gardens they damage. Animals can shed the bacteria when hunting for food, passing it on to amoebae, which could then infect humans.

Leprosy experts also question whether insects help spread the disease. Blood-sucking ticks could be the cause, according to laboratory research.

“Some infected people have little or no exposure to the armadillo,” said Norman Beatty, an assistant professor of medicine at the University of Florida. “There is likely another source of transmission in the environment.”

Campos Krauer, who walks the streets of Gainesville looking for road-killed armadillos, wants to round up the infected animals and let them decompose in a fenced-in area, allowing the remains to soak in a tray of dirt while the flies lay their eggs. eggs. He hopes to test the dirt and larvae to see if they catch the bacteria.

Added to the intrigue is a strain of leprosy found only in Florida, according to scientists.

In the 2015 study, researchers found that seven armadillos from the Merritt Island National Wildlife Refuge, which is primarily in Brevard but runs through Volusia, carried a never-before-seen version of the pathogen.

Ten patients in the region were also affected. Genetically, the strain is similar to another type found in American armadillos, said Charlotte Avanzi, a Colorado State University researcher who specializes in leprosy.

It’s unclear whether the strain causes more severe illness, Lahiri said.

Reduce risks

The public should not panic about leprosy, nor rush to euthanize armadillos, researchers warn.

Scientists estimate that more than 95% of the world’s human population has a natural ability to ward off disease. They believe months of exposure to respiratory droplets are necessary for person-to-person transmission to occur.

But when infections do occur, they can be devastating.

“If we understand it better,” Campos Krauer said, “the better we can learn to live with it and reduce the risks.”

The new research could also provide information on other Southern states. Armadillos, which do not hibernate, have moved north, Campos Krauer said, reaching areas like Indiana and Virginia. They could go further due to climate change.

People concerned about leprosy can take simple precautions, medical experts say. Those working in dirt should wear gloves and wash their hands afterward. Raising flower beds or surrounding them with a fence can limit the risk of soil contamination. If you dig an armadillo burrow, consider wearing a face mask, Campos Krauer said.

Don’t play with or eat animals, added John Spencer, a Colorado State University scientist who studies leprosy transmission in Brazil. It is legal to hunt year-round in Florida without a license.

Campos Krauer’s team has so far examined 16 dead armadillos found on roads in the Gainesville area, more than 100 miles from the state’s leprosy epicenter, trying to get a preliminary idea of ​​the many of them carrying the bacteria.

None have tested positive yet.

This article was produced through a partnership between KFF Health News and the Tampa Bay Times.

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