In Florida, an old enemy is making an unexpected comeback. A recent report of a 54-year-old man with leprosy has turned the spotlight back onto a disease many believed was relegated to the history books, revealing a disturbing trend of increasing leprosy cases in the southeastern United States.
The incidence of leprosy in southern US states has doubled over the past decade, making regions like Central Florida a focal point for nearly one-fifth of the nation’s cases. But experts are unsure of what drives this rise of leprosy and are currently investigating possible environmental or animal reservoirs.
Leprosy, or Hansen’s disease, is a long-term bacterial infection primarily caused by Mycobacterium leprae, and to a lesser extent, by the more recently discovered M. lepromatosis. It’s a curable but neglected tropical disease.
Leprosy infection can damage the nerves, respiratory system, skin, and eyes. The resulting nerve damage can cause paralysis or diminish the ability to sense pain. Individuals with the infection might also suffer from skin rashes, muscle weakness, and impaired vision.
Interestingly, the demographic of leprosy patients is shifting. A smaller proportion of diagnoses are among individuals born outside the US, and many new cases lack traditional risk factors like traveling to affected regions. This change has led public health officials and scientists to acknowledge an unsettling possibility: leprosy is becoming endemic in southern US states.
The US reports about 150 cases annually, with many patients having a history of travel from endemic regions or exposure to certain animals like nine-banded armadillos, which are known carriers of the bacteria.
However, the case of the Florida man, a lifelong resident and landscaper who had no known interactions with affected individuals or wildlife, presents a puzzle. His symptoms, a painful rash and lesions that spread from his extremities to his face, led to a leprosy diagnosis, marking it as potentially locally acquired.
This case isn’t an anomaly. It joins a growing list of literature suggesting that central Florida is a hotspot for leprosy. This has spurred calls for increased local physician awareness and research into the disease’s transmission pathways, especially in cases where traditional risk factors are absent.
The complexity of leprosy transmission is becoming increasingly apparent, with a blend of human-to-human and animal-to-human interactions. The discovery of M. lepromatosis, a new causative agent identified just over a decade ago, has only added to the urgency of understanding this disease’s true spread and impact.
Researchers and health officials are thus faced with a dual challenge: addressing the rising tide of leprosy cases in the US and pinpointing the source of its transmission. This unfolding situation serves as a reminder of the persistent threat of neglected tropical diseases.
Twelve Years Not A Slave 
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