Endemic Leprosy in New York City

Abstract

Report of caseRecently, NYU dermatologists have identified two cases of leprosy in New York that have never been outside the United States. The first case of a person never to travel out of the U.S. was a Caucasian chemist from Queens, NY reported in 2000 (1). A more recent case was a black male from the Bronx, New York in 2008 (2). We now report the third proven identified case of leprosy never out of the continental United States.The patient is a 48 year-old Black woman complaining of skin discoloration of the face, hands and legs for one year. On exam she was well-developed appearing in no acute distress; eyes and mucous membranes were normal. Over the right and left posterior calf there were two lichenified plaques and surrounding hypopigmentation and dyschromia of the skin with hypoesthesia. Biopsy was compatible with BL (Figure 1A-D). It is important to order a Fite stain when suspecting leprosy as the Ziehl-Neelsen stain is usually weak, as in this case, and often is negative. Her lab results were within normal ranges. ELISA was performed against M. leprae Ag85B (ML2028), ND-O-HSA (PGL-I) and LepLAM and compared to three LL patient sera (LL8, LL27 and LL32) which are very well characterized to have high reactivity to all three antigens by ELISA and Western blot (Figure 2) (3). The titer for this patient's serum is consistent with BL/LL individuals.

Autochthonous North American Leprosy: A Second Case in Canada

“…Four such cases have been reported from New York state [ 5 , 13 , 14 , 15 ] and one case from Georgia [ 16 ]. However, it is emerging that a more common risk factor for such autochthonous cases is transmission via droplets or aerosols from foreign-born individuals residing in North America from countries with endemic M. leprae infection (described previously in Spain) [ 5 , 17 ]. It is difficult to trace such exposures given the prolonged incubation period of clinical leprosy after an infectious exposure (mean of four years for tuberculoid leprosy and ten years for lepromatous leprosy) [ 18 ].…”

Autochthonous Leprosy without Armadillo Exposure, Eastern United States

“…In 1991, Mastro et al reported that leprosy was an epidemic phenomenon without secondary transmission ( 2 ). In 2000, however, the first autochthonous cases of leprosy in New York City were reported ( 3 ), and 2 additional autochthonous cases subsequently were reported ( 4 , 5 ). Autochthonous leprosy has been reported in the eastern United States in Georgia ( 6 ) and central Florida ( 7 ); transmission was blamed on armadillos, even though most of these case-patients had no history of exposure to armadillos, and armadillos east of the Mississippi River rarely have leprosy ( 8 ).…”

Current approaches and future directions in the treatment of leprosy

“…In New York City, three cases of leprosy have been diagnosed in patients who had never been outside the US, signifying the emergence of a new endemic area. 11 In the southern US, a genotype comparison of M. leprae in human patients and nine-banded armadillos strongly implicates armadillos as the source of infection: "Leprosy appears to be a zoonosis in the southern United States." 12 Elsewhere in the world, humans are the only known reservoir for M. leprae.…”