Major risk factors for leprosy in a non-endemic area of the United States: A case series

Abstract

Approximately 200 cases of leprosy are reported each year in the United States, and about 175 of the cases are diagnosed for the first time. Florida contributes a large number of reported cases each year and is showing an increasing incidence. Studies from other southern U.S. states demonstrate infection with the same strain of Mycobacterium leprae, confirming human armadillo exposure as the main risk factor. In contrast, cases from Florida show no clear risk factor. We present three cases (two foreign born and one autochthonous case) from Hillsborough county Florida, that were reported from this non-endemic area during the past five years. The first case was a 35-year-old male from Mexico, with history of exposure from a Haitian inmate, who presented with multiple erythematous non-tender cutaneous lesions and numbness in both hands. Biopsy confirmed borderline lepromatous leprosy. The second case was a 34-year-old male, from Florida who presented with sparse annular non-supporative lesions on left cheek with one-month duration and denied leprosy or armadillo exposure. Biopsy confirmed the diagnosis of borderline tuberculoid leprosy. The third case was a 38-year-old female, from Puerto Rico who presented with disseminated painless plaques, edema of the hands with numbness and paresthesia. She denied leprosy or armadillo exposure. The biopsy confirmed borderline lepromatous leprosy with erythema nodosum leprosum. Our case series demonstrates that a history of armadillo exposure is not always present. Other risk factors need to be considered when leprosy is a possible diagnosis in a patient.

Ni Erradicada, Ni Olvidada: Lepra, Una Enfermedad Tropical Abandonada Pero Vigente

“…Algunas asociaciones reconocidas son el contacto con armadillos (lepra zoonótica) y la procedencia de países latinoamericanos. [17,18] También se han planteado factores de riesgo sociales como el bajo grado de escolaridad, el hacinamiento, la inadecuada salubridad, la desnutrición y un bajo nivel socioeconómico; condicionados por la desigual distribución de la salud y la enfermedad de la población. [19] Rev Méd Cient.…”

Leaping over Leprosy

“…1,3,4 Other risk factors may include immigration or exposure to individuals who immigrated from Haiti, though the evidence to support this is anecdotal. 5 Central Florida has the potential to become an epicenter for leprosy spread. Dermatologists can play a crucial role in decreasing the transmission of this devastating illness.…”

Multiple Annular Erythematous Plaques

“…1 In the United States where leprosy is nonendemic, 159 new cases were detected in 2020; the most notable risk factors in the United States are armadillo exposure and travel history. 2,3 Mycobacterium leprae are intracellular bacilli that preferentially infect macrophages and Schwann cells, resulting in erythematous or hypopigmented skin lesions that often are anesthetic. Mycobacterium leprae has the longest doubling time of all bacteria with unknown in vitro growth requirements and a typical in vivo incubation period of 2 to 10 years.…”