How leprosy arrived in Florida, and how it is spreading: New clues are emerging

Health officials are seeing more cases of the rare disease of leprosy in Florida, and want to find out why.

Are foreign travelers bringing the disease to Florida with them? Are people in the state getting it from armadillos, which are naturally infected with the bacteria that causes the disease? How is this rare disease spreading in the Sunshine State, and who is vulnerable to it?

Leprosy, also known as Hansen’s Disease, has been around for centuries, and now mostly is in countries like India, Brazil and Indonesia. People untreated who have the infectious disease caused by the bacteria Mycobacterium leprae often have disfiguring skin sores or deformities like claw hands or hammer toes.

Knowing you have leprosy and getting treated early is crucial. However, it could take about five years after contracting the disease to show symptoms, such as patches of pink skin that become numb, lumps on your face or earlobes, and numbness in your hands and feet.

What’s going on in Florida?

Historically, most cases of leprosy in the United States affected people who traveled to countries where it was more common and had prolonged close contact with someone who has it, or people who had contact with certain armadillos that carry the leprae bacteria.

But in Florida that isn’t always happening, particularly in one area of the state.

While leprosy still remains rare in the United States, reported cases gradually have increased over the last decade, particularly in Florida. Central Florida in particular has seen a disproportionate share of cases.

Health data shows 172 reported cases in Florida since 2015. Almost half of the counties in Florida have at least one case. However, the majority of people infected, 80 of them, are in Brevard County in Central Florida. Brevard runs along the coastline north of Vero Beach and includes Kennedy Space Center.

“That cluster of cases sparked our interest,” said Dr. Charles Dunn, a dermatologist and an author of the Case Report of Leprosy in Central Florida published in the Emerging Infectious Diseases journal.

Dunn and Orlando dermatologist Dr. Rajiv Nathoo became intrigued when they had a patient with the rare disease, a man who had symptoms for five years and went undiagnosed. The man had a deformed forehead, elongated earlobes and a bumpy rash across his body. He did not have the traditional risk factors for contracting the disease, but had been a landscaper, and his case drove the doctors to do more research.

They saw a pattern in Central Florida: “We saw a geographic cluster, an uptrend in cases, and a lack of traditional risk factors,”  said Nathoo, of Advanced Dermatology and Cosmetic Surgery Consortium in Orlando and a senior author of the new case report.

Now, the researchers are suggesting leprosy may be a permanent fixture in Florida and locally acquired. Miami doctors who treat the disease agree.

How are Floridians getting the disease?

No one knows for certain why and how leprosy is spreading in Florida. One way scientists think someone can get leprosy is via droplets from an infected person’s coughs or sneezes during a prolonged period of close contact. Another method is contact with nine-banded armadillos, some of which are naturally infected by leprosy-causing bacteria.

Dunn and Nathoo believe there may be a third way to get it: Indirect contact with the leprae bacteria, possibly from touching contaminated soil.

Their suspicions stem from the fact that a cluster of people in Central Florida with the disease are outdoor workers, and armadillos are common now in the state. “Environmental reservoirs” could harbor the bacteria, they said. In 2006, scientists found the leprae bacteria in soil samples in India.

“Could it be in the soil in Central Florida? We don’t know,” Dunn said. “It is one of the interesting factors to consider in the thought process. We are hoping the scientific community leans into our report.”

Dunn and Nathoos suggest that doctors and other health professionals consider leprosy as a potential diagnosis for patients who have traveled to or lived in Central Florida. The disease can be confirmed with a skin biopsy.

“Travel to this area, even in the absence of other risk factors, should prompt consideration of leprosy,” they wrote in their report.

The Centers for Disease Control and Prevention posted information on its website this week noting that Hansen’s disease is very rare in the U.S., with fewer than 200 cases reported per year.  “In the past, leprosy was feared as a highly contagious, devastating disease, but now we know that it’s hard to spread and it’s easily treatable,” agency officials said.

About 95% of people have natural immunity to the bacteria that causes leprosy. Scientists still are researching why 5% of people are vulnerable.

Miami is a hub for treatment

Florida is a state where cases are cropping up, including in South Florida counties.

With 16 cases in the state reported thus far for 2023, people are traveling to Miami to receive specialized care — typically a multi-drug therapy for one to two years.

Dr. Andrea Maderal is the director of the University of Miami/Jackson Memorial Hospital Hansen’s Disease Program, one of 16 federally funded programs across the nation and the only one in Florida. She sees about a dozen patients a month.

“Our main mission is to treat patients early to prevent disability from the disease,” she said.

Typically her patients arrive with a rash and have lost sensation in that area, Maderal explains. The rash and possibly lesions can be in a few spots, or widespread. A person with leprosy also may have painful sensations in their hands and the feet and possibly even fever and joint pain, she said.

“It’s important to know what people think of with leprosy is untrue for the most part,” Maderal said. “People think it’s highly contagious, and it’s not.”

Maderal says she, too, has questioned how some Floridians contracted the disease.  Some of her patients report international travel (particularly to South America) or contact with armadillos. “But we are seeing some Florida cases where it’s unexplained. Some people do not report direct armadillo exposure but they see armadillos all the time in their yard.”

Her concern is that cases in Florida are going undiagnosed. Dermatologists often mistake early symptoms for other skin conditions like psoriasis or eczema. Left untreated, nerve damage from the infection can lead to paralysis and the crippling of a person’s hands and feet.

“This is a highly curable disease,” she said. “Catching it early and seeing a physician who knows how to treat it is important, not just for people in Florida to know but also for doctors to recognize.”

Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.