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Is leprosy rampant in Florida?

Is leprosy rampant in Florida?

 


Campos-Clauer plans to test the armadillos for leprosy, an ancient disease that causes neurological damage and disfigurement in humans, also known as Hansen's disease. He and other scientists are trying to solve a medical mystery: why Central Florida has become a hotspot for the ancient bacteria that causes leprosy.

Leprosy remains a rare disease in the United States. But in Florida, which often reports more cases than any other state, the number of cases is on the rise, with the epicenter just east of Orlando: A staggering 13% of the 159 leprosy cases reported nationwide in 2020 were reported in Brevard County, 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 how to prevent it, a team of about 10 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 don't really know how this transmission is happening,” said Ramanuj Lahiri, head of the institute's research division. National Leprosy Programmeis researching the bacteria involved and working to treat leprosy patients across the country.

“Everything went wrong.”

Leprosy is The oldest infectious disease in human historyIt has probably plagued people for at least 100,000 years. The disease has been highly condemned, being portrayed in the Bible as a punishment for sin. In modern times, sufferers were isolated in “colonies” around the world, including Hawaii and Louisiana.

University of Florida veterinarian Juan Campos-Clauer (right) takes tissue samples from an armadillo found dead on the side of a road near Gainesville, Fla. He plans to test the animal for the bacteria that causes leprosy in humans. (Douglas R. Clifford / Tampa Bay Times)

Credit: (Douglas R. Clifford/Tampa Bay T

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Credit: (Douglas R. Clifford/Tampa Bay T

In mild cases, slow-growing bacteria Cause some damageIf left untreated, Paralyze the limbs.

But leprosy is difficult to actually develop because it is not very contagious, and it can be cured within a year or two with antibiotics, which are available free of charge through the federal government and the World Health Organization, which began a campaign in the 1990s to eliminate leprosy as a public health problem.

In 2000, reported cases in the United States fell to 77, the lowest level in decades, but cases have since risen, averaging about 180 cases per year from 2011 to 2020, according to data from the National Leprosy Program.

Around that time, a strange trend emerged in Florida.

In the first decade of the 21st century, the state recorded 67 cases, with Miami-Dade County recording 20 cases, the most of any Florida county, and the majority of cases originated outside the United States, according to a Times analysis of Florida Department of Health data.

But over the next decade, Brevard County came into the spotlight and the number of documented cases in the state more than doubled to 176.

University of Florida veterinarian Juan Campos-Klauer (center) hands a tissue sample from a dead armadillo to necropsy technician Amira Richardson (right) of the university's Department of Large Animal Clinical Sciences in Gainesville, who are studying armadillo roadkill to see if the animals harbor the bacteria that causes leprosy in humans. (Douglas R. Clifford / Tampa Bay Times)

Credit: (Douglas R. Clifford/Tampa Bay T

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Credit: (Douglas R. Clifford/Tampa Bay T

Brevard County, with a population about one-fifth the size of Miami-Dade County, reported 85 cases during that period, far more than any other county in the state and nearly half of Florida's total cases, after only five cases in the past decade.

Alarmingly, at least a quarter of Brevard's cases were contracted within the state, not while abroad. India, Brazil and Indonesia have diagnosed more leprosy cases than anywhere else, with more than 135,000 cases reported combined in 2022 alone. People are getting sick without having traveled to those areas or had close contact with anyone with existing leprosy, said Barry Inman, a former epidemiologist who investigated the cases for the Brevard Health Department and retired in 2021.

“Everything was so contradictory,” Inman said.

A few patients remembered touching armadillos, which are known to carry the bacteria, but most did not, he said. Many were lawn workers or avid gardeners who spent a lot of time outdoors. Symptoms were usually mild.

He added that it's difficult to pinpoint where people contracted the disease: Because the bacteria grows very slowly, it can take anywhere from nine months to 20 years for symptoms to appear.

Amoeba or insect?

Increased awareness of leprosy may be contributing to the rise in cases in Brevard County.

Doctors are required to report leprosy to the health department, but many in the county were unaware of it, Inman said, so he began raising awareness after he became aware of cases in the late 2000s.

But that's not the only factor, Inman said.

“I don't think there's any doubt that something new is happening,” he said.

Cases are also on the rise in other parts of Central Florida. Polk County recorded 12 cases between 2011 and 2020, triple the number in the previous decade. Volusia County recorded 10 cases after zero cases in the previous decade.

Scientists are turning their attention to armadillos, as they suspect the burrowing animals may indirectly spread infections through soil contamination.

Armadillos' hard, protected shells make them ideal hosts for bacteria that don't like heat and can thrive inside armadillos, whose body temperatures range from 86 to 95 degrees Fahrenheit.

On Honeymoon Island in Dunedin, Florida, armadillos roam the ocean hammocks searching for food as scientists collaborate to study whether armadillos have caused an increase in human leprosy cases in Florida. (Douglas R. Clifford / Tampa Bay Times)

Credit: (Douglas R. Clifford/Tampa Bay T

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Credit: (Douglas R. Clifford/Tampa Bay T

Lahiri, a scientist with the National Leprosy Program, said it's likely that colonists brought the disease to the New World hundreds of years ago and somehow infected armadillos. As nocturnal mammals, armadillos can develop lesions from the disease just as humans can. Campos-Klauer, an assistant professor in the Department of Large Animal Clinical Sciences at the University of Florida, estimates that there are more than a million armadillos in Florida.

It is unclear how many of them carry leprosy. A study of more than 600 armadillos published in 2015 found that Alabama, Florida, Georgia, Mississippi About 16 percent showed evidence of infection. Public health experts believe leprosy was previously confined to armadillos. West of the Mississippiand then spread eastward.

Handling the animals is known to be dangerous. Laboratory studies have shown that the soil-dwelling, single-celled amoeba It can also carry bacteria.

Armadillos love to dig up and eat earthworms, causing trouble for homeowners whose yards are being vandalized. As they forage, armadillos excrete bacteria that can be transmitted to amoebas that can then infect humans.

Leprosy experts also suspect that insects may play a role in spreading the disease, with laboratory studies suggesting that blood-sucking ticks may be the culprit.

“Some of the infected people have had little or no contact with armadillos,” he said. Norman Beatty“It's likely there are other sources of infection in the environment,” said the University of Florida assistant professor of medicine.

Campos-Klauer, who has been searching Gainesville roads for armadillo roadkill, wants to collect the infected animals and let them decompose in a fenced area, then immerse the carcasses in trays of soil while the flies lay their eggs. He wants to test whether the soil and larvae pick up the bacteria.

Leprosy strains are even more intriguing Found only in FloridaAccording to scientists.

In a 2015 study, researchers found that seven armadillos at Merritt Island National Wildlife Refuge (mostly in Brevard, but with a stretch into Volusia) were carrying a never-before-seen pathogen.

Ten people in the area have also been infected with the virus. At a genetic level, the strain is similar to another type found in armadillos in the United States, said Charlotte Avanzi, a leprosy researcher at Colorado State University.

It's unclear whether this strain causes more severe illness, Lahiri said.

Reduce risk

The researchers warn that the public should not panic about leprosy, nor should they race to euthanize armadillos.

Scientists estimate that more than 95% of the world's population has a natural ability to ward off the disease, and they believe that months of exposure to respiratory droplets is needed for person-to-person transmission to occur.

But if infection does occur, the damage can be devastating.

“The better we understand this, the better we can learn how to live with it and reduce the risks,” Campos-Klauer said.

This new research could be useful for other southern states. Armadillos that don't hibernate Moving north“These birds will make it as far as places like Indiana and Virginia, and with climate change, they may even travel further,” Campos-Klauer said.

Medical experts say people worried about leprosy can take simple precautions: Anyone working in the soil should wear gloves and wash their hands afterward. Raising flower beds or enclosing them with fences may reduce the chance of soil contamination. If you're digging armadillo burrows, consider wearing a mask, Campos-Klauer said.

Do not play with or feed the animals. John Spencera scientist at Colorado State University studying leprosy transmission in Brazil. Hunting is legal in Florida year-round without a license.

Campos-Klauer and her team have so far examined 16 armadillo carcasses found on a Gainesville-area road, more than 100 miles from the state's leprosy epicenter, to get a preliminary idea of ​​how many are carrying the bacteria.

No one has tested positive yet.

This story was produced in partnership between KFF Health News and the Tampa Bay Times.

KFF Health News is a national newsroom producing in-depth journalism on health issues and one of the core operating programs of KFF, an independent source of health policy research, polling and journalism. Learn more about KFF here.

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