Leprosy in the U.S.

Leprosy is considered a disease of the past, but the bacterial infection continue to cause cases today in the United States, including in Florida, where nine people have been diagnosed with the disease this year.

 
What could possibly be causing the 50-100 cases seen in the U.S. every year? Experts believe that it could be the nine-banded armadillo that makes its home across much of the Southeast. It’s one of the few animals that has increased its range in the face of human development (the coyote is another).

They’re cute in an ugly-pugly kind of way, but the best advice is to keep your distance. They’re not an animal you should eat unless you have no choice, and don’t keep one as a pet.  They’re chock full of disease-causing microbes, and are a “reservoir” for the bacteria that cause Leprosy, much as fruit bats are the natural reservoir for the ebola virus.

 
I’ll admit that I may be giving the armadillo a bad rap. The cause of the Florida cases is yet to be determined. Researchers do know, however, that armadillos can transmit the disease to humans. Every year, 2-10 Floridians are diagnosed with leprosy, now called Hansen’s disease after the scientist who discovered the bacteria in 1873.

Leprosy isn’t just a potential problem in Florida, it’s also seen in Texas, armadillo paradise, where 10-25 people were diagnosed annually from 2010-2014. In Louisiana,  8 leprosy cases were reported in 2011 and 6 a year from 2012-2014.

The strange thing is that the people infected probably didn’t acquire the bug this year, or maybe even last year. The incubation period [the time between exposure and the appearance of symptoms] for Hansen’s disease can be up to 10 years (average 2-3 years). This makes it very difficult to identify the source of exposure, although it’s usually something or someone you have had prolonged contact with (like your pet armadillo).

ALL YOU NEED TO KNOW ABOUT LEPROSY

In the U.S., few doctors have ever seen a case of Hansen’s Disease. I didn’t see a case in 25 years of practice. Therefore, it may be missed as a diagnosis. So what should you know about it?

The bacteria that causes leprosy began infecting humans at least 4,000 years ago, is a chronic condition caused by the bacterium Mycobacterium leprae. It’s the second most common infectious disease caused by mycobacteria after tuberculosis.

 
Despite victims being cast out from society in the past, leprosy is actually not that contagious. You can catch it only if you come into frequent contact with droplets from coughs and sneezes from someone who has it.

 
Leprosy primarily affects the skin, where the first signs usually occur. It also affects the nerves outside the brain and spinal cord, called the peripheral nerves. It may also involve the eyes, the lining of the nose, the kidneys, and even  male sexual organs. Over time, people may experience loss of sensation to these areas.

 
This lack of sensation can lead to injuries, and sometimes, people lose their fingers, toes and even nose if the disease has progressed too far. Muscle weakness and paralysis can also occur, leading to claw-like deformities of the hands and difficulty walking.

 
People can also get leprosy through their circulatory system. When that happens, the bacterium slowly infiltrates the tissues under the skin, and causes sores, pale bumps and skin protuberances on the face. This can lead to unusual features, in which the infected develop an enlarged brow and strong cheekbone features.

Put all these together, and leprosy sufferers looked pretty darn scary to ancient societies. Many banished “lepers”, but with the advent of antibiotics, successful treatments became available. These days, the disease is treatable with 6 months-2 years of multiple therapies. Despite this, an estimated 2 million people around the world have been permanently disfigured by leprosy.

(As an aside, even with all we know in modern times, it’s still not known exactly how Mycobacterium Leprae causes the effects of the disease. Also unknown is why many people are simply immune to it.)

 
In survival settings, it’ll be hard to do much of anything for these poor folks. No one’s going to have 6 months to 2 years of daily antibiotics to spare for one patient. Yet I’ll bet some of us will be reduced to eating a leprosy-carrying armadillos to live, so the medic may just see it from time to time. Without drugs or even effective natural treatments for the disease, the medic will take steps to ensure that the patient avoids injury and treat sores as they occur.

Victims of the disease, if in an advanced stage, may have to go back to relative isolation to protect the rest of the community, or at least restrict contact in some way. That’s the hard reality when a disaster takes away the miracle of modern medicine.

Joe Alton, MD

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