Autochthonous Leprosy without Armadillo Exposure, Eastern United States

Rendini, Tina; Levis, William R.

doi:10.3201/eid2311.171145

Cited by 9 publications

(14 citation statements)

References 10 publications

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“…This data supports that international migration of patients with HD is a likely scenario for human transmission as stated before by Rendini et al [7] The incidence of immigration in Florida was consistently increased between 2010–2014, and about two-thirds of all immigrants to Florida from abroad came from the Americas with a specific increment in those from the Caribbean, and South America [13]. Although notably fewer cases have been recently registered among people migrating from Cuba and Puerto Rico (1.69% of total cases for each country in 2015) [3], immigration from these areas still represents the most likely risk factor for leprosy infection in our Case 3.…”

Section: Discussionsupporting

confidence: 91%

“…After a whole-genome sequencing analysis, Truman et al found that wild armadillos from southern states and U.S. born patients with leprosy are infected with the same strain of M. leprae , demonstrating that zoonotic transmission from nine-banded armadillos is the principal source of infection in this region [5]. Furthermore, Levis et al reported in 2000, the first autochthonous case of leprosy in Toronto, (where there are no wild armadillos) and suggested immigration from endemic countries as the likely scenario for autochthonous transmission of HD [6,7].…”

Section: Introductionmentioning

confidence: 99%

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

Aslam

Peraza

Mekaiel

et al. 2019

IDCases

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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.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

Aslam

Peraza

Mekaiel

et al. 2019

IDCases

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“…About 60%–75% of new cases seen in the USA occur in immigrants, especially those from the Federated States of Micronesia or Marshall Islands, or in people who have close contact with these immigrants 6–8 10. This is thought to be the main form of leprosy transmission in areas such as New York City with high numbers of immigrants and international travellers but no armadillo exposure 11 12. In the last 20 years, the largest number of new leprosy cases has been reported in the Gulf Coast states 4 6 8.…”

Section: Discussionmentioning

confidence: 99%

“…H&E staining shows granulomas as well as epithelioid histiocytes filled with intracellular bacilli 16. The intracellular organisms are acid-fast 11 14. The tissue should also treated with Anti-phenolic glycolipid antigen (PGL)-1 and PCR testing that targets the M. leprae -specific RLEP gene 2 13.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous leprosy in Central Florida man with significant armadillo exposure

Logas¹,

Holloway²

2019

BMJ Case Rep

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Leprosy is a chronic infectious, granulomatous disease caused by the intracellular bacillus Mycobacterium leprae that infects macrophages and Schwann cells. While relatively rare in the USA, there is about 200 new cases of leprosy every year with the majority occurring in the southern parts of the country. It is believed to be linked to the region of the nine-banned armadillo in patients with no significant travel history outside of the country. In this case report, we encountered a 58-year-old Central Florida man that had extensive exposure to armadillos and presented with the typical symptoms of large erythaematous patches, numbness and peripheral nerve hypertrophy. Once diagnosed properly, patients are then reported to the National Hansen’s Centre who provides the multidrug therapy for 12–24 months. Due to its rarity and its ability to mimic other more common ailments, leprosy should be included in the differential diagnosis in patients that have significant exposure to armadillos, live in the southern part of the country or have recently travelled to countries that have a high prevalence of leprosy.

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“…17 Autochthonous leprosy has been reported in metropolitan cities such as New York City, thought to be related to international migration. 18 A leprosy clinic at Emory reported managing 37 patients referred from 2002 to 2014. 19 There are also rare cases reported in other developed countries, including Canada and European nations, generally related to foreign travel.…”

mentioning

confidence: 99%

Neurological Complications of Leprosy

Lau

2019

Semin Neurol

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Leprosy is a challenging international health concern. Despite tremendous efforts in reducing worldwide disease prevalence in the past decades, some countries remain endemic and are plagued by high levels of disability. The neurological complications of leprosy are varied and complex, with current research focused on evaluating tools for earlier diagnosis of neuropathy, especially in resource-limited countries. While treatment with multidrug therapy is highly effective, active research aims to simplify regimens to improve adherence, minimize adverse effects, and prevent antimicrobial resistance. Although promising progress has been made in the past decades, further efforts are needed to push the international community toward achieving worldwide elimination.

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Autochthonous Leprosy without Armadillo Exposure, Eastern United States

Cited by 9 publications

References 10 publications

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

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

Cutaneous leprosy in Central Florida man with significant armadillo exposure

Neurological Complications of Leprosy

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