Increasing incidence of leprosy and transmission from armadillos in Central Florida: A case series
2016; Elsevier BV; Volume: 2; Issue: 3 Linguagem: Inglês
10.1016/j.jdcr.2016.03.004
ISSN2352-5126
AutoresRenee Domozych, Esther Kim, Sarah Hart, Jeffrey Greenwald,
Tópico(s)Infectious Diseases and Tuberculosis
ResumoIntroductionLeprosy, or Hansen's disease, is caused by the acid-fast bacillus Mycobacterium leprae. Leprosy is transmitted by human-to-human contact, although zoonotic transmission has been described, and contact with the nine-banded armadillo (Dasypus novemcinctus) is a risk factor for development of leprosy.1van Beers S.M. Hatta M. Klatser P.R. Patient contact is the major determinant in incident leprosy: implications for future control.Int J Lepr Other Mycobact Dis. 1999; 67: 119-128PubMed Google Scholar, 2Moet F. Meima A. Oskam L. Richardus J. Risk factors for the development of clinical leprosy among contacts, and their relevance for targeted interventions.Lepr Rev. 2004; 75: 310-326PubMed Google Scholar, 3Truman R. Fine P. 'Environmental' sources of Mycobacterium leprae: issues and evidence.Lepr Rev. 2010; 81: 89-95PubMed Google Scholar, 4Truman R.W. Singh P. Sharma R. et al.Probable zoonotic leprosy in the southern United States.N Engl J Med. 2011; 364: 1626-1633Crossref PubMed Scopus (222) Google Scholar Cases 1 and 2 in this case series show zoonotic transmission from armadillos. An additional source of M leprae infection may be soil or land contaminated by leprosy-infected armadillos.3Truman R. Fine P. 'Environmental' sources of Mycobacterium leprae: issues and evidence.Lepr Rev. 2010; 81: 89-95PubMed Google Scholar, 5Lane J.E. Walsh D.S. Meyers W.M. Klassen-Fischer M.K. Kent D.E. Cohen D.J. Borderline tuberculoid leprosy in a woman from the state of Georgia with armadillo exposure.J Am Acad Dermatol. 2006; 55: 714-716Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 6Lavania M. Katoch K. Katoch V.M. et al.Detection of viable Mycobacterium leprae in soil samples: insights into possible sources of transmission of leprosy.Infect Genet Evol. 2008; 8: 627-631Crossref PubMed Scopus (56) Google Scholar Cases 3 and 4 support this potential mode of transmission.Florida recently experienced an increased incidence of leprosy, including 72 confirmed cases since 2010. We report 4 patients seen over 2 years in Central Florida, an area in which leprosy is not endemic.Case reportsCase 1An otherwise healthy 55-year-old white man from Central Florida presented to clinic in January 2014 with a 2-year history of enlarging, pink, anesthetic skin lesions on the left ankle and thigh. The patient denied a history of travel to areas where leprosy is endemic, and the patient had not previously come in contact with individuals with leprosy. He reported multiple exposures to armadillos over the last decade; the most significant exposure was when his vehicle struck an armadillo. Armadillo carcass transferred to the patient's shoes and skin on his left arm and ankle. He recalled smelling his left arm before wiping off the remains.On physical examination, 8- to 15-cm hypopigmented, annular plaques with erythematous borders and central anesthesia to touch and pinprick were located on the left lower extremity (Fig 1). Two- to 5-cm annular, erythematous plaques were found on the scalp, face, trunk, and left upper extremity. Punch biopsies from ankle and leg lesions found mycobacterial infection with granulomatous inflammatory response suggestive of borderline tuberculoid leprosy IntroductionLeprosy, or Hansen's disease, is caused by the acid-fast bacillus Mycobacterium leprae. Leprosy is transmitted by human-to-human contact, although zoonotic transmission has been described, and contact with the nine-banded armadillo (Dasypus novemcinctus) is a risk factor for development of leprosy.1van Beers S.M. Hatta M. Klatser P.R. Patient contact is the major determinant in incident leprosy: implications for future control.Int J Lepr Other Mycobact Dis. 1999; 67: 119-128PubMed Google Scholar, 2Moet F. Meima A. Oskam L. Richardus J. Risk factors for the development of clinical leprosy among contacts, and their relevance for targeted interventions.Lepr Rev. 2004; 75: 310-326PubMed Google Scholar, 3Truman R. Fine P. 'Environmental' sources of Mycobacterium leprae: issues and evidence.Lepr Rev. 2010; 81: 89-95PubMed Google Scholar, 4Truman R.W. Singh P. Sharma R. et al.Probable zoonotic leprosy in the southern United States.N Engl J Med. 2011; 364: 1626-1633Crossref PubMed Scopus (222) Google Scholar Cases 1 and 2 in this case series show zoonotic transmission from armadillos. An additional source of M leprae infection may be soil or land contaminated by leprosy-infected armadillos.3Truman R. Fine P. 'Environmental' sources of Mycobacterium leprae: issues and evidence.Lepr Rev. 2010; 81: 89-95PubMed Google Scholar, 5Lane J.E. Walsh D.S. Meyers W.M. Klassen-Fischer M.K. Kent D.E. Cohen D.J. Borderline tuberculoid leprosy in a woman from the state of Georgia with armadillo exposure.J Am Acad Dermatol. 2006; 55: 714-716Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 6Lavania M. Katoch K. Katoch V.M. et al.Detection of viable Mycobacterium leprae in soil samples: insights into possible sources of transmission of leprosy.Infect Genet Evol. 2008; 8: 627-631Crossref PubMed Scopus (56) Google Scholar Cases 3 and 4 support this potential mode of transmission.Florida recently experienced an increased incidence of leprosy, including 72 confirmed cases since 2010. We report 4 patients seen over 2 years in Central Florida, an area in which leprosy is not endemic.
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