More leprosy cases are showing up in Florida and the rest of US

Central Florida cases of ancient scourge return, but doctors say odds are slim you’ll catch it

MIAMI — Leprosy, a disease of the skin and nerves, hearkens back centuries, all the way to its reference in the Bible in the Book of Leviticus. People in Florida are talking about leprosy again and not just in church or Sunday school.

While leprosy remains rare in the U.S., more cases are popping up across the country, including in Florida, where the disease may have become endemic, experts say. A disease is considered endemic when it is consistently present in a place. A pandemic, like COVID, can spread far and quickly.

Even though most people have natural immunity against the ancient bacteria that causes leprosy, thousands across the world get ill with it every year.

And in the U.S., which sees about 150 cases a year, infections in the Southeast U.S. have more than doubled in the last decade, according to research published last year in the U.S. Centers for Disease Control and Prevention’s Emerging Infectious Diseases peer-reviewed journal. The report was written by Central Florida doctors Aashni Bhukhan, Charles Dunn and Rajiv Nathoo.

The handful of Florida cases in recent years have largely been in Central Florida, with many in Brevard County on the Space Coast.

But there is no reason to sound alarms, the doctors say.

“The ultimate message for the general public, is do not panic,” said Dunn, chief resident of the ADCS Orlando Dermatology Residency Program. “This is a very rare disease process that is still very uncommon in the United States and something that is highly treatable if caught early, and not something that people need to be anxious or nervous about.

“It’s actually incredibly hard to contract — 95% of the population is genetically not susceptible to contracting it.”

The study, he said, was primarily aimed at educating the clinical community given the strong geographic predilection for leprosy. There’s still much to be learned about leprosy and why it is endemic in some states and wholly absent in others.

The bacteria that fuels the disease is slow-growing and can take five to 20 years for symptoms to appear, which can make it slip under the radar in routine medical visits, Dunn said.

“There’s some misconceptions within the clinical community about how it’s contracted and how it’s transmitted,” he said.

Another takeaway from recent reports is to tell your doctor if you suspect something is wrong.

“If you have any questions about your skin, or if you have any clinical concerns about your exposure history that make you nervous, that you could potentially have it, find your local physician, find your

local dermatologist, and ask them questions and we’ll be able to answer them,” Dunn said. “But this is not something that you need to panic about. It’s not something that is spreading or rampant or anything that the population needs to be concerned about.”

In 2022, 136 leprosy cases were reported in the U.S., mostly in Florida, Texas, New York, California, Arkansas, Louisiana and Hawaii, according to the most recent data available through the National Hansen’s Disease Program in Baton Rouge, Louisiana.

Florida recorded eight cases in 2022, or about 6% of the cases reported in the country that year, and three of those cases were in Brevard County, state data shows.

In 2020, Central Florida accounted for nearly one-fifth of the 159 cases reported in the country, according to the CDC report. Florida’s Reportable Diseases Frequency Report found that of the 27 cases that year in eight counties, 20 of those were in Brevard.

There are just three cases of leprosy in Florida in 2024, through March 26, out of a population of nearly 23 million people, according to U.S. Census data — one leprosy case each in Polk, Sumter and Volusia counties, all in Central Florida.

“There’s this common misconception within the medical community that leprosy only occurs in people that were born in countries outside the United States,” Dunn said.

The majority of cases of leprosy are diagnosed and occur outside the United States. Most cases occur in India, Brazil, Indonesia, Nepal, Bangladesh, he said.

Hansen’s disease, or leprosy, is a disease that affects the nerves and skin. It’s one of the oldest infectious diseases in human history and is caused by a slow-growing bacteria called Mycobacterium leprae.

Symptoms: Leprosy causes discolored patches of skin, lumps and ulcers, and numbness in affected areas. If left untreated, leprosy can lead to paralysis, crippling of hands and feet, disfigurement and blindness.

What to look for: Dunn says leprosy can appear as patches or plaques that are well-marked. “I can take a pen and I can draw a circle around them perfectly,” he said. These skin patches or plaques tend to be lighter in color, but not always. And if you rub your finger over that area it tends to have less sensation than the surrounding skin, Dunn said. “One mimicker of this is actually psoriasis. So it can look a little like a psoriatic plaque,” Dunn said. Other signs to look for include a loss of the eyebrows and eyelashes and a kind of thickening or furrowing of the facial features. “The ear lobes can start to elongate a little bit as the nerves and the connective tissue kind of gets softer,” Dunn said.

Treatment: Leprosy is typically treated with two or three antibiotics simultaneously for one to two years to help prevent the bacteria from developing resistance against the drugs. While treatment can cure the disease and prevent the illness from getting worse, it cannot reverse nerve damage or physical disfiguration from the illness.

The bottom line: “In the past, Hansen’s disease was feared as a highly contagious, devastating disease, but now we know that it’s hard to spread and it’s easily treatable once recognized,” according to the CDC. “Still, a lot of stigma and prejudice remains about the disease, and those suffering from it are isolated and discriminated against in many places where the disease is seen.”

The research report published in the CDC journal indicates that there’s growing evidence leprosy has become endemic in Florida, according to Newsweek.

The age range of people diagnosed with leprosy in the research studies have been 9 to 75. But most patients tend to be older than 50, Dunn said. “As you get older, your immune system starts to shift and change and your susceptibility to particular things becomes increased.”