Hammerling-Hodgers: Brevard County, Florida, is the hot spot of U.S. cases of leprosy

Shannon, 48, had an unusual dry patch on her lower leg that she thought was not attractive and it did not respond to any anti-fungal creams or topical steroids after applying it for several months.

She became concerned when the area did not improve and the affected patch became numb.

Even though she was diagnosed with Hansen’s disease, aka leprosy, she had no known risk factors and had not traveled outside Florida for several years.

Paul, 65, recently diagnosed with colon cancer, had a diffuse scaly rash on his trunk that was being treated for a fungal infection.

After a few months of treatment with no improvement he went to a dermatologist for a punch biopsy of the skin. Two weeks later, the biopsy results came back consistent with Hansen’s disease.

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Both Shannon and Paul had a love of the outdoors and enjoyed gardening.

Are they at higher risk of getting leprosy from gardening?

There are various theories of how patients get leprosy. One theory is that maybe people can get leprosy from exposure to soil contaminated by armadillos when gardening. It is recommended to wear gloves and maybe even a mask while gardening, then make sure to do a thorough washing.

Leprosy is caused by a bacteria Mycobacterium leprae. Most people are genetically resistant to the pathogen, so it's difficult to catch.

Some experts believe the disease might be transmitted from direct contact or is airborne. Others talk about the possibility that armadillos carry the pathogen and can infect humans if ingested after hunting.

It isn't fully known how leprosy is spread due to how uncommon it is. Many scientists state that it's not spread by casual contact or during the birthing process.

In 2020, Brevard County, Florida, accounted for 20 of 159 cases in the U.S., according to National Hansen’s Center.

Some early signs and symptoms of leprosy can include a non-healing rash or discolored patchy areas on the body which can become develop a loss of sensation in the affected area. More advanced symptoms can include numbness in hands and feet or thinning of the eyebrow and eyelashes if the face is involved.

According to Dr. Andrew Miner: “Leprosy is a very treatable disease. In order to kill the organisms, people just need to take appropriate antibiotics for the appropriate amount of time. The length of time people need to take antibiotics is quite long. Many people do well with a once a month regimen of three antibiotics. This regimen is very easy for people to take and has minimal risk factors. Some of the older regimens required blood work and caused changes in skin color (turning people blue), or carry with them a rupture of tendons. These new regimens do not seem to carry the same problems.”

If diagnosed early, leprosy can be cured with standard antibiotics for a year. Within a week, treatment can make patients noninfectious. If not treated early or untreated, the bacteria can damage the nerves and can lead to permanent paralysis.

As Dr. Miner, a dermatologist and dermatopathologist wants to remind us: “The most difficult part of treating leprosy is making a correct diagnosis. Usually a biopsy is necessary, but many patients have very few organisms, and the PCR testing that looks for the DNA of the organism is only positive in about 50% of cases where there are fewer organisms. So a biopsy is usually necessary, but having a good clinician, examine a patient, test, the nerves, and take everything into account is absolutely essential. More education of doctors across central Florida and the south eastern United States is absolutely essential.

Many cases are not reported to the state. It is required to report this diagnosis, but because it is so difficult to diagnose, many cases that are likely leprosy, but not definitively leprosy or not counted in state tallies. This adds a level of complexity when we are trying to figure out how many cases there are that doesn’t exist with many other diseases where the diagnosis is more straightforward. We are drafting a recommendation in our practice that will recommend counting possible and probable cases, in addition to the definitive cases.”

If you have an unexplained rash that is not going away within a few weeks, then make sure to follow up with a dermatologist to make sure you get the correct diagnosis early.

Susan Hammerling-Hodgers, a Member of the National Psoriasis Foundation, is a PA-C (Certified Physician Assistant) and MPAS (Master of Physician Assistant Studies) and works at Brevard Skin and Cancer at the Merritt Island, Titusville and Rockledge offices.

This article originally appeared on Florida Today: Brevard County, FL, had 20 of 159 cases of leprosy in the U.S. in 2020