Rising evidence that leprosy has become endemic in Southeastern United States | Hacker News Reader

Rising evidence that leprosy has become endemic in Southeastern United States

wwwnc.cdc.gov

75 pointsgeox19 comments

While the abstract does say there's "rising evidence that leprosy has become endemic in the southeastern United States", the actual title is "Case Report of Leprosy in Central Florida, USA, 2022" and that's a more honest description of what this is.

The second reference -- https://www.hrsa.gov/hansens-disease -- shows cases in the entire US bouncing from around 160 to 220 since _2011_ up through 2020: "Most (95%) of the human population is not susceptible to infection... Treatment with standard antibiotic drugs is very effective." The Florida dashboard which is the third reference shows 14 cases in that state total in 2021.

For those who keep asking, "why Florida", it is because of the armadillos. I will note that the one case in the article without classic risk factors "works in landscaping, and spends long periods of time outdoors". Armadillos are very common to encounter outdoors, and although the case subject reported no armadillo contact, I would be quite surprised if no one he worked with in landscaping also had no armadillo contact.

The fact Florida Tech has long been a world supplier of leprosy samples from local armadillos is quite relevant: https://news.fit.edu/archive/rising-star-disney-comes-to-cou...

Armadillos are just as common in Mississippi, Alabama, Louisiana, and especially Texas compared to Florida. I don’t feel like that tells the full story.

The ideal temperature for M. Leprae is between 91.4 and 95 degrees Fahrenheit. Those other states have more cold snaps whereas Florida is more temperate.

So what? Over 95% of humans are immune to leprosy. [0] Not only that, it's so hard to even culture in a lab, actually spreading it in the wild is a bit of a challenge.

[0]: https://www.cdc.gov/leprosy/transmission/index.html

[1]: https://www.internationaltextbookofleprosy.org/chapter/assay...

Apparently leprosy is treatable, and with treatment underway is no longer contagious in a matter of days.

Sadly in regions such as this beliefs and new laws are increasingly inhibiting treatments. This is a terrifying outcome in all cases but particularly with infectious diseases.

In Florida??

if all you do is read hit pieces from news/peers about how horrible Florida is, you can easily believe it's a hell hole of corporatism that rivals Haiti in its care for citizens. Ain't true, but echo chambers do their thing.

Yeah, I suppose one would have to really live in a bubble.

Forgive me if I'm out of touch, but what beliefs or laws would inhibit treatment of leprosy?

The conscience law, or the immigration law.

One day, in fact, with standard MDT.

I've actually been involved in a leprosy case investigation in a school. Everyone was freaked out, community meetings, the works. No second cases were ever identified. It really is quite difficult to spread outside of household contacts.

Similarly, the case of leprosy I myself diagnosed (off a skin biopsy that was initially thought to be cutaneous tuberculosis) had no related cases either.

So but...why Florida? This is a disease with a vector that requires close interpersonal contact. I figured it was sort of rare I. 2023

Close interpersonal contact sounds a lot like spring break in tourist towns. Off the cuff guess.

Title is misinformation and doesn't match the content of the link.

It's possible leprosy is endemic and the detected cases are a "tip of the iceberg", but I think an infectious disease doctor looked at a similar report recently and was confused why that would be assumed to be the case. Institutional knowledge on leprosy has probably been lost, and it's possible in the past that undetected infection and spread was commonly known about but not told to the public or new doctors and a current infectious disease doctor would not know about it, but I'm not sure about this situation in general.

The title is lifted verbatim from the abstract:

> Those trends, in addition to decreasing diagnoses in foreign-born persons, contribute to rising evidence that leprosy has become endemic in the southeastern United States.

and the paper itself says the same thing in the summary:

> In summary, our case adds to the growing body of literature suggesting that central Florida represents an endemic location for leprosy.

How is that misinformation?

Just fyi, "endemic" doesn't mean in humans specifically, it is being spread via zoonotic transmission, and it is endemic in certain animal populations in the southeast. The title is accurate.

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