Major Risk Factors for Leprosy in a Nonendemic Area of the USA

BACKGROUND: 178 new cases of leprosy were reported in 2015 with Florida being one of six states and contributing a large number (72%) of registered cases. It was also the only state showing an increasing occurrence compared with the previous years. Studies from other southern U.S. states in armadillos and leprosy patients demonstrate infection with the same strain of Mycobacterium leprae, confirming human armadillo exposure as the main risk factor for leprosy. In contrast, cases from Florida show no clear risk factor. We present three cases of leprosy from Hillsborough county (Florida) with no previous armadillo exposure but a different risk factor in common: being foreign-born. METHODS: We report three cases of leprosy presenting in a non-endemic area of Florida during the past five years and highlight the absence of direct armadillo exposure as a risk factor for developing the disease. RESULTS: Case 1: A 35-year-old male from Mexico presented with multiple erythematous non-tender cutaneous lesions and numbness in both hands. He had a history of leprosy exposure from a Haitian inmate during incarceration in Florida. Biopsy confirmed borderline lepromatous leprosy. Case 2: A 67-year-old female from Cuba presented with disseminated circular ulcerative lesions and severe hypesthesia of lower extremities. She denied leprosy or armadillo exposure. Diagnosis of borderline lepromatous leprosy was made through biopsy. Case 3: A 38-year-old female from Puerto Rico presented with disseminated painless plaques, edema of the hands with numbness and paresthesias. She worked as a nurse but denied leprosy or armadillo exposure. A biopsy confirmed borderline lepromatous leprosy with erythema nodosum leprosum. CONCLUSION: 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. Place of birth is a very important factor due to the diverse and increasing foreign-born population in the United States. DISCLOSURES: All authors: No reported disclosures.