TAMPA, Fla. (WFLA) — Florida is seeing a rise in leprosy cases that could mean the disease has become endemic in the Sunshine State, according to a letter published by the Centers for Disease Control and Prevention.

The letter, which was published in mid-July, said while leprosy is historically uncommon in the United States, cases more than doubled in the South over the last 10 years.

Leprosy, also known as Hansen’s Disease, is caused by the bacterium Mycobacterium leprae and is characterized by discolored patches of skin, ulcers, lumps and damage to the nerves.

The CDC said if untreated, the disease can progress to paralysis, blindness, the loss of one’s eyebrows, physical disfigurement, and even the “shortening of toes and fingers due to reabsorption.”

The Florida Department of Health said the disease first appeared in the state in 1921. The National Hansen’s Disease Program found that 159 cases of leprosy were reported in 2020. Florida was at the top of the list of states with the most new cases.

According to the Florida Health Charts, the state had 26 reported cases in 2019, 27 in 2020, and 14 in 2021.

“Central Florida, in particular, accounted for 81% of cases reported in Florida and almost one-fifth of nationally reported cases,” the letter said. “Whereas leprosy in the United States previously affected persons who had immigrated from leprosy-endemic areas, [about] 34% of new case-patients during 2015–2020 appeared to have locally acquired the disease.”

A disease becomes endemic when it occurs regularly within a certain community or area.

The CDC letter said multiple cases showed no sign of animal-to-human transmission or “traditionally known risk factors.”

One patient, a 54-year-old man in Central Florida, was treated at a dermatology clinic for a progressive rash caused by leprosy.

When asked, the man said he had lived in Central Florida his whole life, did not travel domestically or internationally, had no exposure to armadillos (which can carry the disease), had no contact with immigrants with endemic leprosy, and had no connection to someone with the disease.

Figure. Lepromatous leprosy found in a 54-year-old man in central Florida (Photo and caption by the CDC)

Experts said there was some support for the theory that an increase in migration from other countries to the United States may have caused the disease to enter non-endemic areas. However, while leprosy cases are increasing in the U.S., the rate of new cases in people born outside of the U.S. had been on a decline since 2002.

“This information suggests that leprosy has become an endemic disease process in Florida, warranting further research into other methods of [local] transmission,” the letter said.

In the state of Florida, medical practitioners must report leprosy by the next business day so contact tracing can be done and reduce further infections.

“In our case, contact tracing was done by the National Hansen’s Disease Program and revealed no associated risk factors, including travel, zoonotic exposure, occupational association, or personal contacts,” the letter said. “The absence of traditional risk factors in many recent cases of leprosy in Florida, coupled with the high proportion of residents, like our patient, who spend a great deal of time outdoors, supports the investigation into environmental reservoirs as a potential source of transmission.”

The CDC said travel to Florida must now be considered when conducting contact tracing for leprosy in any state.

Leprosy, when contracted, can be treated by a combination of different antibiotics to prevent it from developing resistance to the medication, according to the CDC. Leprosy can be cured after one or two years of treatment.

However, even when cured, any nerve damage and disfigurement caused by the disease will be permanent.