Armadillos: An emerging zoonosis in Florida

To the Editor:We read with considerable puzzlement Dr Levis’ critique of our case report conclusion that armadillos infected with Mycobacterium leprae were the likely source of our patients’ Hansen’s disease.We believe that both the clinical and genotypic evidence that the armadillo is an important vector for Hansen’s disease in Florida is quite overwhelming. Dr Levis’ statement that ‘‘It is incumbent on your journal to not assume such cases are from armadillos especially when there is no history of armadillo exposure’’ (our emphasis) completely ignores the facts of 2 of the cases we report. In both cases, the 2 patients had actually handled armadillo carcasses. In our opinion, it is quite absurd to consider thismost unusual extraordinarily close contact with armadillos a mere coincidence in these patients subsequently developing leprosy. But not only is Dr Levis ignoring these important historic facts in these 2 patients, he is also overlooking the excellent study published by Sharma et al last year. In this careful and important publication, Sharma et al report on the molecular ( genetic) studies Dr Levis claims are lacking. They published in this study that armadillos over a 4-state area in the Southern United States including Florida were infected with M leprae of the same genotype as 42% of M lepraeeinfected patients in these same states. Again, this is highly unlikely to be yet another coincidence and certainly would have nothing to do with the 14% foreign-born travelers in Florida that Dr Levis is erroneously suggesting explains these leprosy cases. There is no evidence to support this supposition. We strongly suggest that the combination of the rapid increase of the incidence of leprosy in Florida, in conjunction with the rapid increase of infected armadillos (documented by Sharma et al), and the genetic identity ofM lepraeeinfected armadilloswith the same genotype of M leprae infecting Florida patients, offers compelling evidence of the armadillo as the vector for many of the Florida leprosy cases. Additionally, our report of 2 patients with no travel history and no known contact with other leprosy patients and with close direct contact with armadillos coincident with their development of leprosy (3-4 years after contact), provides yet further convincing evidence of this emerging zoonosis in the southeast United States.