Leprosy was one of the last things on dermatologist John Abide's mind when a 78-year-old man walked in for a screening at the doctor's Greenville, Miss., practice. Unbeknownst to the man, two large red bumps had formed on his back. Abide diligently tested samples to make sure they did not indicate tuberculosis. When the results came back positive for atypical mycobacteria, another doctor suggested sending the samples away to have them tested for leprosy.



"I thought that was a waste of time," he says. When they came back positive, Abide was stunned. "I didn't know that they still studied it—or that it was still in existence."



In the next few years, he came across two other local patients—an 81-year-old woman with a growth above her left elbow and a 73-year-old man with a red rash on his chest—who also tested positive for leprosy, also known as Hansen's disease.



None of them had been traveling where leprosy was common, but all three reported close contact with armadillos. Did Abide ever imagine as a Mississippi dermatologist he would be treating leprosy patients? "No, indeed," he says. "It's kind of scary."



That humans would catch the disease from these armored animals might seem unlikely. The nine-banded armadillo (Dasypus novemcinctus) is common across parts of more than a dozen southern states. Leprosy is not. Although many cases might go undiagnosed, in the U.S. there are only about 150 to 200 new cases reported each year—and about 3,600 people being treated for the chronic condition. And the majority of the cases, roughly 70 percent, are presumed to be from people who picked up the bacteria while traveling abroad.



But a new study, published in the April 28 issue of The New England Journal of Medicine, found a new strain of the disease, common to both local people and armadillos, suggesting that the animals are, indeed, a wild reservoir for leprosy.



Improbable couriers

Leprosy might sound like an exotic, extinct disease, locked in the annals of history or sequestered in quarantine colonies in far-off lands. But it persists here in the U.S., and new research suggests, in addition to being spread by infected people, it is also being carried on the leathery backs of ambling armadillos.



By a fluke of genetics, armadillos and humans seem to be the only two species that are natural habitats for the bacterium Mycobacterium leprae, which causes the disease. And sometime in the past four centuries, since leprosy landed in the New World via European explorers, it made its way into these insectivores, which are also common throughout Mexico.



In addition to an unexpected genetic predisposition for leprosy, armadillos have one thing that might make them more conducive mammalian hosts: a cool body temperature. At about 32 degrees Celsius (90 degrees Fahrenheit), their core temperature is cooler than that of many mammals, which might make for a better host environment for the bacteria. In the wild, a leprous armadillo might not appear to be different from an uninfected one, Richard Truman of the U.S. Health Resources and Service Administration's National Hansen's Disease Program at Louisiana State University and a co-author of the new study explains. Sick animals will likely be picked off by predators and not survive long enough to develop obvious symptoms.



Fortunately, M. leprae is a finicky organism. It cannot survive for long outside of a living cell—a couple hours on a microscope slide, and maybe a couple weeks in moist soil, Truman notes. And most people—about 95 percent of us—are naturally immune to it. A person's likelihood of getting the disease, even with close contact, is slim and rests on variables such as his or her genetic makeup and immunologic strength.



Because the bacterium that causes leprosy cannot be grown in lab dishes, finding that the armadillo could also carry the disease proved to be a boon to researchers bent on finding new treatments.



Aside from the characteristic skin sores, in humans leprosy can cause lasting nerve damage in the extremities and sensory deterioration. Rather than shipping the afflicted away to colonies, the disease can now be treated with a long course of three drugs (rifampicin, clofazimine and dapsone), which are not without their own side effects.



The disease was only confirmed in wild armadillo populations in 1975. And the new study pinpoints Alabama, Arkansas, Louisiana, Mississippi and Texas as the states where the newly described genotype was found. As Truman points out, the genotype itself might not be so new, but rather, researchers now have more advanced genomics tools to recognize it.



Close contact

For the new study Truman and his colleagues examined M. leprae from 33 wild-caught southern armadillos and 50 U.S. patients from the region. Most of the animals (28), along with 26 of the 29 patients who had not traveled abroad tested positive for the newly described strain of the bacteria (genotype 3I-2-v1).



Only eight of the patients surveyed for the study had a noted history of contact with armadillos. But, Truman and his colleagues note, symptoms often do not appear for some time—sometimes years—making it tricky to pinpoint when the disease was contracted.



The new paper by the research team cannot prove that the leprosy patients with the new strain contracted it from armadillos. However, "this is a long-held hypothesis that we've had," Truman says, noting that the new study presents some of the first hard microbiological and genetic data to "strongly implicate armadillos as a source of infection," he and his colleagues wrote in their paper.



And, notes, Abide, who was not part of the research team, "You make that leap that they must have gotten it" from armadillos—it is "just more incriminating evidence that it's transferable from armadillo to man."



Researchers are still not exactly sure how humans can catch the disease from armadillos. "This is a really weird bug," Truman says of M. leprae. It needs a cut or mucus membrane to enter into the body.



And Abide's patients indicated different kinds of exposure. The man who came in with a chest rash had "frequent exposure to armadillos, including killing one and getting blood on his hands when he disposed of it," Abide and colleagues described in a 2008 paper about the cases published in the Southern Medical Journal. The female patient said that although she had tried armadillo meat decades earlier, the only recent run-ins she had had were "problems with armadillos digging in her flower beds which she often tended."



"I am sure, just with these cases, that there's more out there that I just don't know about—that it's incubating," Abide says.



James Krahenbuhl, who is the director of the National Hansen's Disease Program in Baton Rouge, hopes the new findings will help alert doctors to keep a better eye out for the disease. And he notes that the link does not mean people are any more likely to contract leprosy from armadillos than they were before. Truman suggests that, "just by touching an armadillo you're not going to get leprosy."



But Abide is not going to take any chances. He says he will advise people to avoid "playing with them if they're dead on the side of the road, or eating them"—or even buying souvenirs. "If my car ran over one of those things, I'd get a hose and wash it off." Since learning of the link, he says, "I wouldn't go near an armadillo skin." Even for a nice pair of cowboy boots.