Victoria Garcia-Albea, NP, discusses highlights from her lecture on Hansen's Disease on Wednesday, November 8, 2023, at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, California.

In this video

Drawing on her work at a dedicated Hansen's clinic in Massachusetts, Garcia-Albea explains that leprosy is far from a Biblical relic — while many patients come from endemic areas like Brazil, India, Micronesia, and Nepal, some Americans who never traveled abroad are contracting it here. Central Florida sees most of the domestic cases, tied to armadillos, the natural reservoir, which have migrated north and east through Texas, Louisiana, and beyond. She notes roughly 150 U.S.-originating cases in the last couple of years, and points out that armadillos shed the bacteria in their feces, so landscaping and working in the dirt are potential exposures.

On diagnosis, she keeps it practical: biopsy anything suspicious, send it in regular H&E and formalin (leprosy is "notoriously hard to culture"), and if results come back consistent with leprosy, refer to the nearest Hansen's disease program rather than trying to manage its many complications alone. She adds a reassuring point about contagion — person-to-person spread requires years of close contact because about 95% of the population is immune, and patients are no longer contagious within a day or two of starting treatment.

  • Hansen's disease is still present in the U.S.; most domestic cases arise in central Florida, tied to armadillos that have spread north and east.
  • Armadillos shed the bacteria in their feces, so dirt and landscaping exposure can transmit it even without direct animal contact.
  • Person-to-person spread requires years of close contact — about 95% of people are immune, and susceptibility can be inherited.
  • Diagnose by biopsy in regular H&E and formalin (not culture — leprosy is notoriously slow-growing), and note suspicion for leprosy on the requisition.
  • If a biopsy comes back consistent with leprosy, refer to the nearest Hansen's disease program rather than managing treatment nuances yourself.
  • Reassure patients: once treatment starts, they are no longer contagious within a day or two, even though the full treatment course is long.