Wrestling Armadillos: A Case of Zoonotic Transmission of Leprosy in the American South

Co-Authors:

• Davis Melin, MPH, OMS-IV, Liberty University College of Osteopathic Medicine
• Mark Melin, MD, Gonda Vascular Center Wound Clinic, Mayo Clinic, Rochester, MN
• Anna Lin, PA, Gonda Vascular Center Wound Clinic, Mayo Clinic, Rochester, MN
• Crystal Bain, RN, Gonda Vascular Center Wound Clinic, Mayo Clinic, Rochester, MN
• Tina Wangen, RN, Gonda Vascular Center Wound Clinic, Rochester, MN

Case

We recently encountered a 90ish year-old male in our wound clinic being evaluated for a sacral wound. Unrelated to the sacral wound was a recent diagnosis of leprosy. Thoughts of Paul Brand, the legendary orthopedic surgeon immediately came to mind. But this is 2026! Where does a Texas native encounter leprosy in 2026? He stated he had been wrestling an armadillo under his deck at his Texas home…

Epidemiology

Termed a chronic pandemic,¹ leprosy (also called Hansen’s disease after the Norwegian physician Gerhard Hansen who identified the responsible bacteria), continues to be a global disease. Approximately 180,000-250,000 new cases are reported worldwide annually from over 140 countries, with a heavy concentration in India, Brazil and Indonesia.¹ Multidrug therapy has decreased the global prevalence of the disease by 90% since 1983, but given the associated stigma, late presentation is still common, resulting in significant disability even if the disease is treated.^2,3

In the United States, between 1994-2011 there were 2,323 cases of leprosy in the United States with a slightly overall decrease in incidence when comparing 1994-1996  (0.52 cases per 1 million persons) and 2009-2011 (0.43 cases per 1 million persons).³ About 70% of cases are in foreign born persons, meaning they acquired the disease outside the U.S. prior to being diagnosed here.³ Yet, between 2009-2011, an average of 56 cases per year were diagnosed in U.S.-born persons, indicating continued endemicity of the disease.³ The most recently published incidence numbers are back from 2015 when 178 cases were reported that year.⁴

While often thought as transmitted from human-to-human, zoonotic transmission (i.e. animal to human) is emerging as an important secondary route of spread, especially in the southern United States, in addition to Mexico and Brazil.^2,5–7 In fact, based on phylogenic genomic analysis, it is very likely armadillos acquired the disease from humans sometime after colonization of the New World by Europeans.⁵ With biological features (like an ideal body temperature for growing M. leprae at 32-35°C vs. human body temperature of 37°C), armadillos effectively became a natural reservoir for the bacteria.⁸ A landmark study published in 2011 led by long-time leprosy researcher Dr. Richard Truman established wild armadillos as a large natural reservoir of Mycobacterium leprae, the bacteria most commonly responsible for zoonotic spread.⁵ But in order to get leprosy from an armadillo, there needs to be significant contact between a human and an infected animal. A recent metanalysis and systematic review found that direct contact (like our patient) is strongly associated with an increased risk of leprosy (odds ratio 2.60, 95% CI 1.78–3.80, p < .001).⁹ This could be in the form of hunting, handling, eating,⁶ or in our case, a wrestling match.  Texas and Louisiana are known places where zoonotic transmission has occurred, since in the southern U.S. estimated prevalence among the wild armadillo population exceeds 20% in some areas.⁵ Zoonotic transmission has also occurred in other southern states such as Alabama, Arkansas, Mississippi.⁵

There are “conspiracy” theories regarding experimentations with armadillos and leprosy research which resulted in this current situation, however there is no sound data that would support such suppositions.

Conclusions

Dr. Paul Brand, an orthopedic surgeon, and his wife Dr. Margaret Brand, an ophthalmologist, are widely regarded for their committed care to leprosy patients in India and ground-breaking research on the treatment of the disease.¹⁰ In his book Fearfully and Wonderfully Made, Dr. Brand combines his Christian faith and wonderous descriptions of the intricate biology of the human body. We conclude this article with a passage from the book where Dr. Brand reflects on how Jesus, who frequently healed what was termed leprosy in Biblical times, healed often through touch:

I have sometimes wondered why Jesus so frequently touched the people he healed, many of whom must have been unattractive, obviously diseased, unsanitary, smelly. With his power, he easily could have waved a magic wand. In fact, a wand would have reached more people than a touch. He could have divided the crowd into affinity groups and organized his miracles–paralyzed people over there, feverish people here, people with leprosy there–raising his hands to heal each group efficiently, en masse. But he chose not to. Jesus’ mission was not chiefly a crusade against disease (if so, why did he leave so many unhealed in the world and tell followers to hush up details of healings?), but rather a ministry to individual people, some of whom happened to have a disease. He wanted those people, one by one, to feel his love and warmth and his full identification with them. Jesus knew he could not readily demonstrate love to a crowd, for love usually involves touching.¹¹

For our patients with wounds, many have not had their wounds touched for similar reasons. But, in caring for this patient with leprosy, we are reminded how Dr. Caroline Fife recently educated us of the Paul Brand legacy. Dr. Fife was recently recognized as the distinguished 13^th Paul Brand lecturer.¹² She stated “the underlying reason for chronic wounds may be systemic”, a brilliant yet simplistic call to action to maintain intellectual curiosity with every patient as we interact with and holistically treat patients with long suffering from chronic disfiguring wounds. And please, touch your patients; their healing and recovery depends upon it.

References

1. Molyneux DH, Savioli L, Engels D. Neglected tropical diseases: progress towards addressing the chronic pandemic. The Lancet. 2017;389(10066):312-325. doi:10.1016/S0140-6736(16)30171-4
2. Agudelo Higuita NI, Avanzi C, Henao-Martínez AF, et al. Leprosy. The Lancet. 2026;407(10530):805-819. doi:10.1016/S0140-6736(25)01963-4
3. Nolen L, Haberling D, Scollard D, et al. Incidence of Hansen’s Disease — United States, 1994–2011. MMWR Morb Mortal Wkly Rep. 2014;63(43):969-972.
4. Hansen’s Disease Data & Statistics | HRSA. Accessed March 17, 2026. https://www.hrsa.gov/hansens-disease/data-and-statistics
5. Truman RW, Singh P, Sharma R, et al. Probable Zoonotic Leprosy in the Southern United States. New England Journal of Medicine. 2011;364(17):1626-1633. doi:10.1056/NEJMoa1010536
6. Silva MB da, Portela JM, Li W, et al. Evidence of zoonotic leprosy in Pará, Brazilian Amazon, and risks associated with human contact or consumption of armadillos. PLOS Neglected Tropical Diseases. 2018;12(6):e0006532. doi:10.1371/journal.pntd.0006532
7. Vera-Cabrera L, Ramos-Cavazos CJ, Youssef NA, et al. Mycobacterium leprae Infection in a Wild Nine-Banded Armadillo, Nuevo León, Mexico – Volume 28, Number 3—March 2022 – Emerging Infectious Diseases journal – CDC. doi:10.3201/eid2803.211295
8. Balamayooran G, Pena M, Sharma R, Truman RW. The armadillo as an animal model and reservoir host for Mycobacterium leprae. Clinics in Dermatology. 2015;33(1):108-115. doi:10.1016/j.clindermatol.2014.07.001
9. Deps P, Antunes JMA de P, Collin SM. Zoonotic risk of Hansen’s disease from community contact with wild armadillos: A systematic review and meta‐analysis. Zoonoses & Public Health. 2021;68(2):153-164. doi:10.1111/zph.12783
10. Margaret and Paul Brand CBE – TLM Heroes. The Leprosy Mission International. Accessed March 17, 2026. https://www.leprosymission.org/the-leprosy-missions-150th-anniversary/the-leprosy-missions-heroes/margaret-and-paul-brand-tlm-heroes/
11. Brand P, Yancy P. Fearfully and Wonderfully Madehe: The Marvel of Bearing God’s Image. Zondervan Publishing House; 1980.
12. Fife C. The Paul Brand Award Lecture: The Journey Toward Data-Driven Wound Care. Caroline Fife M.D. December 17, 2025. Accessed March 18, 2026.

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