title: Probable zoonotic leprosy in the southern United States.
abstract: BACKGROUND
  In the southern region of the United States, such as in Louisiana and Texas, there are autochthonous cases of leprosy among native-born Americans with no history of foreign exposure. In the same region, as well as in Mexico, wild armadillos are infected with Mycobacterium leprae.
  
  
  METHODS
  Whole-genome resequencing of M. leprae from one wild armadillo and three U.S. patients with leprosy revealed that the infective strains were essentially identical. Comparative genomic analysis of these strains and M. leprae strains from Asia and Brazil identified 51 single-nucleotide polymorphisms and an 11-bp insertion-deletion. We genotyped these polymorphic sites, in combination with 10 variable-number tandem repeats, in M. leprae strains obtained from 33 wild armadillos from five southern states, 50 U.S. outpatients seen at a clinic in Louisiana, and 64 Venezuelan patients, as well as in four foreign reference strains.
  
  
  RESULTS
  The M. leprae genotype of patients with foreign exposure generally reflected their country of origin or travel history. However, a unique M. leprae genotype (3I-2-v1) was found in 28 of the 33 wild armadillos and 25 of the 39 U.S. patients who resided in areas where exposure to armadillo-borne M. leprae was possible. This genotype has not been reported elsewhere in the world.
  
  
  CONCLUSIONS
  Wild armadillos and many patients with leprosy in the southern United States are infected with the same strain of M. leprae. Armadillos are a large natural reservoir for M. leprae, and leprosy may be a zoonosis in the region. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
authors.affiliation: Bureau of Primary Health Care, Health Resources and Services Administration, Department of Health and Human Services, National Hansen's Disease Program, Louisiana State University, Baton Rouge, USA. rtruman@hrsa.gov
authors.forename: Richard W
authors.initials: RW
authors.lastname: Truman
authors.forename: Pushpendra
authors.initials: P
authors.lastname: Singh
authors.forename: Rahul
authors.initials: R
authors.lastname: Sharma
authors.forename: Philippe
authors.initials: P
authors.lastname: Busso
authors.forename: Jacques
authors.initials: J
authors.lastname: Rougemont
authors.forename: Alberto
authors.initials: A
authors.lastname: Paniz-Mondolfi
authors.forename: Adamandia
authors.initials: A
authors.lastname: Kapopoulou
authors.forename: Sylvain
authors.initials: S
authors.lastname: Brisse
authors.forename: David M
authors.initials: DM
authors.lastname: Scollard
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Gillis
authors.forename: Stewart T
authors.initials: ST
authors.lastname: Cole
mesh_terms: D000818:Animals; D001135:Armadillos / Q000382:microbiology*; D004197:Disease Reservoirs; D016680:Genome, Bacterial; D005838:Genotype; D006801:Humans; D007918:Leprosy / Q000382:microbiology / Q000635:transmission*; D018598:Minisatellite Repeats; D009166:Mycobacterium leprae / Q000145:classification / Q000235:genetics*; D010802:Phylogeny; D020641:Polymorphism, Single Nucleotide; D017422:Sequence Analysis, DNA; D014481:United States; D015047:Zoonoses / Q000635:transmission*