March 28, 2016 |by Susan Abram | Daily News, Los Angeles
This insect bites people near the lips or eyes, inserts bacteria, then about 20 years later, the victim suffers a heart attack. Olive View-UCLA Medical Center is working to help detect Chagas. The clinic is holding community screenings across the San Fernando Valley to find people who may be infected.
Some call it the kissing bug because it leaves a painless bite near a sleeping person’s lips.
But among health experts, including those from the federal government, the cone-headed Triatomine is no prince awakening a sleeping beauty. It’s an assassin, because it leaves behind a parasite in its love bite that can be deadly.
Photos of the dime-size insect hang inside Dr. Sheba Meymandi’s medical office as if on a wanted poster. The bug, she said, carries the Chagas disease, which can cause heart failure if left untreated.
An estimated 300,000 people across the United States may have Chagas disease, Meymandi said, and the only place in the nation where it’s treated is the clinic she oversees at Olive View-UCLA Medical Center in Sylmar. Started in 2007, the Chagas clinic has treated 200 people, but Meymandi and her team said they are ready to take on more patients.
That’s why she and her staff are working with primary physicians at the four hospitals and 19 health clinics overseen by the Los Angeles County Department of Health Services. In addition, Providence Health & Services will offer Chagas screenings at a dozen free health clinics on Sundays at churches across the San Fernando Valley for the rest of the year. An upcoming screening will be held from 1 to 5 p.m. April 3 at New Hope of the Nazarene, 15055 Oxnard St, Van Nuys, California.
“It’s very clear that we need to diagnose early and treat early before the onset of complications,” said Meymandi, a cardiologist. Ten percent of those with Chagas suffer from heart failure, one of the most expensive conditions to treat, costing $32 billion year nationwide, she said. That figure could rise to $70 billion by 2030.
Chagas disease was once considered exotic, but more is known about it now than about the Zika virus. Still, most people have no idea they have it or, once they do, lack information about where to receive treatment, Meymandi said.
The disease is most common in rural Mexico and Latin America, researchers have said, adding that it kills more people in South America than malaria.Meymandi said anyone who was born in Mexico or South America should have a blood test.
But U.S.-born residents also are infected. The insect is present in more than 20 states. At least 40 percent of raccoons tested in Griffith Park carried Chagas disease, Meymandi said.
“Most of the people we see and treat in the U.S. have had it for decades,” Meymandi said. “We have the bug here, we have the parasite here. You can definitely acquire Chagas in the United States.”
An infected insect, which hides in dwellings made from mud, adobe, straw or palm thatch, crawls out at night to feed on blood. It is called the kissing bug because it feeds on a sleeper’s face, then defecates on the wound, leaving a parasite behind.
Infection takes place when the parasite enters the body through mucous membranes or broken skin, caused when the sleeper scratches the wound, eyes or mouth, according to the federal Centers for Disease and Prevention. The parasite can lie dormant for years, then cause heart disease, and if not found and treated, death.
Symptoms can include fever, fatigue, body aches, headaches, rash, loss of appetite, diarrhea and vomiting. But sometimes there are no symptoms until decades later.
Only two drugs exist to treat Chagas disease, and neither is approved by the U.S. Federal Drug Administration yet, though both can be provided through the CDC, Meymandi said.
“It’s very simple to treat,” Meymandi said. “But the process to go get the drugs is a challenge.”
Jose Duran, a Bellflower resident, said he learned he had Chagas disease after he tried to donate blood seven months ago. He said he would have never known he had Chagas disease otherwise. He had no symptoms.
“I went to donate blood for the first time, because I heard it was good for you to donate once in a while,” he said. Then he received a phone call.
It’s not uncommon for people to learn they have Chagas disease after donating blood, Meymandi and others said. In 2006, the Red Cross isolated 21 cases of Chagas in Southern California donors. In 2007, the figure more than doubled to 46. In 2008, there were 55 cases.
The National Red Cross would not provide additional figures.
“I got scared. I was like, wow, what is this?” the 40 year old Duran said of his reaction,when he learned what he had.
As a child, Duran lived on a ranch in Querétaro, a small state in north-central Mexico. His brother also tested positive for Chagas. He doesn’t remember being bitten, he said.
Duran was referred to the Chagas clinic and, after two months of treatment, learned Thursday he was in good health.
“Most people don’t know they have this,” he said. “If they get tested, they can get well.”
October 1, 2015 | by Judy Stone | Forbes
Chagas, a parasitic disease, is the latest invisible killer infection to be recognized as a growing threat here. The infection is transmitted by the Triatomine bug, known as the “kissing” bug. The bugs infect people through bites—often near the eyes or mouth—or when their infected feces are accidentally rubbed into eyes or mucous membranes. Some transmission occurs from mother to child during pregnancy. Occasionally, transmission is through contaminated food or drink. Triatoma sanguisuga – CDC/James Gathany
Most people in the U.S. with Chagas disease probably became infected as children, living in Latin America. The infection often has few symptoms early on, but after several decades, strikes fatally, often with sudden death from heart disease. I suspect that, similar to Lyme disease, the magnitude of disease and deaths from the protozoan parasite, Trypanosoma cruzi, which causes Chagas disease, is unrecognized in the U.S.
In Latin America, however, up to 12 million people might be infected, with a third going on to develop life-threatening heart complications. Chagas is a major cause of congestive heart failure and cardiac deaths, with an estimated 11,000 people dying annually, according to the WHO.
There are an estimated 300,167 people with Trypanosoma cruzi infection the U.S., including 40,000 pregnant women in North America. There are 30,000-45,000 cardiomyopathy cases and 63-315 congenital infections each year. Most of the people come from Mexico, El Salvador, Guatemala, Honduras, or Argentina; Bolivia has the highest rate of Chagas in the world.
But in the U.S., we don’t often think of Chagas. Even as an infectious disease physician, I’ve never treated anyone with it, and it is not on my radar. So when a physician sees a patient who may have come to the U.S. as a child, and now has diabetes and hypertension, he or she is likely to attribute the heart disease to that and not look for infection. In fact, though, there are large pockets of undiagnosed disease. For example, a survey in Los Angeles of patients with a new diagnosis of cardiomyopathy who had lived in Latin America for at least a year, found 19% had Chagas disease, and they had a worse prognosis than those without the infection.
There are other reasons Chagas is overlooked. One is that Chagas is not a reportable disease except in four states, and Texas only began reporting in 2010. Most cases here have been detected by screening of blood donations, which has found about 1 in every 27,500 donors to be infected, according to CDC. However, a 2014 survey showed “one in every 6,500 blood donors tested positive for exposure to the parasite that causes Chagas disease.” A map of positive donations is here. While the triatome bugs are most common in the southern half of the U.S., they are actually quite widespread, as shown here.
Much bigger barriers to diagnosis are social and cultural. Many patients lack health insurance. Others are undocumented immigrants fearing deportation. Health literacy and language barriers are huge. There is a stigma associated with the diagnosis, as there is for many patients with TB, as Chagas is associated with poverty and poor living conditions. As Daisy Hernández noted in her excellent story in the Atlantic, “it’s hard, if not impossible, for moms with Chagas and no health insurance to see the doctors who would connect them to the CDC” and “patients don’t necessarily have savings in case they have adverse reactions to the medication and can’t work.”
There are pockets of Chagas in the states, including Los Angeles, the Washington metropolitan area, and the Texas border, where there are large immigrant communities from endemic areas. But I suspect that with climate change, we’ll see more Chagas in the southwest U.S., as more triatomine bugs are found further north. One recent study found more than 60% of the collected bugs carried the Trypanosome parasite, up from 40-50% in two similar studies. There are also now seven reports of Chagas infection that are clearly autochthonous, or locally acquired. University of Pennsylvania researcher Michael Levy has shown that bedbugs might be capable of transmitting Chagas, but no one has shown that they actually do. Entomologist and Wired author Gwen Pearson nicely explains why bedbugs are an unlikely vector and notes that you “far more likely to be injured by misusing pesticides to try to exterminate” them.
There’s more bad news. Treatment for Chagas is effective if given early in infection, although with significant side effects. There is no effective treatment for late stages of gastrointestinal or cardiac disease. A newly released study showed that benznidazole was no more effective than placebo in reducing cardiac complications, even though it reduced levels of parasites in the blood.
The two drugs available to treat Chagas, benznidazole and nifurtimox, are not yet FDA approved and are only available through the CDC under investigational protocols. Both carry significant side effects. Treatment of children with early Chagas is generally effective but, as with many drugs, treatment is hampered by lack of data on pediatric dosing and limited formulations. There is little research funding for new drug development, with less than US $1 million (0.04% of R&D funding dedicated to neglected diseases) focused on new drugs for Chagas disease, according to the Drugs for Neglected Diseases Initiative (DNDi).
Where do we go from here? The most immediate and cost-effective proposals are to increase surveillance for disease and screening of high-risk populations. Since the most effective treatment is given early in the course of infection, screening of pregnant women and children is a priority, as is education for these women and Ob-Gyn physicians.
While there is no effective treatment for advanced disease, efforts are underway to develop a vaccine against Chagas. The National School of Tropical Medicine at Baylor College of Medicine just received a boost from a $2.6 million grant from the Carlos Slim Foundation for their initiative.
Chagas, like sickle cell, highlights disparities in access to screening and early treatment for serious illnesses disproportionately affecting the poor and people of color. While a moral and ethical issue, the choices made to gut public health programs for “cost saving” will also be unnecessarily costly in the end.
Q: Is the Kissing Bug the only vector for the disease?
A: Yes, there are many different Triatoma species throughout the Americas, although they are all considered “kissing bugs”. Different species may have different behaviors that make infection more or less likely. Some of the bugs in South America defecate as soon as they feed, which places the infected feces directly near the open bite wound.
Q: Where is it common? in what countries?
A: Chagas’ disease has been found in North, Central, and South America where the reduviid bugs live. T. Cruzi can not exist without the kissing bug as the vector. It is considered endemic in South America and Mexico in humans. Recently we have been seeing a increase in canine cases in some of the southern United States as the disease travels north through Mexico (Texas, Louisiana, and California are among the states with confirmed cases).
Q: Who can get Chagas’ disease?
A: Many mammals can be infected by T. Cruzi, including, but not limited to; humans, rats, dogs, raccoons, skunks. Opossums and armadillos have also been reported to carry the disease. Wildlife can serve as an important reservoir for the disease.
Q: Why is Chagas’ disease a problem in dogs?
A: The initial infection with Trypanosoma Cruzi, can cause vague or even no clinical signs. Fever, enlarged lymph nodes, and anorexia (lack of appetite) are a few of the vague symptoms seen in the acute phase. There is also a latent phase that may last for years, where the protozoa is present in the body, but does not cause any signs of disease. The chronic infection of Chagas’ disease can cause heart disease by damaging the heart muscle and ultimately causing a heart arrhythmia and heart failure. Sudden death due to a heart arrhythmia is sometimes the only sign of the disease. To make it even more confusing, some dogs that are infected will never develop signs of the disease.
Q: Who is at risk?
A: Dogs that live outside and in wooded areas in sections of the country that have the kissing bug are most at risk. People and animals who travel to areas that are endemic for the disease also are at higher risk.
Q: Do you see Chagas’ disease often in your clinic? Is it common or rare?
A: Now that we are looking and testing more for Chagas’, we see around 2 to 3 positive cases a month. Before I graduated from vet school, 10 years ago, I was taught that I may diagnose 1 case in my professional lifetime. So although Chagas’ is not as common as heartworm disease in our practice (which we diagnose daily), it is definitely something I test and look for in certain cases.
Q: Is there a treatment for Chagas’?
A: There is no published proven “cure” for Chagas’ disease. There are some anti-protozoal treatments that have been used in humans, but are difficult to acquire and have had limited success in dogs. Treatment has been aimed at treating the symptoms of the disease, such as the heart failure. Fortunately through research, there have been some experimental treatments which are promising. I have had three canine cases so far that have proven this treatment to be successful. This research will soon be published and available by the researcher that has discovered it.
Q: How does I know if my dog has Chagas’?
A: Testing for Chagas’ disease in dogs can be done by having your veterinarian submit a blood sample to a specialized lab for further analysis. PCR (VRL lab) and IFA Antibody tests (Texas A&M Veterinary Diagnostic Lab) are both available only through your veterinarian.
Q: How do I prevent the disease?
A: There is no medicine or vaccine that can prevent the disease. Prevention is more aimed at decreasing the exposure of animals and humans to the kissing bug that harbors the disease. These bugs live in wooded areas, and are attracted to light at night. Keeping dogs inside at night and away from wooded areas, where the bug may be hiding, can help limit exposure to the disease. Certain insecticides can be used to treat areas that may serve as a habitat for the kissing bug.
Q: What about humans?
A: Transmission of Trypanosoma cruzi from dog to human has NOT been reported. Although the presence of the disease in dogs, could show that the disease is present in that region, and may indicate that humans may also be exposed.
Q: Anything else about the disease?
A: I don’t want everyone all throughout the country to worry that their dog has Chagas’ disease. Right now the disease is emerging into the United States, but it is still a rare disease in most parts of the country. I do see a lot of stray and rescue animals at my practice, and these dogs are more likely to have been exposed to the kissing bug through their prior living conditions. These animals are at higher risk, which is why I have more positive cases in my hospital.
My personal goal is to have veterinarians in certain areas of the country to now have Chagas’ disease as a possible differential diagnosis for certain patients. Earlier detection of the disease will also help improve the outcome for the patient because once the heart has been damaged, the effects are permanent. Hopefully this experimental treatment protocol will continue to be successful and this disease will not always equal a death sentence every time it is diagnosed.
My desire to help patients with this disease comes from the loss of two young dogs that were owned and loved by my personal friends. Through the frustration of losing these pets, I have learned more about this emerging disease, and now have successfully treated new patients.
Q: Is there anything you’d like to acknowledge?
A: I would also like to thank Dr. Roy Madigan of The Animal Hospital of Smithson Valley in Spring Branch, Texas for his help and for sharing his knowledge of this disease.
February is American Heart Month and a good time to spotlight one of the leading causes of heart failure worldwide – and one that is preventable through simple screenings.
Chagas disease, caused by the chagas bugs found in Central America and some areas of the U.S., can lie dormant in victims for decades, then manifest itself with devastating consequences.For the past eight years, Providence Health & Services has teamed with the Center of Excellence for Chagas Disease at Olive View-UCLA Medical Center in Sylmar to screen for chagas.
UCLA cardiologist Sheba Meymandi, M.D., program director, believes all migrants from Central America, from infants to age 60, should be screened for the disease, which is curable in its early stages.
“Complications of chagas are horrific,” Meymandi said. “We have a lot of patients who need heart transplants. But if you catch them before complications, you either cure them or slow the progression.”
Eight years ago, Providence adopted the prevention program as a community outreach project, providing volunteers who screen patients.
Last month, Providence contributed $20,000 to the program for outreach in the community as part of its ongoing financial support.
A recent screening coordinated by Providence volunteers resulted in blood samples from 100 people.
The disease is caused by the chagas bug, which bites humans then defecates. Scratching the bite can result in the feces entering the bloodstream, causing a disease victims unknowingly carry for decades. The sooner one discovers the disease, the better the chance of cure, or medication to prevent its escalation.
The parasite exists in our country, but living conditions and the likelihood the species behaves differently result in fewer cases of chagas disease.
This article is a news release provided by Providence Health & Services.
Bed Bugs Will Outlive All Of Us Unless We Screw With Their Genes
Bed bugs, like cockroaches and new seasons of The Bachelor, seem impossible to eradicate from the face of the Earth, no matter how many exterminators our landlords call to spray that one time and then never, ever again. But Science says there’s some small hope for the extinction of a moviegoer’s biggest fear—screwing with their genome.
Scientists have managed to map the genome of the common bed bug, revealing some fun things about the little suckers. For instance, bed bugs are actually able to break down toxins, like the ones an exterminator might use, to render them harmless, allowing them to survive even when you try to whack them with bug killer. They’ve also been MUTATING, producing genes that make them resistant to certain insecticides and making it all the more difficult to eradicate an infestation. Another fun fact is that bugs’ genes vary from location to location—a Brooklyn bed bug will have a different genetic sequence from a Queens bed bug, though both are equally disgusting.
Bed bugs also inbreed, and their sex is quite violent. This violent sex has been well-documented, and for those of you who have not yet seen Isabella Rossellini’s bed bug porno, you’re welcome, and sorry:
The takeaway here is that bed bugs have been able to hold us hostage for a long time, but scientists might be able to murder them, provided they make a few genetic tweaks. First, though, let’s kill all the mosquitoes.
[A. Steiner: So…..Messing with Genes Could Carry Other Risks – YES!]
February 2, 2016 | by Ryan Biek | Newsy
Bedbugs are reportedly building up a strong resistance to some of the most powerful insecticides due to overuse, which means we might need to turn to non-chemical solutions to get rid of them.
Researchers from Virginia Tech and New Mexico State University tested the most common class of insecticide called neonicotinoids, or neonics, which is often combined with pyrethroids in commercial treatments for bedbugs.
They took a group of bedbugs that came from homes in Ohio and Michigan, which had previously been exposed to neonics, and compared those bedbugs to a population that has been kept in isolation for 30 years, before the insecticide was used.
A third group of bedbugs that was resistant to pyrethroids but never exposed to neonics was also included in the study.
Depending on the specific types of neonic tested, the Ohio and Michigan bedbugs were hundreds to tens of thousands of times more resistant than the isolated group.
The third group’s results were in the middle: more resistant than the isolated group but less resistant than the Ohio and Michigan bedbugs.
Because that third group had never been exposed to neonics, the researchers believe the bedbugs may have a pre-existing resistance mechanism.
The researchers said more non-chemical methods need to be used to combat bedbug infestations. However, they noted the most resistant bedbugs in the study only came from two areas, and not all of the U.S. may be facing this level of resistance.
“Kissing bugs” are now carrying Chagas in the U.S.
If you’re one of the people freaked out by Ebola, here’s another thing to potentially freak out about. “Kissing bugs” may be spreading a rare disease in the U.S.
Trypanosoma cruzi, or “kissing bugs” as they’re better known, crawl on people’s faces at night and suck their blood.
And there’s more. The bugs are spreading a disease called Chagas, which can lead to heart problems and intestinal complications.
The Centers for Disease Control and Prevention says Chagas occurs primarily in rural areas of Latin America and in recent years has been showing its face in the U.S.
While much of the outbreak in Latin America has to do with the kissing bugs, the CDC believes most U.S. cases occur from a patient visiting an affected country or from mother-to-baby, blood transfusions and organ transplants.
However, researchers from Baylor College of Medicine in Houston found 36 percent of the 17 Texas blood donors who tested positive for Chagas appeared to have contracted it from the kissing bugs. The team also found several bugs in the area carrying the disease, although no direct correlation has been made.
Chagas researcher Nolan Garcia said, “Physicians should consider Chagas when patients have swelling and enlargement of the heart not caused by high blood pressure, diabetes or other causes, even if they do not have a history of travel.”
The World Health Organization says Chagas presents in two phases. In the acute phase, a large amount of parasites circulate in the blood. Some people show no symptoms at all, while others may have fever, headache and chest pains along with other symptoms.
In the chronic phase, the parasites are mainly in the heart and digestive muscle. Around 30% of patients suffer from a heart disorder and 10% suffer from a digestive disorder.
When discovered early, Chagas can be treated [but not cured] with medication. As with most illnesses, doctors say the earlier you catch it the better.
The CDC reports the Kissing Bug has been discovered in the Southeastern U.S., including Florida. (Source: CBS4)
The bugs have invaded the southern United States, including Florida.
The infected inch-long Triatomine bugs carrying the parasite can pass it through bites. The bites are typically around the mouth and face, which is how they get their nickname “kissing bugs.”
Once in the body, the parasite can remain hidden for years, or even decades, eventually resulting in heart disease.
According to the CDC, it estimates about 8 million people are infected worldwide. Most of the infected are reportedly in Central and South America.
The CDC reports that infections have been reported in Arkansas, Arizona, Massachusetts, Tennessee and Texas.
Studies show dogs highly at risk for deadly Chagas disease
Stott Friedman, Eva Parks and Dr. Seema Yasmin | November 17, 2015
An NBC 5 investigation found hundreds of dogs in Texas are infected with the deadly parasite that causes Chagas disease.
For months, NBC 5 Senior Investigative Reporter Scott Friedman teamed up with The Dallas Morning News’ Dr. Seema Yasmin to investigate a hidden threat known as The Kissing Bug, which has infected at least a dozen people in Texas.
In Texas the disease has infected family pets; prized hunting dogs and even military K-9’s that protect U.S. troops. Right now, no one seems to know exactly how many more dogs could be at risk.
Meet Kiska, a Japanese Spitz, a rare dog breed kept alive with a pacemaker.
“My husband called me and said Kiska fell over,” said Cora Fortin, who at the time lived in Plano.
Kiska kept collapsing. A vet in Plano said Kiska’s only hope was a pacemaker operation at Texas A&M in College Statio“She was passing out all the way down there, so we didn’t know if she would make it,” said Fortin.
Kiska survived but what caused her heart to fail was a bigger surprise. It was Chagas disease, caused by a rare parasite transmitted by kissing bugs.
Chagas is usually found in tropical climates of Mexico, South and Central America. But cases of locally transmitted Chagas disease have not been documented in Texas until more recently.
“I diagnosed a little Yorkie that lived in Downtown Dallas not too long ago, so yes, it’s everywhere,” said Dr. Ashley Saunders, a veterinary cardiologist with Texas A&M.
In some cases the dogs are so sick there’s no saving them.
“I think we shock a lot of people and I think it’s one of the hardest things for me is we have some clients who come in and they have no idea the disease even exists,” said Saunders.
Researchers at Texas A&M tested dogs at animal shelters statewide and found many shelter dogs have Chagas.
“The study that just wrapped up, about 10 percent of dogs across the state were infected,” said Sarah Hamer, Texas A&M researcher.
Tom Sidwa, State Public Health Veterinarian with the Texas Department of State Health Services, said there’s no doubt Chagas will grow and kill more dogs in the state.
However, it’s hard to estimate the total number of dogs infected because many dogs are never tested.
“So many of the dogs seen are young dogs that are just really hit hard by the disease … and sometimes, sudden death,” said Sidwa.
It’s already killed U.S. Military working dogs in Texas.
At Lackland Air Force Base in San Antonio, about 70 military working dogs have been infected in the last nine years.
Bomb, drug and patrol dogs train at Lackland to serve with U.S. troops all over the world.
“When one of these dogs become sick, and for any reason can’t do its job that’s a major loss because that whole team is taken out they’re not able to perform their mission,” Col. Cheryl Sofaly, Director of the DOD Military Working Dog Hospital at Lackland Air Force Base.
Some dogs with Chagas are still working, but ones that develop more serious symptoms are retired from service.
“If they’ve got heart disease that makes it very hard for them to do that job effectively,” said Sofaly.
Losing a military dog is expensive. It costs about $20,000 to train each one.
When Chagas first surfaced here in 2006, military veterinarians worked to track down the source.
A search of the base turned up bugs in and around kennels where the dogs sleep.
Dogs that sleep outside and hunting dogs are more likely to be infected. The bugs like wooded areas and bite at night. Because dogs sometimes eat infected bugs it may be even easier for them to become infected than people.
That’s how the Fortin’s suspect Kiska got sick.
“One day she brought this strange looking insect into the house,” said Fortin.
Before they could snatch it away, she ate it.
Recently, Kiska has developed more symptoms including an enlarged heart.
“We just really don’t know what’s going to happen next,” said Fortin.
There’s no cure, so the Fortin’s appreciate every day.
“She’s totally a member of the family and we will be devastated when the day comes we lose her,” said Fortin.
At Lackland, the military has been able to reduce the number of new cases of Chagas by putting up screens around the kennels and by treating the areas with pesticides, but they are still seeing about 4-5 new cases a year in dogs.
To protect your pets, veterinarians suggest keeping them indoors late at night and don’t let them sleep outside.
Keep piles of wood and brush away from your home and any area where small animals might nest will attract the bugs.
If your dog coughs, has shortness of breath and has fainting spells, it’s worth asking your vet about Chagas.
[Reporting from behind. A. Steiner.]