This bug could give you the ‘kiss’ of death

Misstated info on Video 1.5 Million in US infected CHAGAS & 50 million World Wide with 15 to 20,000 deaths annually.

Nov. 19 Video transcript provided by Newsy.com

Texas health officials say “kissing bugs” have infected at least 12 people with a parasite that has the potential to kill.

“I’ve never left the United States. I’ve never even been on a cruise,” a woman told KXAS.

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Video still via Newsy

“I was infected right here in Texas.”

Kissing bugs get their nickname because they favor biting human faces and lips at night. The parasite they leave behind causes Chagas disease. The bugs and parasite are usually only found in the tropics.

The disease has an acute phase much like the flu to start. Then it transitions into a chronic phase, during which up to 30 percent of people develop heart problems and 10 percent develop gastrointestinal issues.

In rare cases, Chagas disease can end in death.

The Centers for Disease Control and Prevention estimates 8 million people in Mexico and Central and South America are infected with Chagas disease, yet most don’t even know it.

There’s no approved treatment for the disease. The CDC only has experimental drugs, which reportedly can be up to 85 percent effective, but they have to be taken soon after a person is infected.

Most counties in Texas have reported kissing bug sightings. (Video via KXAS)

KXAS reports the rise in infections is likely due to the growth of suburbs on land infested with the bugs rather than the bugs coming into the state.

This video includes images from Glenn Seplak / CC BY 2.0 and Simon Fraser University – University Communications / CC BY 2.0.

The Hidden Threat: The Kissing Bug

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These seven tropical diseases are closer to home than you think. Lurking in your Dallas-area backyard is Chagas disease, caused by a parasite that infects more than 300,000 Americans. The disease can cause heart failure and death in humans and dogs and is often missed by doctors.

Or maybe you live near a typhus hot spot such as Houston? Spread by rat-biting fleas, typhus causes headaches, fever, chills and a rash.

Farther north, close to the Oklahoma border, Texans have been plagued by skin boils and sores caused by a disease called leishmaniasis — also known as the Baghdad boil. Many have suffered for years because doctors have misdiagnosed them with staph infections and given them the wrong treatment.

You’ve already heard of West Nile virus, another tropical disease that has strong-armed its way into Texas. West Nile virus has infected close to 5,000 Texans since 2002. But the real number of humans infected is probably 25,000, since about 80 percent of people who are infected don’t show symptoms.

Now get ready to meet two new tropical diseases on their way to you. Dengue and chikungunya are viruses spread by mosquitoes. Common in the Caribbean and South America, they’re being lured to the U.S. by a combination of rising temperatures and poverty.

Don’t expect your doctor to save you from these tropical diseases. Medical students spend a few days learning about this group of infections, and studies show that many health care providers in Texas and the U.S. are unaware that these infections are here or on their way.

Americans living with diseases such as Chagas can go undiagnosed for many years, by which time the infection can cause irreversible damage to the heart.

Dr. Seema Yasmin’s reporting on this project was undertaken while she was a National Health Journalism Fellow at the University of Southern California’s Center for Health Journalism. Yasmin, a physician and former CDC epidemiologist, is a professor at the University of Texas at Dallas.

Not just tropical

Kissing Bug

Chagas disease

About: A parasite spread by the blood-sucking kissing bug — so-called because the bug likes to bite us on the face around the lips and eyes. Kissing bugs poop where they eat, and when we scratch the bite, we rub the poop and the parasite into our skin. About a third of people infected with the parasite, called Trypanosoma cruzi, develop heart disease. One in 10 suffer digestive or nerve issues.

 

Spread by: The dime-sized kissing bug, which lives in rats’ nests and wood piles and in the nooks of furniture and cracks in homes.

 

Symptoms: Swollen eyelids, breathing problems, chest pain, heart failure, death.

 

Testing: Blood test.

Treatment: Anti-parasitic drugs that can be 60 percent to 85 percent effective if given early.

 

Illustrations by Troy Oxford/The Dallas Morning News

A Fatal Flaw

Blood supply system lacks key safeguards against dreaded Chagas disease

Blood centers screen first-time donors for the disease with a one-off test. Donors who test negative are never screened again and are able to donate blood repeatedly.

New technology that inactivates contagious diseases in donated blood is used to protect the blood supply in some states but not in Texas.

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Chagas disease, caused by the parasite Trypanosoma cruzi, can lead to heart failure and sudden death. Globally, about 11 million people are infected. An estimated 300,000 live in the U.S. The parasite can hide in heart muscle and the gut for two to three decades before causing symptoms.

One in every 6,500 blood donors in Texas are infected with the parasite that causes Chagas disease, according to researchers at the National School of Tropical Medicine in Houston. That compares with one in every 27,500 donors across the U.S.

The rate is higher in some parts of South Texas, where an estimated 1 in 3,000 donors are infected, experts say. Half of the infected donors acquired the disease in Texas.

Blood centers began voluntarily testing donors for the parasite in 2007. Since then, blood screening has identified more than 2,000 infected donors.

The parasite is spread to humans and dogs through the bite of a kissing bug, an insect that lives in rats’ nests or wood piles or in the nooks of furniture or cracks in homes. Chagas disease is also spread through pregnancy from mother to baby, as well as through organ transplants and blood transfusions.

But blood donors are tested only once for Chagas disease under the current protocol outlined by the Food and Drug Administration. First-time donors who have a negative test are never screened again.

Three federal agencies work with blood banks to monitor threats to the blood supply. The FDA sets guidelines for blood screening, the U.S. Centers for Disease Control and Prevention performs disease surveillance, and the National Institutes of Health researches the science of blood safety.

Nearly 10 million Americans donate blood each year. Four components of donated blood — red cells, platelets, plasma and cryoprecipitate — are given to an estimated 5 million patients a year.

Blood is screened for HIV, syphilis, West Nile virus, hepatitis B and C and other viruses and bacteria each time a person donates blood. New technologies that inactivate blood pathogens including HIV, malaria and the parasite that causes Chagas disease have been recently approved by the FDA.

Intercept

One of these technologies, the INTERCEPT Blood System, has been used in 20 European countries since 2003. It is now used by some blood centers in Florida and Delaware, and there are plans for its use within the next year at a Colorado blood center and at the National Institutes of Health in Maryland.

The system, made by Cerus Corp. in Concord, Calif., works on plasma and platelets. It uses a chemical that latches on to the genes of various pathogens. The blood is then exposed to ultraviolet light, which tightly binds the chemical to the genes so the pathogens cannot replicate. Plasma and platelets are not affected because they don’t contain genes.

Blood centers in Texas are not using the technology. Blood screening guidelines set out by the FDA do not call for the use of systems such as INTERCEPT. But states and blood centers can choose to go above and beyond federal guidelines.

“We do still screen donors for Chagas by asking them about their health,” said Dr. Laurie Sutor, vice president of medical and technical services at Carter BloodCare, the largest blood supplier in Texas.

“We ask if they feel well,” said Sutor, referring to a questionnaire that donors fill in before they give blood.

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But many people infected with Chagas disease feel well for decades. That’s because the parasite can lie dormant for 20 to 30 years before causing heart and gut symptoms.

One in three people infected with the parasite will develop chest pain, fatigue and breathlessness from heart failure that can be fatal. One in 10 suffer damage to the nerves and gut. Between 1 percent and 10 percent of pregnant women pass the parasite on to their babies.

“Americans are sitting ducks waiting for an epidemic to happen,” said Dr. Richard Benjamin, chief medical officer at Cerus. From 2002 to 2015, Benjamin was chief medical officer at the American Red Cross, where he supervised donor and patient safety.

One-time screening might be appropriate in states where Chagas disease is not common, he said, but in Texas, where rates are higher, there should be a more rigorous protocol.

Sutor disagrees. “The experts in our field feel that the current screening methods are accurate even in Texas because the evidence right now is that Chagas is not being transmitted by blood transfusions,” she said.

The CDC and FDA say that Chagas disease can be spread by blood transfusions. In a 2010 FDA guidance document for blood banks, the agency said that transfusion-related Chagas disease infections are “not likely to be diagnosed, and in many cases, even if symptoms appear, infection may not be recognized.”

Seven people have been infected with Chagas disease after receiving blood transfusions in the U.S. and Canada, according to the FDA. Five have been infected after organ transplantation. Since screening began, two people have been infected from platelet transfusions.

The same FDA document says that in Los Angeles, one in every 2,000 blood donors may be infected with the Chagas-causing parasite. “That’s really a very high number,” said Benjamin. “Much higher than for any other infectious disease that we deal with routinely, like hepatitis or HIV.”

The FDA declined to be interviewed, as did the chair of its blood safety committee. In an emailed statement, an FDA spokesperson said the agency continues to work with the CDC and National Institutes of Health to monitor threats to blood safety and ensure that the medical community is aware of risks associated with blood transfusions.

Another tropical disease that can spread through transfusions is West Nile virus. By the time blood banks started screening for the virus in 2003, at least 23 people had been infected by tainted blood.

West Nile virus and the parasite that causes Chagas disease aren’t the only tropical agents threatening the safety of the blood supply.

Chikungunya, a virus spread by mosquitoes, has caused outbreaks in the Caribbean in recent years, and experts warn that it could become established in Texas.

The risk is that when a traveler brings the virus to Texas, the virus could circulate among local mosquitoes and become established in mosquitoes and humans.

A chikungunya epidemic in Puerto Rico last year forced a shutdown of the local platelet donation system. The American Red Cross stopped accepting donations from locals and had to import platelets from the continental U.S.

Benjamin fears a similar situation could occur in Texas.

“I’m concerned, and I think there should be a more general concern than there seems to be,” he said. “It’s time to consider Chagas again and look to see if what we are doing is correct or not.”

US and Mexico Must Jointly Combat Chagas Disease

Eureka

Rice University

HOUSTON – Nov. 2, 2015 – Chagas disease — the third most common parasitic infection in the world — affects approximately 7.5 million people, mostly in Latin America. To help reduce outbreaks of this disease in their countries, the United States and Mexican governments should implement a range of programs as well as fund research for the development of Chagas vaccines and treatments, according to a new policy brief by tropical-disease and science policy experts at Rice University’s Baker Institute for Public Policy.

The paper, “Chagas Disease: Sharing the Burden and the Solutions in the United States and Mexico,” was co-authored by Kirstin Matthews, fellow in science and technology policy, and Jennifer Herricks, postdoctoral fellow in disease and poverty.

“Traditionally, Chagas disease is commonly believed to afflict only the poor in rural parts of Latin America,” Matthews said. “However, the migration of infected humans, animals and insects has brought the parasite causing the disease, T. cruzi, to other parts of the world, including the U.S. and Mexico. Through cross-border collaborations, the two countries’ governments can take steps to reduce the risk of Chagas disease by increasing awareness among health care providers and the community to protect their most vulnerable citizens, implementing control and surveillance programs and developing novel treatments for acute and chronic Chagas disease.”

T. cruzi is not normally transmitted from person to person but is spread through insects called triatomines, also known as “kissing bugs.” Kissing bugs spread Chagas disease directly to humans through their feces. The term “kissing bug” is used because the triatomine usually takes a blood meal from around the face when a person is asleep outside or in a housing structure that allows the bugs to get inside. As the bug feeds, it also defecates. When the person rubs the irritated spot, they unintentionally rub the bug’s feces, containing the parasite, into an open wound or into the eye. From there the parasite can enter the bloodstream.

Without treatment, some patients, mostly children and immune-compromised individuals, will progress to myocarditis (inflammation of the heart muscle) or meningoencephalitis (inflammation of the central nervous system), which can be fatal. Pregnant women with the disease can experience miscarriage and preterm labor. T. cruzi can be passed from mother to child during pregnancy, a condition known as congenital Chagas disease. This condition represents over one-quarter of the world’s cases.

The biggest risk factor associated with contracting Chagas disease is poverty, especially extreme poverty. An estimated 1.6 million households in the U.S. and 5 million people in Mexico live in extreme poverty and earn less than $2 per person per day. Many of these impoverished individuals are living in poor-quality homes that may sometimes lack basic utilities, air conditioning and indoor plumbing, which increases their risk of exposure to the insects that can spread diseases, including Chagas.

In Mexico, Chagas disease is estimated to impact 1.1 million to 5.5 million people, and yet research suggests that less than 0.5 percent of infected individuals are able to access treatment for the disease, the authors said.

In the U.S., the impact of Chagas disease is greatest in California and Texas in terms of estimated numbers of cases. Despite the fact that many states are affected by Chagas, the disease is formally reportable in only three states: Texas, Arizona and Tennessee. In Texas, approximately 50 percent of kissing bugs and 20 percent of dogs are estimated to be infected with the T. cruzi parasite. Conservative assessments suggest that there are 300,000 people living with Chagas in the U.S., but other estimates suggest nearly a million people in the country — 300,000 in Texas alone — may have Chagas disease, the authors said.

To help those infected with T. cruzi, the U.S. and Mexico should fund initiatives directed toward new treatments for Chagas disease — at both the acute and chronic stages, according to the authors. “Unfortunately, since the poor are the most likely to be affected by Chagas disease, there is not a great financial incentive for pharmaceutical companies to develop new drugs,” Herricks said. “However, philanthropic organizations and government-funding agencies can help push for increased research, and new public-private partnerships with pharmaceutical companies can fund development to ensure treatments are accessible to vulnerable populations.”

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