‘Kissing bug’ case in Delaware raises alarm for summer

(CNN) April 25, 2019 | Jacqueline Howard and Nadia Kounang

A bloodsucking “kissing bug” bit a Delaware girl on the face last summer while she was watching television. Now, the US Centers for Disease Control and Prevention is calling the incident the first confirmed identification of the bug in the state.

Triatoma sanguisuga, often called the “kissing bug” because it usually bites around the eyes and mouth, can transmit a parasite called Trypanosoma cruzi. The parasite causes Chagas disease, which can have serious cardiac and gastrointestinal complications.
When the girl was bitten, her family contacted the Delaware Division of Public Health and the Delaware Department of Agriculture for help in identifying the creature. They were concerned about possible disease transmission from the insect, according to a CDC report Thursday.
“The girl who was bitten had no ill effects,” the report said, and although the bug’s presence was confirmed in Delaware at the time, there is no current evidence of Trypanosoma cruzi in the state.
Yet the case raises new concern about how many additional kissing bug bites might occur this summer across the nation — and what that means for public health.
Although the risk of Trypanosoma cruzi transmitted by kissing bugs is minimal, most of the kissing bugs in the United States are potential disease vectors, and parasite transmission could increase because of climate change, according to a paper in the journal Emerging Infectious Diseases in 2012.
Love_Bug.jpg
Chagas is endemic to Latin America, where a different species of the bug lives and can find its way into rural households.

“They might have thatched roof or poorly insulated walls, and the bugs set up shop and feed on animals and people at home,” Sarah Hamer, now an associate professor of epidemiology at Texas A&M University’s Veterinary Medicine and Biomedical School, said in 2015.
Yet the bugs exist here in the United States, too.
Hamer said the kissing bug and Chagas have long been our neighbors: “The earliest reports are from the 1800s. The first parasites have been reported since the 1940s. We’re just diagnosing more disease. We’re paying attention to it now.”

 
The CDC estimates that there are 300,000 people living with Chagas in the United States, but most cases are contracted in other countries.

Only a few cases of Chagas disease from contact with the bugs have been documented in this country, and kissing bugs have been reported in 28 states, mostly in the southern half of the nation, according to the CDC. The bugs in the United States are most likely to be found outside.
To prevent infestation, the CDC recommends that you:
  • Seal cracks and gaps around windows, walls, roofs and doors
  • Remove wood, brush and rock piles near your house
  • Use screens on doors and windows and repair any holes or tears
  • Seal holes and cracks leading to the attic, to crawl spaces below the house and to the outside
  • Have pets sleep indoors, especially at night
  • Keep your house and any outdoor pet resting areas clean, in addition to periodically checking both areas for the presence of bugs
If you suspect that you’ve found a kissing bug, the CDC says not to squash it. Instead, place it in a container and fill with rubbing alcohol or freeze in water, and take it to your local health department.

CDC ALERT – DEADLY ‘KISSING BUG’ HAS INVADED NEW JERSEY

July 2, 2019 | by Matt Ryan | 943thepoint

The CDC is alerting New Jersey residents about the Triatomine bug, or ‘Kissing Bug.’ The way it infects is straight out of a horror movie.

CDC

The name ‘Kissing Bug’ came from the fact that this bug is known for biting people on the face. Guess I’ll never be sleeping again. This bug can infect animals as well. Once bitten, humans and animals run the risk of contracting Chagas.

Symptoms of Chagas include fever, fatigue, swelling, and a rash. It can, however, be deadly leading to stroke or heart failure. Chagas has even caused heart failure in dogs.

Don’t let the name fool you, this is no joking matter. ‘The Kissing Bug’ looks like this.

Steve Lenz

According to the CDC, these bugs can live indoors, in cracks and holes of housing, or in a variety of outdoor settings including the following:

  • Beneath porches
  • Between rocky structures
  • Under cement
  • In rock, wood, brush piles, or beneath bark
  • In rodent nests or animal burrows
  • In outdoor dog houses or kennels
  • In chicken coops or houses

So how do you keep these suckers out of your space? The CDC recommends:

  • Sealing cracks and gaps around windows, walls, roofs, and doors
  • Removing wood, brush, and rock piles near your house
  • Using screens on doors and windows and repairing any holes or tears
  • If possible, making sure yard lights are not close to your house (lights can attract the bugs)
  • Sealing holes and cracks leading to the attic, crawl spaces below the house, and to the outside
  • Having pets sleep indoors, especially at night
  • Keeping your house and any outdoor pet resting areas clean, in addition to periodically checking both areas for the presence of bugs

Consult a licensed exterminator when it comes to this bug.

S. Kjos via CDC

If you think that you’ve found a Triatomine bug, DO NOT TOUCH OR SQUASH IT! It’s a common reaction to kill a bug when you see one, but it’s not ideal with ‘The Kissing Bug.’

Instead, the CDC says to place a container on top of the bug, slide the bug inside, and fill it with rubbing alcohol or, if not available, freeze the bug in the container. Then, you may take it to your local extension service, health department, or a university laboratory for identification.

Surfaces that have come into contact with the bug should be cleaned with a solution made of 1 part bleach to 9 parts water (or 7 parts ethanol to 3 parts water).

If you think that you have been bitten, go to a healthcare provider immediately!

Nashville among worst bed bug infested cities in the U.S.

“Goodnight. Sleep tight. Don’t let the bed bugs bite.”

NASHVILLE, Tenn. (WTVF) | Emily Luxen |June 3, 2019 — On a week where thousands of visitors from around the world will come to Nashville for CMA Fest, the city is ranked as one of the worst in the country for bed bugs.

A new survey by pest control company Terminix finds Nashville is the 18th most bed bug infested city in the country. Music City was ranked 21st last year.

Philadelphia was ranked number one in the report, followed by New York City. Memphis was ranked 17th.

Terminix said the rankings were based on the number of services the company has performed in the city in the past year.

“A lot of the problem we have here in Nashville is driven by the fact we are a transient city,” said Chris Bryant, a Service Manager at Terminix. “Summer tourism is starting to peak this time of year.”

To prevent transporting or being bitten by bed bugs, Bryant recommended people check headboards, mattresses, and sheets in hotels or Airbnbs for any signs of bed bugs.

“What you are going to be looking for looks like small black dots, like someone tapped it with a black ball point pen,” said Bryant.

Bed bugs are visible, and when fully grown are about the size of an apple seed.

Bryant also recommended hanging all clothing rather than putting it in drawers, and to keep your luggage away from the bed. When you return home from a trip, wash all your clothes in hot water.

The bugs can bite and leave behind red itchy marks on your skin. Bed bugs do not transport disease.

“Especially if it’s at night and you are in bed and you are being bitten by bed bugs, it will wake you up and cause you to itch,” said Brian Todd with the Metro Health Department.

Todd said any bed bug sighting in a hotel should be reported to management immediately. Problems can also be reported to the Metro Health Department at (615) 340-5630. It is helpful to provide the name of the hotel and the room number. The Department’s Environmental Health Bureau will look into the cases.

Bryant said Terminix hoped the study would increase awareness that bed bug sightings are on the rise, and to educate people on how to prevent transporting them.

“It just takes one to hitch a ride on you, and when you go back home, you’ve taken it with you.”

As Boise grows, bed bug infestations are on the rise in the Treasure Valley

BOISE, Idaho — You may have heard of bed bugs being a problem in big cities like New York, but as Boise grows, it’s taking on those big-city problems as well.

In the past six months, Ada County Paramedics have noticed an increase in bed bug calls.

Because of more people traveling to and from Boise, Dina Hardaway, Infection Control Officer for Ada County Paramedics, said that more bed bugs are coming into our area as well.

“There is so much more international travel now; we’re getting more populated just within our city and within our county,” Hardaway said. “Just with those conditions alone, they are brought into our area.”

Due to the uptick in bed bug cases, Ada County Paramedics have spent the past few months learning new protocols, including tracking data on infestations and learning techniques on how to identify and exterminate them from equipment.

Hardaway says that while the bugs aren’t a public health crisis– because they don’t spread disease– they can still be a nuisance.

To prevent the spread of bed bugs, be sure to check the seams of mattresses and underneath base boards. Make sure to wash second hand clothing and clean up used furniture after buying it. If you’re traveling, wash all of your clothing and vacuum your suitcase.

If you do end up getting beg bugs, there’s no need to call 911– just be sure to call your local exterminator.

For more information on how to get rid of bed bugs, visit the Environmental Protection Agency’s website.

Experts Warn of Bed Bug Encounters Ahead of Busy Travel Season

travel.jpgFAIRFAX, Va.–(BUSINESS WIRE)–May 29, 2019

The National Pest Management Association shares tips to avoid contact with hitchhiking pests during Bed Bug Awareness week.

As the busy travel season commences and families finalize their vacation plans for summer, experts at the National Pest Management Association (NPMA) are warning vacationers to remain vigilant during Bed Bug Awareness Week, this June 2-8. An annual observance recognized by Chase’s Calendar of Events, Bed Bug Awareness Week serves as an important reminder that bed bugs can wreak havoc if brought home after traveling, making prevention key to staving off an infestation.

Bed bugs are one of the most common pests, and according to NPMA’s 2018 Bugs Without Borders survey, 97 percent of U.S. pest control professionals surveyed reported they treated for bed bugs in 2018, with 68 percent saying they treated hotels specifically. A recent online research study conducted between January 2018 and May 2019 by Advanced Symbolics Inc. using a representative sample of 274,500 Americans revealed a 9 percent increase in people reporting bed bugs from just April to May, 2019, and a 21 percent increase in concerns regarding bed bugs as a potential health and home threat during that same time period.

“Bed bugs can be found anywhere, whether it be a 5-star hotel or a summer camp,” said Cindy Mannes, vice president of public affairs for NPMA. “These pests do not discriminate, and many people usually transport bed bugs with them back to their homes without even knowing they’re doing so. To prevent these freeloaders from hitchhiking back home with your family, it is important to take proper precautions when traveling this summer.”

To help vacationers avoid bringing home any hitchhiking pests this travel season, the NPMA is sharing the following prevention tips:

  • Thoroughly inspect the entire room before unpacking, including behind the headboard, under lights, and inside dressers, drawers, sofas and chairs.
  • Pull back hotel sheets and inspect the mattress seams, particularly at the corners, for telltale stains or spots. If you see anything suspect, change rooms/establishments immediately.
  • Carry a small flashlight to assist you with visual inspections.
  • Vacuum and properly inspect suitcases after returning from a vacation. Do not bring the suitcase into your home until it has been inspected.
  • If you think you may have brought bed bugs home with you, seek professional pest control assistance to address an infestation, as this is not a do-it-yourself pest.

For more information about how to prevent bed bugs visit PestWorld.org.

DEADLY ‘KISSING BUG’ HAS INVADED INDIANA

Deadly_Kissing_Bug.PNGThe Center for Disease Control and Protection is warning residents in the United States about a deadly bug that has made its way to 12 different states including Indiana. An insect know as a Triatominae, has been known to bite people in the face and infecting them with disease called Chagas. This disease has been dubbed as the deadly “Kissing Bug.”

These insects are not something to mess around with. Some of the symptoms of Chagas are fever, fatigue, swelling and a rash but it can be more serious causing strokes or even heart failure. Your pets aren’t even safe from the triatomine insects, as Chagas can actually give your pets heart disease.

I found what looked like a Triatominae in my house the other day. I can’t say for sure if it was, but it certainly looked like one. These bugs, when found inside your home, are typically located near the places your pets sleep, in areas of rodent infestation, and in/around beds and bedrooms (especially under or near mattresses or night stands.

The one I found was on my night stand. I didn’t take my chances, so I squished it…which apparently you aren’t supposed to do if you find one. According to the CDC:

If you find a bug you suspect is a triatomine, do not touch or squash it. Place a container on top of the bug, slide the bug inside, and fill it with rubbing alcohol or, if not available, freeze the bug in the container. Then, you may take it to your local extension service, health department, or a university laboratory for identification.

Surfaces that have come into contact with the bug should be cleaned with a solution made of 1 part bleach to 9 parts water (or 7 parts ethanol to 3 parts water).

If you want to take precautions to keep the triatomine bug out of  your house, the CDC recommends that you contact a licensed pest control operator before you use any insecticides to kill triatomine bugs. It should also be noted that roach hotels or other “bait” formulations do not work against these bugs. Other precautions to prevent house infestation recommended by the CDC include:

  • Sealing cracks and gaps around windows, walls, roofs, and doors
  • Removing wood, brush, and rock piles near your house
  • Using screens on doors and windows and repairing any holes or tears
  • If possible, making sure yard lights are not close to your house (lights can attract the bugs)
  • Sealing holes and cracks leading to the attic, crawl spaces below the house, and to the outside
  • Having pets sleep indoors, especially at night
  • Keeping your house and any outdoor pet resting areas clean, in addition to periodically checking both areas for the presence of bugs

(Source: CDC- Triatomine Bugs)

Bed Bugs Don’t Need Beds, or Humans, to Survive. They Never Did…

Nova_PBS.jpg

The rise of bed bugs preceded modern humans by at least 100 million years. They survived the extinction that killed the dinosaurs. Could they outlive us all?

By Katherine J. Wu   May 16, 2019

Nova.jpgDon’t be fooled by their charming name: Bed bugs don’t need beds to set up shop. These intrepid insects will colonize pretty much any place where people pile up, including hotels, movie theaters, libraries, even the occasional subway—ready and waiting to ruin a human life with their bloodsucking mouthparts and death-defying durability.

It’s easy to dismiss bed bugs as loathsome pests that exist to make humans miserable. But in reality, bed bugs predate humans by leaps and bounds, making us the unwanted interlopers that first crossed into their turf.

According to a newly mapped bed bug family tree, these puny pests have been guzzling the blood of other animals for more than 100 million years, long before the rise of both modern humans and bats, their most common host. The research, published today in the journal Current Biology, shows that the bed bug timeline stretches further back than even the mass extinction that wiped out 75 percent of Earth’s plant and animal species, including all dinosaurs, 66 million years ago.

The surprising longevity of bed bugs means we’re no longer certain of the identity of these bloodthirsty buggers’ first host. But the study’s findings could still offer clues on how bed bugs once made the jump to humans, and if that transition will have an encore act in the future.

“Bed bugs didn’t evolve on humans,” says study author Michael Siva-Jothy, an entomologist and evolutionary biologist at the University of Sheffield in the United Kingdom. “We just happen to be their current host at the moment—which means they’re very good at what they do.”

iStock-165162859.jpg
Bed bug bites are caused primarily by two species—Cimex lectularius and Cimex hemipterus—which pierce human skin and drink blood with their sucking mouthparts. Luckily, neither is thought to transmit disease. Image Credit: smuay, iStock

The scourge of bed bugs on humankind is believed to stretch back to the very dawn of our species. But only three species—Cimex lectulariusCimex hemipterus, and, less commonly, Leptocimex boueti—routinely spend their nights supping on human blood. At least 100 other types of bed bugs exist worldwide, feeding mostly on bats and, to a lesser extent, birds, and researchers still don’t have a good understanding of these insects’ origins, and how species have split and diversified over time.

To generate a more complete bed bug catalog, an international team of scientists led by Klaus Reinhardt, a molecular and evolutionary biologist at the Dresden University of Technology in Germany, set out to amass insects from around the world.

A handful of specimens weren’t too hard to come by, arriving via the generosity of natural history museums, or scientific colleagues who had seen the team’s requests for help on Twitter. Collecting the lion’s share of the data, however, required some pretty gnarly field trips that featured amateur cliff scaling, treks through knee-deep guano, and hikes into remote mountaintop caves—all in search of nondescript insects just millimeters long.

In all, sample collection alone took the study’s 15 authors the better part of 15 years. But the result was an unprecedented collection of pristine bed bug DNA, representing 34 species hailing from 62 localities around the globe.

“It’s really difficult to collect these specimens,” says Christiane Weirauch, a systematic entomologist at the University of California, Riverside who was not involved in the study. “It’s just so cool that this team has pulled this together.”

By comparing DNA sequences across species, Reinhardt, Siva-Jothy, and their colleagues were able to trace the evolutionary relationships between the bed bugs they’d collected. The researchers then combined their data with evidence from known insect fossils to pinpoint when bed bug lineages had split in the past. And when the bed bug family tree was finally mapped, the team was met with a set of findings that flew in the face of almost everything they’d expected.

Because bats remain the most common host of bed bugs (technically, bat bugs) today, Siva-Jothy says, most researchers have assumed that the first bed bugs to scuttle the Earth also gorged on the blood of these winged mammals. Cozied up to cave-dwelling bats, bed bugs would’ve then had an easy time making the hop to our human ancestors seeking shelter some 2 million years ago, and evolved alongside the genus Homo ever since.

Neither of these theories panned out.

The researchers’ analysis now places the origin of bedbugs around 115 million years ago, during the Cretaceous—a whopping 30 to 50 million years before bats are believed to have come onto the scene. It’s not yet clear what species first drew the bed bug straw, but a good candidate might be a small, social, cave-dwelling mammal, Reinhardt says.

Others, however, aren’t ready to completely rule out bats, or at least an early bat-like ancestor. “The fossil records for [both bed bugs and mammals] are patchy…that makes it hard to make definitive statements,” says Jessica Ware, an entomologist and evolutionary biologist at Rutgers University who was not involved in the study. “It’s possible bats are older, and we’ve just underestimated.”

Some 70 more bed bug species have yet to be analyzed in this way, and the family tree could still change with the addition of new data, Ware says. “That being said, this is the first and maybe most comprehensive analysis people have done for [this group of insects].”

Regardless of where, and on whom, bed bugs got their start, it appears these insects were hardy enough to weather a mass extinction—and have remained alarmingly adaptable ever since. The researchers’ findings suggest that, throughout their evolutionary history, several bed bug species went from bothering bats to terrorizing birds and vice versa. Along the way, at least three species dipped their spindly legs into human stock. Surprisingly, all three species appear to have evolved independently, with each making a separate jump to human hosts.

In other words, we humans didn’t actually do much to shape the evolution of one of our most iconic pests, who were perfectly content binging on the blood of bats and birds. It just so happened that, when an unlucky member of the genus Homo stumbled onto their path, certain bed bugs were flexible enough to expand their palates.

Bat and bed bug - credit Mark Chappell, Univ Cailf, Riverside.jpg
Bats were once thought to be the first host of bed bugs. But a newly mapped family tree shows that bed bugs predate bats by 30 to 50 million years. Image Credit: Mark Chappell, University of California, Riverside

There’s even a chance another bed bug species might one day develop a taste for human blood, Reinhardt says (in fact, it might already be happening). Based on the historical data, these transitions happen roughly every half a million years.

But the more pressing concern might be the enemies we already know, Siva-Jothy says. “With human populations expanding, and our reliance on animals, and the way cities grow and communicate…there will be more opportunities for the species we’ve already got to become more widespread.”

Given the stubbornness of bed bug infestations, that’s not great news. It’s enough to make us wonder if bed bugs have the apocalyptic armor to outlive us all.

We might not have made our bed bugs. But we still have to lie with them.

‘Kissing bug’ sickens more in Los Angeles than Zika and few know they have it – deadly Chagas disease

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

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.”

#SayNOtoPESTICIDES!

 

Deadly CHAGAS: An Emerging Infectious Disease Threat In U.S.

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.

 2014 map of blood donors testing positive for CHAGAS disease. 

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.

   Trypanasoma cruzi parasite in heart tissue – CDC

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.

#SayNoToPesticides!

Here’s how California could be missing pesticides’ cancer risk – #sayNOtoPESTICIDES!

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The local community is concerned about high levels of pesticides used near Rio Mesa High School in Oxnard, Calif., which is surrounded by strawberry fields on all four sides.  Photo:Sam Hodgson

February 17, 2016 | by Andrew Donohue | Reveal

The local community is concerned about high levels of pesticides used near Rio Mesa High School in Oxnard, Calif., which is surrounded by strawberry fields on all four sides.

California’s pesticide police could be missing a serious health concern for residents and farmworkers by failing to monitor what happens when pesticides get mixed together.

As a new report from UCLA highlighted today, California studies only how each individual pesticide affects human health. Often, however, workers and residents are exposed to a number of pesticides at the same time.

That can happen when pesticides get mixed together before they’re applied to fields or when different pesticides are used in the same field on the same day. A growing body of science is showing that the chemical cocktails could create greater health risks than each pesticide does on its own.

In particular, the report shows how three fumigants – a type of gaseous pesticide central to the strawberry industry and used near schools and homes – might combine to increase the risk of cancer for bystanders. Essentially, once in the human body together, the chemicals can team up to attack and mutate DNA in a way they wouldn’t on their own.

“The regulatory system that is supposed to protect people from harmful levels of pesticide exposure has been slow to deal with interactive effects when setting exposure limits for pesticides,” the report says.

The California Department of Pesticide Regulation’s mission is to protect humans and the environment from the dangers of pesticides. The report’s authors, who come from UCLA’s law and public health schools, said the department must begin studying the combined effects. And they point out that low-income and minority residents are at the greatest risk.

“DPR is required to assess this risk and protect public health, but isn’t doing so,” the authors wrote.

The department already is under fire for how it has managed fumigants, which can spread easily through the air. A Reveal investigation found that department leaders allowed growers and Dow AgroSciences to use heavy amounts of one fumigant despite strenuous objections of scientists because of its potential to cause cancer.

When Ventura County residents subsequently raised concern about the pesticide’s use in strawberry fields near Rio Mesa High School, department Director Brian Leahy responded with a series of exaggerations and contradictions.

The department has curtailed the pesticide’s use and begun drafting rules that would limit pesticide use around schools and require residents to be notified of fumigant use near their homes. However, the state continues to keep open the loophole it created at Dow’s request.

Last week, the department’s second-in-charge, Chris Reardon, left without explanation after nearly 13 years with the agency. An appointee of the governor, Reardon maintained close ties with the agricultural industry, copies of his calendars show.

The UCLA report focused on the fields around Rio Mesa High School to make its case. The school is boxed in on all four sides by conventional strawberry fields. Although pesticides aren’t applied during school hours, the gases can linger in the air for weeks after they’re applied without teachers or students knowing.

Combined, the health risk could be much greater than those of the individual pesticides.

“In fact, modeling shows that over the course of about one week people who live and work in the area around Rio Mesa High School in Ventura County were exposed to large doses of multiple fumigants,” the report says. “This level of exposure raises concerns about possible interactive effects.”

The report points out that 35 percent of all fumigants were applied on the same field on the same day as another fumigant, and 26 percent were applied as part of a pesticide mix.

The authors recommend the following changes in California’s pesticide regulation:

  • Pesticides sold as part of a mixture should be tested before being approved for use.
  • When pesticides are mixed at the field or applied near each other, regulators should require testing or create strict restrictions if there’s a reasonable chance of human harm.
  • The combined effects of the pesticides should be considered in the initial health research done by the Department of Pesticide Regulation and the rules it creates around the pesticides’ use.

#SayNOtoPESTICIDES!