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.

 photo

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.

‘Kissing Bug’ Disease, Chikungunya, and Dengue Arrive in US Amid Rising Temperatures

Healthline
Faraway tropical countries no longer have the market cornered on painful bug-borne illnesses.

'Kissing Bug' Disease, Chikungunya, and Dengue Arrive in US

Chagas, dengue, and chikungunya are likely to become more familiar words in the United States in coming decades. Once limited to climates more tropical than our own, these infectious diseases are now increasingly affecting Americans.

There have always been a handful of Americans who return from tropical travel infected with these diseases. But experts think it’s likely that they will take root here.

As the climate continues to warm, the insects that spread these diseases from one person’s bloodstream to another’s will inhabit larger swaths of the map, according to the United Nations International Panel on Climate Change (IPCC). The habitats of the mosquitoes that carry dengue and chikungunya are already expanding in the United States.

“Climate change is definitely having an effect on parasitic disease worldwide,” said Patricia Dorn, Ph.D., a Chagas expert at Loyola University New Orleans. But, she said, we’re also getting better at testing for these diseases, so part of what looks like an uptick in cases is really an uptick in diagnoses.

For patients, the difference is academic: They’re being diagnosed with diseases they may have never heard of — and their doctors may not know to look for them.

Chagas Disease: It’s Not Just in Rural Areas

Chagas is the latest addition to the list of tropical diseases that Americans have to fear. The disease initially has few symptoms — possibly a fever, rarely some swelling at the site of the bug bite — but if left untreated the parasites accumulate in the cardiovascular system and cause heart damage in 1 in 3 patients.

Triatomine, or “kissing,” bugs spread Chagas disease — though their nickname puts an overly positive spin on what they do: suck the blood of a mammal host and then defecate. The feces spread the parasite that causes the disease.

Chagas is widespread in Latin America and has rarely been considered endemic to the United States, but experts say that’s because we weren’t looking for it.

In 2007, Chagas was added to the list of tests performed on donated blood. Those who tested positive were contacted and interviewed. It suddenly it became clear that at least a few of the 300,000 Americans who tested positive for Chagas disease had not traveled to Latin America.

Triatomine

Bugs in the triatomine family capable of spreading the disease inhabit the bottom two-thirds of the United States. The now-outdated conventional wisdom said that the bugs, which bite at night, only fed only on humans living in thatched huts in rural areas.

“The dogma for years was, ‘We live in improved housing; we have air conditioning — yeah, the bugs are here but they live in wooded areas and we’re just not in contact with them.’ Our most recent study shows that that dogma is wrong,” Dorn said.

A forthcoming study co-authored by Dorn documents that triatomine bugs in Louisiana often feed on human blood. Among the bugs that had fed on humans, 4 in 10 tested positive for the Chagas parasite.

A Texas study published in October used blood donation data to identify five people who had been infected with the virus in Texas.

As the climate continues to warm, triatomine bugs will likely push further northward. And as forested lands are cleared, the bugs are likely to feed more often on humans.

Just this week, a study suggested that bedbugs could spread the parasite, too. But Dorn and Melissa Nolan Garcia, M.P.H., who co-authored the Texas study, said those findings don’t mean much on the practical level.

Although bedbugs are seemingly capable of transmitting the parasite, they probably don’t, based on empirical data. Among different triatomine species, some are far more efficient at transmitting the Chagas parasite, and even the most efficient do so only once in a thousand bites.

“We think that our bugs have better manners,” said Dorn, referring to U.S. triatomine bugs. “In Latin America the better vector takes a blood meal and defecates at the same time. The studies that we did showed that the bug took the blood meal — it was from a mouse — and left the host and defecated later.”

What does all this mean for patients? It means that those who hunt and camp in the South and those who have traveled to Latin America should get screened for Chagas.

“It’s a simple blood test,” Nolan Garcia said.

However, U.S. doctors don’t necessarily know what to do about Chagas. Dorn told the story of a California woman who got a “really scary letter” telling her that she’d been permanently banned from blood donation after testing positive for Chagas. But when she went to her doctor, he didn’t know how to treat her.

The only two drugs to treat Chagas disease are available through the Centers for Disease Control, which has dubbed Chagas a “neglected parasitic infection” and targeted it for public health action.

Nolan Garcia compared treatment with these drugs to “chemotherapy.”

The parasites settle in the heart tissue, and to eliminate them, the drugs have to kill off some healthy tissue too. The treatment is recommended for patients younger than 50 and on a case-by-case basis for those older than 50.

Dengue Fever: It’s Creeping up from Latin America

Dengue is a mosquito-borne viral infection so painful that it’s also called “breakbone fever.” Found throughout the world in tropical and subtropical regions, it’s rarely fatal. Those infected a second time with a different strain of the virus risk developing a more severe form of the disease called dengue hemorrhagic fever; without good medical care, 1 in 5 patients die from this form of the disease.

Dengue has become more common since the 1950s. In the Americas, it’s become at least five times more prevalent since the 1980s. But only in this century has it crept into the United States. Hawaii saw a cluster of infection in the early 2000s, but in recent years Texas and Florida have been U.S. hotspots.

Last year, there were 49 confirmed cases of locally transmitted dengue in the United States. So far this year, all of the hundreds of reported dengue cases along the U.S.-Mexico border have come in from Latin America, Texas public officials told Healthline. However, Florida has confirmed six local cases.

Some counties in Mississippi may also be at “extreme risk” for domestic transmission, experts say.

The mosquitos that carry the dengue virus, Aedes aegypti and Ae. albopictus, are expanding their range, in part due to climate change. As they do, more Americans will be at risk.

I do think it’s a real possibility that we could have sustained transmission [of dengue] in parts of the U.S., in the southern U.S. in particular, and in parts with lower socio-economic status.
Crystal Boddie, UPMC Center for Health Security

“I do think it’s a real possibility that we could have sustained transmission in parts of the U.S., in the southern U.S. in particular, and in parts with lower socio-economic status,” said Crystal Boddie, M.P.H., at the Center for Health Security at the University of Pittsburgh Medical Center in Baltimore.

Window screens, air conditioning, and an indoor job all diminish one’s risk of infection.

The United States won’t be hit as hard as developing countries, where screens are rare and air-conditioning is a luxury reserved for the very rich. But as dengue becomes more common, U.S. doctors will have to learn to diagnose it and provide the right kind of palliative care.

“The initial symptoms are pretty similar to the flu. It’s hard to distinguish if it’s dengue or flu,” Boddie said. “It’s difficult to diagnose if you’re not looking for it specifically.”

The good news is that, because dengue is so widespread in other parts of the world, researchers have been trying to develop a vaccine. Five candidates are currently being tested in advanced clinical trials.

Chikungunya

Chikungunya has symptoms similar to dengue and is spread by the same two types of mosquito. The two diseases often arise in the same places, but more people get sick from chikungunya because infected mosquitos are about three times as likely to transmit it.

Standing water

The disease is less likely to be fatal than dengue, but it’s painful enough to have earned its own colorful name. Chikungunya m­eans, roughly, “writhing disease” in a local language of East Africa, where it first emerged.

“It’s not a trivial disease,” said Roger Nasci, Ph.D., the chief of the Arboviral Diseases Branch at the CDC. He described “prolonged, debilitating joint pain where people just can’t get out of bed.”

About 1 in 3 chinkungunya patients will experience joint pain for months or even years after they recover from the initial infection. There are currently no medications to treat chikungunya and there is no vaccine to prevent it.

Until chikungunya entered India in 2005 and infected 2 million people, it wasn’t on the global health community’s radar. Last year, it earned still more attention when it jumped the Atlantic, sickening people on several Caribbean islands. This year, there have been 11 cases of locally transmitted chikungunya in Florida.

Public health officials say more domestic infections are “inevitable.”

The CDC is trying to educate doctors to make them aware of chikungunya and dengue. Beginning in 2010, doctors were required to report cases of dengue. On Jan. 1, 2015, they’ll be obligated to report chikungunya cases as well.

Mosquitoes breed in pools of standing water, so removing these breeding sites is a top priority. Nasci said the CDC is working with local mosquito control programs to try to limit the number of tires, buckets, and other outdoor sites that collect rainwater. In that one respect, climate change may actually help curb mosquito populations, as California and other Western states experience record droughts.

Healthline News | Cameron Scott | November 20, 2014

Memphis_Channel_3

‘Kissing bugs’ may be kiss of death for babies & small children

MEMPHIS, Tenn. — The ‘kissing bug’ can cause Chagas disease, which can lead to heart problems and, in some cases, death.

The bugs often emerge at night and attack while you are sleeping.

“They’re called kissing bugs because they may bite around the lips,” Daniel Sprenger, manager of Vector Control in Shelby County, said.

The Centers for Disease Control (CDC) explained people who live in the South need to be on the lookout.

The ‘kissing bug’ is most commonly found in South America, but a CDC map reveals there have been reported cases in the Mid-South.

triatomine_map_sm

“They’ll maybe get in the garage,” Sprenger said. “I heard of behind peg board.”

The CDC said the bugs can also be found under porches, stones, animal structures, and rodent nests.

“It actually can lead to death, unfortunately,” Sprenger said.

Death is most common in babies or small children, according to Sprenger. Most people who contract the disease end up breaking out into a severe allergic reaction.

Sprenger said there is a moderate amount of ‘kissing bugs’ in Tennessee and doesn’t believe people need to be extremely concerned.

“Worrying is excessive,” Sprenger said. “Being aware of something like this is good.”

November 13, 2014 | Michael Quander

Bedbugs may play role in spread of drug-resistant bacteria MRSA, study finds

WP

Smith_2
In a study released Wednesday, Canadian scientists detected drug-resistant MRSA bacteria in bedbugs from three hospital patients from a Vancouver neighborhood.

Anyone who has ever had a bedbug infestation knows full well what a nuisance the pests can be. Unlike ticks and mosquitoes, however, bedbugs, which feed on human blood, are not known to spread disease and are generally not viewed as a major public health threat.

But a peer-reviewed study published online Wednesday in a journal of the U.S. Centers for Disease Control and Prevention suggests the pests could play a role in transmitting disease. In a tiny sample of bedbugs, collected from a small number of residents living in crowded conditions in a poor neighborhood in Canada, researchers found the drug-resistant bacterium known as MRSA.

The researchers at a Vancouver, B.C., hospital tested three patients from the neighborhood who were infested with bedbugs. Researchers collected five bedbugs and determined that the insects carried two types of drug-resistant bacteria. Three bedbugs from one patient contained methicillin-resistant Staphylococcus aureus (MRSA), and the two from the other patients each contained vancomycin-resistant Enterococcus faecium (VRE).

MRSA has increasingly turned up in hospitals and in outbreaks outside of health-care settings, such as among athletes, prison inmates and children. MRSA, which is spread by casual contact, can cause serious health problems, including disfiguring “necrotizing” abscesses that eat tissue and life-threatening infections if the microbe gets into vital organs.

“Even though this is a small study, it suggests that bedbugs may be playing a role in the transmission of MRSA in inner-city populations where bedbug infestations are a problem,” said Marc Romney, one of the study’s authors. Romney is medical director of infection prevention and control at St. Paul’s Hospital.

Other experts said the new information was interesting but inconclusive.

“It emphasizes the need for some further studies to determine the potential bedbugs have for transmitting these agents,” said Robert Wirtz, chief of entomology at the CDC’s Center for Global Health. “While the work was well done and it shows an association, it doesn’t establish that bedbugs are capable of transmitting the bacteria.”

The study leaves many key questions unanswered. It did not determine whether the bacteria were transmitted from bugs to patients or the other way around. Nor did it determine whether the bacteria were on the outside of each bug or living and growing inside it, which would be more significant, researchers said.

But even if the bugs were carrying the bacteria on their exteriors, the finding is still significant, Romney said. Bedbugs could spread the germ from person to person, especially in crowded places, such as the homeless shelters where many patients were living in downtown Vancouver. The bacteria typically survive for hours, and possibly days, under the right conditions, he said.

Residents in that Vancouver community tend to be more susceptible to infection because their immune systems are compromised by chronic illness, drug use, crowding and poor nutrition.

Vancouver, like New York, Washington and other cities, has had a disturbing increase in bedbugs in recent years. Experts suspect the resurgence is related to greater domestic and international travel, to the bugs’ resistance to available pesticides, and to lack of knowledge about pests that were virtually eradicated in the 1940s and ’50s by widespread used of DDT. The insecticide was banned in the 1970s.

Bedbugs can live for months without a meal, hidden deep in mattress seams, baseboard cracks and clutter near beds. They travel easily, hitchhiking from person to person, city to city. They have turned up in college dorms, government buildings, Google’s offices and even luxury hotels such as the Waldorf-Astoria, which has been sued by guests who say they were bitten at the New York landmark.

Researchers in Canada wanted to know whether bedbugs may spread the bacteria in poor, overcrowded communities, such as the downtown area where the patients lived.

The CDC’s Wirtz said the next step should be to determine whether a colony of bedbugs fed with blood infected with MRSA or VRE could transmit the bacterium to a clean, sterile system, he said.

Bedbug research has focused more on insecticide resistance and less on public-health effects, scientists said, because they are not known to spread disease.

The study was published online in Emerging Infectious Diseases, a journal published by the CDC that analyzes and tracks disease trends.

By Lena H. Sun | May 11, 2011

Penn Study Shows Bed Bugs Can Transmit Parasite that Causes Chagas Disease

Penn_Medicine

Like the “Kissing” Bug, Bed Bugs Can Transmit Deadly Parasite Via Feces

PHILADELPHIA — The bed bug may be just as dangerous as its sinister cousin, the triatomine, or “kissing” bug. A new study from Penn Medicine researchers in the Center for Clinical Epidemiology and Biostatistics demonstrated that bed bugs, like the triatomines, can transmit Trypanosoma cruzi, the parasite that causes Chagas disease, one of the most prevalent and deadly diseases in the Americas.

In a study published online this week in the American Journal of Tropical Medicine and Hygiene, senior author Michael Z. Levy, PhD, assistant professor in the department of Biostatistics and Epidemiology at the University of Pennsylvania’s Perelman School of Medicine, and researchers at the Universidad Peruana Cayetano Heredia in Peru conducted a series of laboratory experiments that demonstrated bi-directional transmission of T. cruzi between mice and bed bugs.

In the first experiment run at the Zoonotic Disease Research Center in Arequipa, Peru, the researchers exposed 10 mice infected with the parasite to 20 uninfected bed bugs every three days for a month. Of about 2,000 bed bugs used in the experiment, the majority acquired T. cruzi after feeding on the mice.  In a separate experiment to test transmission from bug to mouse, they found that 9 out of 12 (75 percent) uninfected mice acquired the parasite after each one lived for 30 days with 20 infected bed bugs.

In a third experiment, investigators succeeded in infecting mice by placing feces of infected bed bugs on the animal’s skin that had either been inflamed by bed bug bites, or scraped with a needle. Four out of 10 mice (40 percent) acquired the parasite by this manner; 1 out of 5 (20 percent) were infected when the skin was broken by the insect’s bites only. A final experiment performed at the Penn bed bug lab in Philadelphia demonstrated that bed bugs, like triatomines, defecate when they feed.

“We’ve shown that the bed bug can acquire and transmit the parasite. Our next step is to determine whether they are, or will become, an important player in the epidemiology of Chagas disease,” Levy said. “There are some reasons to worry—bed bugs have more frequent contact with people than kissing bugs, and there are more of them in infested houses, giving them ample opportunity to transmit the parasite. But perhaps there is something important we don’t yet understand about them that mitigates the threat.”

T. cruzi is also especially at home in the guts of bed bugs.  “I’ve never seen so many parasites in an insect,” said Renzo Salazar, a biologist at the Universidad Peruana Cayetano Heredia and co-author on the study. “I expected a scenario with very low infection, but we found many parasites—they really replicate well in the gut of the bed bugs.”

Wicked Cousins

Bed bugs and kissing bugs are distant cousins but share many striking similarities. Both insects hide in household cracks and crevices waiting for nightfall and the opportunity to feed on sleeping hosts. They are from the same order of insects (Hemiptera) and both only feed on blood.  (One main difference is their size: kissing bugs are five times as big as a bed bug). With so much in common, it seemed logical to the authors that the kissing bug’s most infamous trait, the transmission of T. cruzi, is also shared by the bed bug.

Other investigators have shared this suspicion. In 1912, just three years after Carlos Chagas described the transmission of the disease by kissing bugs, French parasitologist Émile Brumpt recounted that he had infected almost 100 bed bugs exposed to an infectious mouse, and then used them to infect two healthy mice. Decades later an Argentine group replicated his work.  These experiments, largely ignored during the recent bed bug resurgence, missed one key point.

“Mice can hunt and eat bed bugs,” said Ricardo Castillo-Neyra, DVM, PhD, coauthor and postdoctoral fellow at the Universidad Peruana Cayetano Heredia and Penn. “The older studies were almost certainly only documenting oral transmission of the parasite. Our work shows for the first time that bed bugs can transmit the parasite when their feces are in contact with broken skin, the route by which humans are usually infected.”

Emerging Problem

More people in the U.S. are infected with T. cruzi now than ever before. The Centers for Disease Control and Prevention estimates that the number of Chagas disease cases in the U.S. today could be as high as 300,000.

“There have always been triatomine bugs and cases of Chagas disease in the U.S., but the kissing bugs we have here don’t come into homes frequently like the more dangerous species in South and Central America do,” Levy said. “I am much more concerned about the role of bed bugs. They are already here—in our homes, in our beds and in high numbers. What we found has thrown a wrench in the way I think about transmission, and where Chagas disease could emerge next.”

Equally worrying is the invasion of bed bugs into areas where Chagas disease is prevalent, especially in countries where traditional insect vectors of the parasite have been nearly eliminated, Levy said.  In these areas, bed bugs will be repeatedly exposed to T. cruzi, and could re-spark transmission where it had been extinguished.

“Bed bugs are harder to kill than triatomines due to their resistance to common insecticides.” Levy said. “No one is prepared for large scale bed bug control. If the parasite starts to spread through bed bugs, decades of progress on Chagas disease control in the Americas could be erased, and we would have no means at our disposal to repeat what had been accomplished.”

Often referred to as a silent killer, Chagas disease is hard to diagnose in its early stages because the symptoms are mild or absent. The parasites are hidden mainly in the heart and digestive muscle and over time can cause cardiac disorders and sometimes digestive or neurological problems. In later years, the infection can lead to sudden death or heart failure caused by progressive destruction of the heart muscle. Although there are some drugs to treat Chagas disease, they become less effective the longer a person is infected.

The long asymptomatic period of Chagas disease complicates surveillance for new outbreaks of transmission. In Arequipa, Peru, thousands became infected with the parasite before a case appeared in the hospital. The same could happen in cities in the United States if the parasite were to emerge in the bed bug populations, the authors say.

“Carlos Chagas discovered T. cruzi in triatomine insects before he saw a single case of the disease,” Levy said. “We need to learn from his intuition—check the bugs for the parasite.”

Other co-authors of the study include Aaron W. Tustin, Katty Borrini-Mayorí and César Náquira.

November 14, 2014

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Bed Bugs Transmit Deadly Chagas Disease into U.S. Population

40,000 Pregnant Women and 300,167 People Infected in U.S.

forbes

Chagas: An Emerging Infectious Disease Threat In U.S.

October 1, 2015 | By:  Judy Stone

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.

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.

About:  Judy Stone

I cover infectious diseases, medicine, drug development, and ethics.

I am an Infectious Disease specialist, experienced in conducting clinical research and the author of Conducting Clinical Research, the essential guide to the topic. I survived 25 years in solo practice in rural Cumberland, Maryland, and now work part time as an Infectious Diseases locum tenens physician. I especially love writing about ethical issues, and tilting at windmills as I advocate for social justice. As part of my overall desire to save the world when I grow up, I have become particularly interested in neglected tropical diseases. In my next life, I would love to teach overseas. When not slaving over hot patients, I can be found playing with photography, friends’ dogs, or in my garden. Follow on Twitter @drjudystone

Indoor Pesticide Exposure Tied to Childhood Cancers. Childhood Exposure to Indoor Insecticides Linked to 47% Increased Risk of Childhood Leukemia and 43% Increased Risk of Childhood Lymphomas

A new analysis of existing research finds that kids exposed to pesticides indoors are at higher risk for childhood cancers.

Reuters Health – POSTED: 16 Sep 2015

(Reuters Health) – A new analysis of existing research finds that kids exposed to pesticides indoors are at higher risk for childhood cancers.

The study, based on data mainly from North America, Europe and Australia, suggests that policies should be developed to limit children’s exposures at home and school to insect killers, researchers say.

“When you apply pesticides so close to where kids are and they spend so much time in the household, I’d really be concerned about their exposure,” said Chensheng Lu, the senior author of the analysis from the Harvard T.H. Chan School of Public Health in Boston.

The researchers write in Pediatrics that children can be exposed to pesticides when they play on treated surfaces and then put their fingers in their mouths.

Unlike adults, children may not be able to break down or excrete some of the chemicals used in pesticides. Reports show children had respiratory, stomach, nerve and hormone problems tied to pesticides, Lu and colleagues add.

In the same issue of the journal, researchers from Italy published a report of a seven-month-old child dying after repeated exposure to massive amounts of a household insecticide.

“I think that case highlights the acute effects of insecticides,” Lu told Reuters Health. “The blood cancers highlight the risks of chronic exposure.”

For the new study, Lu’s team looked at published research on childhood exposures to pesticides both indoors and out, and any associated cancers. Sixteen studies were included in the final analysis, each looking at samples of a few hundred to a few thousand children.

The studies looked at exposure both to professionally-applied pesticides and to household bug sprays and weed killers.

Overall, childhood exposure to indoor insecticides was linked to a 47 percent increased risk of childhood leukemia and a 43 percent increased risk of childhood lymphomas, which are cancers of the lymphatic system.

The researchers also found a slightly increased risk of childhood cancers with the use of outdoor herbicides, or weed killers, but the association was only significant for leukemia.

The link between outdoor exposure and childhood cancers was not as strong as for indoor exposure, because people tend to spray more pesticides indoors, Lu said.

More research is needed to determine how exposure to pesticides may be linked to childhood cancers, the researchers write. Lu cautions, however, that parents should keep in mind that many pesticides are meant to be deadly to insects and pests.

“Those chemicals have lethal potencies,” he said. “Why would people want to spray so close to their kids?”

Eliminating the possibility of increased risk for childhood cancers comes down to parents and caregivers not spraying pesticides in their homes, Lu said.

Shelter Dogs, Family Dogs and Purebred Show Dogs Carrying Deadly Chagas in US

npr-home

Dogs Carry Deadly Kissing Bug Disease In Texas And Latin America

July 16, 2014 Michaeleen Doucleff
Dogs throughout Latin America carry the Chagas parasite — and boost the risk of people catching it. And it's not just shelter dogs, like these in Mexico, who are at risk. Even family dogs get the deadly disease.

Dogs throughout Latin America carry the Chagas parasite — and boost the risk of people catching it. And it’s not just shelter dogs, like these in Mexico, who are at risk. Even family dogs get the deadly disease.  Jose Luis Gonzalez /Reuters/Landov

We often think about people spreading diseases around the world. This spring, vacationers brought chikungunya from the Caribbean to the United States. Businessmen have likely spread Ebola across international borders in West Africa. And health care workers have carried a new virus from the Middle East to Asia and Europe.

But what about (wo)man’s best friend?

From shelter mutts to purebred show dogs, canines across the state of Texas are becoming infected with a parasite that causes a potentially deadly disease in people, scientists report Wednesday in the journal Emerging Infectious Diseases.

Don't let the name fool you. The kissing bug, or Rhodnius prolixus, isn't your friend. The insect transmits the Chagas parasite when it bites someone's face. i

Don’t let the name fool you. The kissing bug, or Rhodnius prolixus, isn’t your friend. The insect transmits the Chagas parasite when it bites someone’s face.

Dr. Erwin Huebner/University of Manitoba

Although the dogs aren’t spreading the parasite directly to people, they are helping to make the disease more prevalent in the southern U.S. (Not to mention the parasite can make dogs sick and even kill them.)

The disease is called Chagas. And it’s transmitted by an insect known as the kissing bug.

Don’t let the name fool you. This isn’t a friendly bug. The insect bites the faces and lips of sleeping people, then passes on the Chagas parasite through its fecal matter. (The parasite is a protist called Trypanosoma cruzi.)

About 300,000 people in the U.S. are infected with the Chagas parasite. Researchers have estimated that the disease cost the U.S. about $800 million each year in lost work time and medical bills.

Many people with Chagas’ disease don’t even know it. They have no symptoms. But for about a third of those infected, the parasite damages the heart or digestive tract. And there are no drugs to cure a chronic infection. So once the parasite takes up residency in somebody’s tissue, it never leaves.

Most people with Chagas’ disease in the U.S. likely caught it in Latin America, where about 8 million people are infected with the parasite.

But in the past decade, researchers have found evidence that Chagas’ disease is spreading locally in Texas and around New Orleans. The new study in dogs points up how widespread the problem is, says microbiologist Nisha Jain, at the University of Texas, Medical Branch at Galveston.

“It shows that active transmission is going on in the U.S.,” says Jain, who wasn’t involved with this research. “Having infections in dogs in the U.S. serves a role in maintaining the infection cycle of Chagas’ disease.”

In the study, veterinarian Sarah Hamer and her team at Texas A&M tested 205 shelter dogs across Texas for signs of chronic Chagas infection. About 9 percent of the dogs, in every part of the state, tested positive.

“The study was just on shelter dogs,” Hamer says. “But we’re also looking at other dogs in Texas — working dogs, show dogs, you name it. They are all exposed to and have Chagas. It’s common in dogs in Texas.”

But the chances of a dog spreading the parasite to its owner is very low, Hamer says.

“The last thing we want to do is put a bad taste in people’s mouths about shelter dogs,” she says. “Shelter dogs are not posing a direct risk to humans.”

Why? Because for the parasite to move from the dog to a person, it needs to go through the kissing bug. And the dog can pass the parasite to the bug only at the beginning of the infection.

So for a person to catch Chagas from their pooch, a kissing bug would have to bite the dog and then its owner right after the dog gets infected. “We don’t have kissing bugs in our homes,” Hamer says, “so the chance of that happening is small.”

That’s not the case in South and Central America. In many poor communities, kissing bugs live in the roofs of thatched and mud homes. Scientists in Argentina have found that having a dog or two in the family greatly boosts your chance of getting Chagas’ disease, Jain says.

“There’s been a lot of research on this question in Argentina,” she say. “When the dogs live around the house, they are certainly important for spreading the disease there. The dogs harbor the parasites and serve as a source for humans infections.”

South Carolina – Virginia – Tennessee – Florida – Deadly kiss? Bug could spread deadly disease to the Lowcountry

Charleston

July 2015 – Bo Peterson

The triatomine bug, popularly known as the kissing bug, can carry a serious disease. CDC

The kissing bug is no beauty. A half-inch long, it looks like a cross between a roach and a paper wasp, with wings folded back like a bat.

Kissing_Bug

Don’t pucker up to it in the Lowcountry. It could be carrying Chagas, a disease that researchers are calling the new AIDS in the Americas.

And if that doesn’t cause you to cringe, the leprosy-prone armadillo might.

Health officials are becoming more concerned about the spread of once-obscure diseases like Chagas and leprosy, partly because of the apparent expanding range of both in the Southeast.

Chagas had been a disease found largely in Latin America and the arid Southwest. It is a disease caused by a parasite. At first the symptoms are fever, headache and nausea symptoms, a lot like a flu. But over time it can lead to complications, such as sudden-onset heart attacks and intestinal problems. A National Institutes of Health study suggested that it could kill as many as a third of the people infected with it in Latin America.

The parasite is known to be spread by the triatomine bug, popularly called the kissing bug because of a tendency to bite humans on or near the mouth. More than 130 species of the bug are bloodsuckers, literally, and at least a few carry a parasite that causes the disease.

South Carolina has at least three of the species, including a new one identified last year.

Now bed bugs have been shown to be able to carry it, too. So have coyotes.

The disease hasn’t shown up in the state so far except in dogs, as near as anyone can tell. Incidents aren’t required to be reported in South Carolina. But researchers recently found an outbreak in northern Virginia, brought in by people from other countries. Tennessee is among the states that do test for it, after it turned up there.

At least 300,000 people are thought to carry the disease in the United States, according to the Centers for Disease Control and Prevention. Most of them are thought to have acquired it in Latin America, said Sue Montgomery of the CDC. Only 28 cases are confirmed to have been acquired here.

“Because it’s not notifiable in key states where the bug lives and many infections have not been identified, the burden (incidence) among non-Latin Americans is not known,” Montgomery said.

Only five states now require reporting of the disease. Few doctors are experienced with it. Blood supplies are not screened for it.

Meanwhile, nine cases of leprosy have been diagnosed in Florida so far this year, according to CNN, in a state that usually sees two to a dozen per year. Leprosy is the skin disease usually thought of as a biblical scourge that is all but wiped out in the developed world.

But one carrier is the armadillo, the armor-shelled beast now burrowing under a fence near your yard. Once confined to the arid Southwest, the creatures have swarmed the Southeast lowlands and into the foothills. First spotted in South Carolina in the Lowcountry in the 1990s, they’re now common in subdivision neighborhoods.

The Florida leprosy reports are alarming because previously only one or two cases were known of humans getting the disease from a wild armadillo; in those cases the persons ate raw or undercooked meat, according to University of Georgia’s Center for Urban Agriculture.

Investigators for the Florida Department of Health haven’t determined yet just how the nine people became infected. But the department is recommending that people avoid contact with wild animals such as armadillos, and take precautions by using gloves and washing hands.

Chagas is a bigger puzzle because less is known about it in this country. The bright spot about the disease is that, like leprosy, it appears to be very hard to get. The bug is nocturnal, and doesn’t tend to be found indoors unless it is in cracks or holes in the walls.

If it has the parasite, it has to defecate — repeatedly, some health professionals think — on a person to transmit it.

Once the parasite is in the blood of humans, though, it can be transmitted with the exchange of blood. Chagas, in fact, has been called “the new AIDS in the Americas,” according to the Harvard University School of Health, because of its rapid spread through the hemisphere and because it infects the blood.

The disease certainly could turn up in South Carolina, said Brian Scholtens, College of Charleston entomologist.

“We have the bugs in the state and plenty of potential vectors. Up to this point, the only thing we have lacked is the actual disease organism,” he said. But that can change very quickly with movement of either infected dogs or humans, he said.

“Most humans are unlikely to get bitten (by the bug),” Scholtens said. “It is more likely that the other hosts would be involved in the overall increase in transmission rates, and humans may be more at risk from infected blood supplies if we don’t start routinely screening for the parasite.”

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