Details of First Locally-Acquired Case of Chagas Disease in Missouri

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CONTAGIONLIVE.COM | by Grant M. Gallagher | February 28, 2020

In May 2019, the US Centers for Disease Control and Prevention (CDC) published details on the first detection of Triatoma sanguisuga—the insect vector for Chagas disease causing parasites—in Delaware.

While locally-acquired Chagas disease is rare in the United States, its precise impact is hard to quantify because few states have active surveillance measures in place. However, the CDC has recommended that more states with frequent travelers to/from countries where Chagas disease is endemic (such as Bolivia) introduce surveillance measures.The CDC’s Morbidity and Mortality Weekly Report  includes an article from Missouri health officials detailing an incident in their state in which a blood donation sample screened positive for antibodies to Chagas-causing Trypanosoma cruzi parasites. The case marks what is likely the first documented locally-acquired case of Chagas disease in Missouri.

The Missouri Department of Health and Senior Services was first notified of a potential case of Chagas disease in a Missouri woman on December 13, 2017. The 53-year-old patient had visited her local blood donation center in October 2017. An Abbott Prism Chagas screening test indicated the blood sample positive for antibodies to T cruzi. A further confirmatory multistep enzyme strip immunoassay test also returned a positive result.

The patient was not aware of any relevant insect bites. She had briefly crossed the Mexican border 28 years prior, but did not recall any medical incidents during the trip.

After further testing, an electrocardiogram was obtained due to the potential for T cruzi infection to cause cardiomyopathy. The electrocardiogram showed arrhythmias, including primary atrioventricular block. She also underwent an echocardiography which showed mild concentric left ventricular hypertrophy.

Both findings were consistent with chronic T cruzi infection. The individual completed a 60-day course of benznidazole to treat Chagas disease.

The patient had lived in Missouri for the entirety of her life. She did not report seeing triatomine bugs at any property she had lived at, though her husband recalled seeing some insects consistent with digital images of the bugs without being able to recall when or where.

“In Missouri, Triatoma sanguisuga vectors have been identified during 2012–2016 and as recently as July 2019,” the authors wrote.

T cruzi transmission involving triatomine and wild animal reservoirs has been documented in the southern United States for approximately 150 years. There are roughly 300,000 people likely living with Chagas disease in the United States, but only 28 locally-acquired infections have been confirmed and documented between 1955 and 2015.

“The likely autochthonous case described in this report underscores importance of health care provider awareness of possible Chagas disease even in the states considered low risk for this infection and need for the careful consideration of the patient’s history to identify possible risks for T cruzi infection,” authors concluded.

BedBugs Plague New Jersey Library – Summer Reading?

 

June 29, 2016 | by Miranda Leah for FiOS1

City officials say that after receiving a complaint, staff at the South Orange Library found bedbugs inside the library furniture.

Library patrons say they’re not surprised by the news, and extermination experts say that anyone who has visited the library should thoroughly examine their homes for the bugs and bug bites.

Community members say they just hope the library takes care of the problem quickly.

There is no word yet on when the library will re-open.

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BedBug Infestation at USF – Invades Classrooms

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‘Chagas Considered Emerging Global Disease’ – CSUF Researchers study spread of Plague to Parasites. Note, Kissing Bugs are cousins to Bed Bugs.

Back in 2011 we had alarming find: Bedbugs with ‘superbug’ germs MRSA and VRE

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May 14, 2011 | by Christian Nordqvist | MNT, Medical News Today

Not only are there more bed bugs about in North America in Europe, but more of them appear to be carrying two types of superbugs – methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) – bacteria that are resistant to antibiotics and very hard to treat when there is an infection.

Staph infection caused by MRSA is extremely difficult to treat because it is resistant to most antibiotics, including oxacillin, peicillin, methicillin, amoxicillin, and even methicillin.

VRE bacteria are resistant to vancomycin, an antibiotic. They are strains of the genus Enterococcus.

Bed bugs, also known as Cimex lectularius (Cimicidae) are tiny wingless insects that feed exclusively on the blood of warm-blooded animals, including humans. During their evolution they have become common nest parasites, infesting bird nests and bat roosts. Some bed bugs have learnt how to thrive in our nests, meaning our homes, and especially our beds. A baby bed bug is called a nymph and is about the size of a poppy seed. Adults reach about ¼ of an inch in length. They have an oval, flattened shape. Both adults and young are visible to the naked eye.

Bed bugs feed on us when we are asleep. As they feed we feel nothing, the process is painless. They inject a small amount of saliva into human skin while they feed. If they keep feeding on the same human night after night, that person can eventually develop a mild to intense allergic response to their saliva.

The study’s Canadian researchers wrote:

“Further studies are needed to characterize the association between S. aureus and bedbugs. Bed bug carriage of MRSA, and the portal of entry provided through feeding, suggests a plausible potential mechanism for passive transmission of bacteria during a blood meal. Because of the insect’s ability to compromise the skin integrity of its host, and the propensity for S. aureus to invade damaged skin, bed bugs may serve to amplify MRSA infections in impoverished urban communities.”
This latest report informs that the MRSA phenotype found in bed bugs is the same as those identified in many Eastside (Vancouver) patients infected with MRSA.

The scientists believe that the bed bugs probably promote the spread of MRSA in impoverished and overcrowded communities. The study took place in a poor part of Vancouver.

The researchers examined five bed bugs that had been taken from three patients staying at St. Paul’s Hospital – they all lived in Downtown Eastside, a poor part of Vancouver. In that part of Vancouver, MRSA infection incidence and cases of bed bugs had been rising steadily over the last few years. The scientists wanted to determine whether the two were linked.

They examined the bed bugs and found that three samples carried MRSA, while another two had VRE.

We still do not know whether the humans infected the bed bugs or the other way round. Further research is needed to determine where exactly on/in the bed bug the bacteria were – inside them or on their backs.

If bed bugs are able to carry and spread MRSA like the anopheles mosquito spreads malaria, we could be looking at a completely new vector of human disease.

Study author, Marc Romney, said:

“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.”

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Woman warns – her dog was given ‘kiss of death’ from Kissing Bug bite

April 3, 2016 | by Nestor Mato | CBS 4 News

Many triatomine bugs carry the parasite Trypanosoma cruzi, which causes Chagas disease.

San Benito woman warns about potentially deadly Chagas disease spread by ‘kissing bug’

For Lisa Leal’s dog, a bug bite became the kiss of death.

A triatomine bug — commonly called a kissing bug — bit her 8-month-old dog.”I feel bad because she’s been given, literally, a death sentence,” said Leal, who lives in San Benito.

Many triatomine bugs carry the parasite Trypanosoma cruzi, which causes Chagas disease.

“The bugs are found in houses made from materials such as mud, adobe, straw, and palm thatch. During the day, the bugs hide in crevices in the walls and roofs,” according to the Centers for Disease Control and Prevention website. “During the night, when the inhabitants are sleeping, the bugs emerge. Because they tend to feed on people’s faces, triatomine bugs are also known as ‘kissing bugs.'”

Chagas disease may later cause intestinal and cardiac complications, including sudden death.

Leal’s dog is already suffering heart problems.

Veterinarian Noel Ramirez said there’s no sure way to avoid Chagas disease.

“It happens within city limits. It happens out in the country,” Ramirez said. “There’s not a whole lot of prevention that we can do.”

In humans, Chagas disease can be diagnosed with a blood test. Treatment varies depending on the symptoms.

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CDC Warns Tennessee Of Kissing Bug, deadly Chagas Disease

November 24, 2015 |NewsChannel 5

To prevent Kissing Bug  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, 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 you’ve found a kissing bug, the CDC says don’t squash it. Instead, place it in a container and fill with rubbing alcohol or freeze in water and take to your health department.

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High School students sent home with letter “bedbugs found”

March 31, 2016 | by Taylor Stuck |The Herald-Dispatch

HUNTINGTON, WV – Huntington High School students were sent home Thursday with a letter alerting parents bed bugs were found in the school.

Jedd Flowers, Cabell County Schools communications director, said one or two bugs were found, probably “hitchhiking” in on a student.

“It’s pretty common these days,” he said. “It’s not an infestation of the building.”

Flowers said every student was sent home with a letter because the high school students travel throughout the school for classes, so it would be impossible to determine who came in contact.

The school will follow state protocol, calling in an exterminator to assess the building. Flowers said they will check for bugs and vacuum. If that does not rid the building of the problem, chemicals will be used.

Flowers said they just want to make sure parents and guardians are aware, and to ask them to let the school know if bed bugs are in their home. Cabell County Schools will help families who need assistance ridding their homes of bed bugs.

Residential bed bugs have been on the rise across the country, said Stan Mills, program manager at the Cabell-Huntington Health Department.

Mills said a couple bed bugs at the high school is as common as the school having a cricket, and the chance of a bed bug being taken home by a student is about the same chance of that student winning the lottery.

Mills said the health department worries more about people overdosing on chemicals to remove bed bugs than people having bed bugs in the first place.

“Chemicals are not the only treatment,” he said.

Bed bugs are small, oval, brownish insects that live on the blood of animals or humans. Adult bed bugs have flat bodies about the size of an apple seed.

Initial hiding places are typically in mattresses, box springs, bed frames and headboards. Bed bugs bite in the night, and a spot of blood can also be seen on sheets.

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11 things parents need to know about kissing bugs, aka ‘love bugs’ but are NOT, both ARE cousins to BedBug and deadly Chagas Disease

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December 4, 2015 | by Dr. Peter Hotez, President of Sabin Vaccine Institute

Experts at the National School of Tropical Medicine at Baylor College of Medicine have been studying Chagas disease and working on a therapeutic vaccine for it. Here are the important things to know about the kissing bug and about Chagas disease:

1.  Chagas disease, also known as American trypanosomiasis, is a serious infection caused by a parasitic microorganism, Trypanosoma cruzi, and is transmitted by kissing bugs.

2.  Chagas disease is a leading cause of heart disease resulting in a debilitating and often fatal condition known as Chagasic cardiomyopathy. One in six people with Chagasic cardiomyopathy will die within five years.

3.  An estimated 9 million people are infected in the Western Hemisphere, mostly in impoverished areas. According to the World Health Organization, the largest number of people living with Chagas disease are in poor areas of Argentina, Brazil and Mexico, while Bolivia has the highest percentage of people infected.

4.  The infection can be passed from mother to baby. There are an estimated 40,000 pregnant women in North America alone who have Chagas, and they will transmit the infection to their babies around 5 percent of the time.

5.  The CDC estimates that 300,000 cases occur in the United States, mostly imported from Latin America.

6.  Scientists at the National School of Tropical Medicine at Baylor, including Drs. Kristy Murray and Melissa Nolan Garcia, have uncovered a previously unrecognized level of transmission in the state of Texas.

7.  A high percentage of the kissing bugs in Texas are infected with the trypanosome parasite and show evidence of feeding on human blood.

8.  Dogs, cats and horses also can be infected.

9.  Researchers are finding cases among hunters and campers, as well as people who live in poverty in Texas. Those with extended outdoor exposure appear to have the greatest risk of acquiring the disease.

10.  Repeat exposures are likely necessary to acquire infection.

11.  Drug treatments are available, but they do not always work and are highly toxic. In collaboration with the Sabin Vaccine Institute and the Texas Children’s Hospital Center for Vaccine Development, the National School of Tropical Medicine is developing a new therapeutic vaccine for Chagas disease.

About Dr. Peter Hotez, president of Sabin Vaccine Institute: The US Science Envoy, Dean for the National School of Tropical Medicine, Texas Children’s Hospital Chair in Tropical Pediatrics and President-Sabin Vaccine Institute.

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Leading cause of death in Men is caused by Chagas Disease & Heart failure 

Chagas Disease affects approximately 20 million worldwide, killing 50,000 each year, yet is practically unknown to most in the general public in the US.

If infected, you may not even know initially you have Chagas disease. It can slowly destroy your internal organs, and if you do not die from the acute stage, can cause death in the chronic stage, 10-20 years later.

Chagas is spreading worldwide — due to lack of knowledge and indifference.

Endemic in 21 countries, with 18-20 million infected and another 120 million people at risk

25% of the population of Latin America is at risk of acquiring Chagas Disease

More than 100,000 Latin American immigrants living in the United States are chronically infected and a potential source of transmission of the disease by means of blood transfusions

The disease is lethal, especially for children, and debilitates patients for years.

Previously thought to be endemic in Mexico, South and Latin America, other areas of the world such as the US and Europe are considering testing all blood donations for the parasite, T. cruzi, for the parasite that causes the disease due to travel patterns and rural migrations of populations to urban areas. 

 Chest radiograph of a Bolivian patient with chronic Trypanosoma cruzi infection, congestive heart failure, and rhythm disturbances. Pacemaker wires can be seen in the area of the left ventricle.

Infected triatomine bugs, that transmit T.cruzi, are found in North, Central and South America. Blood banks in selected cities of the continent vary between 3.0 and 53.0% -making the prevalence of T. cruzi infected blood higher than that of Hepatitis B, C, and HIV infection

In parts of South America, Chagas’ heart disease is the leading cause of death in men less than 45 years of age.

Blood transfusions in the US should be screened for antibodies to T.Cruzi; currently U.S. blood banks do not routinely conduct this screening.  

Numerous acute and chronic cases of the disease have been reported in domestic dogs in Texas, Oklahoma, Louisiana, South Carolina and Virginia

It is not known how many dogs or humans in the US actually have the disease due to lack of testing and reporting

The disease may be transmitted by the bite of an infected triaomine, (reduviid, “kissing”, or “assassin”) bugs, or through blood transfusion or transplacentally

In Texas infection rates in kissing bugs are reported to be 17-48%, in other states infection rates may not be known due to lack of knowledge about the disease and inadequate studies with regards to sampling bugs for the disease

The kissing bugs, or carriers of this disease, could be as close as your backyard.

Posted in August 3, 2012 | by CHAGAS Disease Biology Blogspot

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