Kissing Bug of Death

Traveling invites all sorts of new parasites and diseases into your body from drinking untreated water, getting bitten by creepy crawlies, eating pig brains or a variety of other ridiculous travelling circumstances that backpackers stupidly put their bodies through.  Chagas disease is yet another to put on my list of conditions to avoid.

Torah Kachur Kissing Bug Chagas Disease Assassin bug Science in Seconds

There is currently a surge of Chagas disease in Argentina with it affecting rural populations. Chagas disease is transmitted by the kissing bug, and even though ‘Kissing Bugs’ sound so goshdarn cute, they carry a parasite that can lead to a lethal infection. The kissing bug – or Triatominae spp. – are transmittors of the parasite Trypanosoma cruzi that reproduces inside the insect host and waits patiently for an innocent human to get bitten by the Love Bug or Kissing Bug or Evil Assassin Bug.  The parasite enters the blood when humans scratch the itch of the Kissing Bug….. ahem….. scratching the actual bite and not any other ‘itch’ that would come from kissing.

Once inside the blood, the parasite can either hang out in the blood and cause an acute sickness that is easily treated with antibiotics or, worse, enter the tissues where they reproduce into pseudocysts of infected cells.  In someone affected by Chagas disease symptoms may include constipation, trouble swallowing and abdominal discomfort which might be mistaken for the consequences of a late night binge to MacDonald’s.  But, this is a sign of infection of the parasite into the tissues of the body.
In particular, the Trypanosoma parasite seems to have the most acute effects on the heart (maybe that is why the insect is called the Kissing bug?).  The entry and replication of the parasite into the cells of the host cause lesions and inflammation meaning that the valves, neurons and muscle cells of the heart are irreparably damaged over years.  Only after 10-20 years will possibly cause arrythmias that is the most common cause of death from Chagas.
The kissing bug lives in thatched or palm leaf roof houses and mud-brick structures or any structure where crawlies can live and humans are.  New Orleans is experiencing a resurgence of kissing bug infestation in the aftermath of Katrina and the reconstruction efforts including more simple materials.  The types of adobe homes that Triatominae  bugs live in are common across rural South America and Argentina estimates 2.5 million people carry the parasite, thankfully only 25% of those individuals will develop the full disease.  More worrisome is that 3.5% of all expectant mothers carry the parasite which inevitably is transmitted to their newborn wrecking havoc with prevention efforts.

On that note then, I am off to go stay in a lovely adobe hut that creates the true atmosphere of the Argentine wildnerness.  And I only have to wait 20 years to see if I will die of a stupid decision made in my youth.

April 4, 2011 | Torah Kachur | On Location in San Antonio de Areco, Argentina.

First Lady Ann Romney Speaks Out on Deadly Chagas Disease

Facebook page of First Lady Ann Romney | November 11, 2014

Chagas Disease can remain in the victim’s blood for over 20 years before it manifests symptoms. The first stage of the disease has few symptoms, and they can seem like symptoms of other illnesses, with fever, fatigue, achiness, headaches, loss of appetite, vomiting, and diarrhea. Those symptoms can last for weeks or months, but the second stage can trigger an enlarged heart, heart failure, altered heart rate or rhythm, cardiac arrest, or enlarged esophagus or colon.Melissa Nolan Garcia, from the Baylor College of Medicine in Houston, said of the first stage, “People don’t normally feel sick, so they don’t seek medical care, but it ultimately ends up causing heart disease in about 30 percent of those who are infected.” Garcia added that there may be more than 2,000 congenital cases through mother-to-child transmission.

Garcia’s team studied 17 blood donors in Texas who had the parasite that causes Chagas disease. She said, “The concerning thing is that majority of the patients [I spoke to] are going to physicians, and the physicians are telling them, ‘No you don’t have the disease’… A lot of the cardiologists were aware of Chagas disease, but they don’t make the connection when the patient is sitting in front of them.”

The actual parasite causing the disease, Trypanosoma cruzi, is found in Mexico, Central America, and South America. Roughly eight million people have the disease; most are unaware they have it.

The CDC says that the bulk of victims in the U.S. have visited Latin America, and that’s where they picked up the bug. But Garcia said the parasite has arrived in the U.S. She said, “We are finding new evidence that locally acquired human transmission is occurring in Texas. We were surprised to find that 36 percent had evidence of being a locally acquired case. Additionally, 41 percent of this presumably healthy blood donor population had heart abnormalities consistent with Chagas cardiac disease.”

The Washington, D.C. area has been hit; with about two dozen cases reported.

Dr. Rachel Marcus, a cardiologist, says the vast number of immigrants from Bolivia residing in the Northern Virginia area means the numbers could be higher, as the disease is endemic in Bolivia. She asserted that if doctors would use an electrocardiogram (EKG), they could find the victims more easily, concluding,

“If you were to find that EKG from an area where Chagas is common, it’s diagnostic.”

The Food and Drug Administration has not yet approved nifurtimox and benznidazole, which are the current treatments for Chagas. Those drugs, according to ASTMH (American Society of Tropical Medicine and Hygiene), run the risk of nerve damage, nausea, and weight loss.

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

Carlos Slim Foundation Gives $2.6 Million to Battle Chagas Disease

GEN

Sep 30, 2015

The Carlos Slim Foundation has contributed $2.6 million to the National School of Tropical Medicine at Baylor College of Medicine for the Chagas Vaccine Initiative, in an ongoing effort to fight one of the major neglected tropical diseases in Latin America.

Chagas disease, also known as American trypanosomiasis, is found in the poorest areas of the Americas. It is a vector-borne disease, caused by the single celled parasite called Trypanosoma cruzi, which is transmitted to humans by triatomine “kissing” bugs.

The disease, which affects millions of people in the American continent, as well as in the U.S., is an important cause of heart disease in Latin America. Today, between 5 and 10 million people live with Chagas disease in this region, including more than 1 million who suffer severe heart disease known as Chagasic cardiomyopathy. It is estimated that one in four people infected with Trypanosoma cruzi will go on to develop heart complications.

“Together with the Carlos Slim Foundation and a consortium of partners in Mexico and elsewhere, including the Autonomous University of Yucatán and the Center for Research and Advanced Studies of Mexico (CINVESTAV), we are working to develop an innovative therapeutic vaccine to prevent the dreaded cardiac complications of Chagas disease, which include heart conduction disturbances, aneurysms and even sudden death,” said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor and president of the Sabin Vaccine Institute, in a statement.

“This first vaccine may be used alongside existing medicines, such as benznidazole, in order to improve its performance and the clinical outcome of the disease. Because transmission of Chagas disease now also occurs in Texas, we believe that is a neglected tropical disease vaccine that will be used both here and abroad,” added Dr. Hotez.

The Chagas Vaccine Initiative was launched in 2010 with the goal of accelerating Chagas disease vaccine research and development to establish the feasibility of developing and testing a therapeutic vaccine while enhancing and strengthening research and development capacity in Mexico.

Through the Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development—a Product Development Partnership—researchers at Baylor have been working for the last five years to develop and test a bivalent vaccine for the treatment of chronic Chagas disease.

The goal for the next phase is to accelerate one of the lead vaccine candidate antigens into a regulatory filing and begin a first-in-human study, while continuing to enhance biotechnology capacity in Mexico.

Think Ebola Is Bad? Chagas, The ‘Kissing Bug’ Disease, Is Much Worse And Often Symptomless

 chagas-bug

The Rhodnius prolixus is the main vector for the Chagas parasite — also known as the “kissing bug” disease.

The world is reeling over the Ebola outbreak, but many of us are overlooking other viruses and diseases that are far more threatening.  There’s malaria, for example, which killed half a million people in 2012 and continues to sicken people in West Africa, even though fewer doctors are available to treat them due to the urgency of Ebola. HIV/AIDS continues to be a huge problem across the globe.

But there’s also the “kissing bug” disease, or Chagas, which isn’t very well-known. It’s a silent killer, often lurking in people’s bloodstreams for up to two decades before causing their organs to fail.

So a research team from Baylor College of Medicine in Houston chose to find more information about this relatively elusive disease, ultimately presenting their results at the American Society of Tropical Medicine and Hygiene in New Orleans. The researchers examined 17 Houston-area residents who had been infected with the disease, tracking the progression of the disease, and also analyzed blood donors between 2008 and 2012. They found that one in every 6,500 blood donors tested positive for parasite exposure.

“We were astonished to not only find such a high rate of individuals testing positive for Chagas in their blood, but also high rates of heart disease that appear to be Chagas-related,” Melissa Nolan Garcia, epidemiologist and an author of the study, said in a statement.

Chagas disease, also known as American trypanosomiasis, affects up to seven to eight million people worldwide. The parasite Trypanosoma cruzi is carried around by insects primarily in the Americas, infecting humans and other animals by biting or “kissing” their skin. According to the World Health Organization (WHO), up to 30 percent of people who are infected and live with the parasite for a long time develop cardiac problems. Ten percent of infected people, meanwhile, develop digestive or neurological issues. If it’s caught early enough, however, the disease is curable.

Regardless, the WHO’s description of how the disease is transmitted is somewhat terrifying:

In Latin America, T. cruzi parasites are mainly transmitted by contact with the feces of infected blood-sucking triatomine bugs. These bugs, vectors that carry the parasites, typically live in the cracks of poorly-constructed homes in rural or suburban areas. Normally they hide during the day and become active at night when they feed on human blood. They usually bite an exposed area of skin such as the face, and the bug defecates close to the bite. The parasites enter the body when the person instinctively smears the bug feces into the bite, the eyes, the mouth, or into any skin break.

In 2012, scientists called Chagas disease “the New HIV/AIDS of the Americas,” noting that it was one of many neglected tropical diseases (NTDs) that afflict “the estimated 99 million people who live on less than $2 per day in the Latin American and Caribbean region.” While Chagas disease has previously mostly been found in rural and tropical regions in Latin and South America, the scientists pointed out that more cases have been appearing throughout the U.S. and Europe.

latin-america

An Eco-bio research project in Santa Cruz, Bolivia, investigates how to reduce Chagas transmission.  

As somewhat of a follow-up to that study, Garcia and her team argued in their new study that there is “an enormous treatment gap” because not many physicians in Texas — or anywhere in the U.S. for that matter — are aware of the parasite, or the fact that it’s not just limited to poor, rural areas in South America. “We are concerned that individuals who test positive are not seeking medical care or being evaluated for treatment,” Garcia said. “And even if they do seek medical care, we heard from some patients that their primary care doctors assumed the positive test represented a ‘false positive’ due to low physician awareness of local transmission risk.”

In short, the authors argue that Chagas disease shouldn’t be dismissed as something that’s not serious. But until more research is done — which will involve taking many blood samples as the only way to test for the parasite — nothing can be certain. “So little surveillance has been done that we don’t know the true disease burden here in the United States,” Kristy Murray, an associate professor of tropical medicine at Baylor and an author of the study, said in the press release. “The next step is to study populations considered high risk. There is still a lot to be learned in terms of who is contracting the disease within the United States.”

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.”

Benign Symptoms May Signal Something More Dangerous: Chagas Disease

Contributed by Sharon Van Zweiten — Body aches. Fever. Vomiting. Swelling, around the site of a possible bug bite. You could just have the flu. But if you’ve been bitten by the kissing bug, an assassin bug or a bedbug, you could be at risk for a deadly disease: Chagas.

Caused by the parasite Trypanosoma cruzi, Chagas is transmitted by blood-sucking bugs—and according to a recent study—by  the everyday bed bug. When Chagas-carrying bedbugs emerge in numbers, hundreds of millions of people worldwide will become more vulnerable to the deadly disease.

Chagas disease detection is only possible through screenings, which may include:
·      Blood culture
·      Chest x-ray
·      Echocardiogram
·      Electrocardiogram
·      Blood smear
·      Enzyme-linked immunoassay (ELISA) to detect signs of infection

Factors Leading to Chagas Deaths
Left undetected and/or untreated, Chagas may thrive even during apparent periods of remission. Victims may not show any signs of the disease for as long as 20 years. But, 20-30 percent of Chagas victims will develop chronic symptoms that can result in irreversible and fatal damage.
·      Abnormal heart rhythms can lead to sudden death.
·      Permanent and irreversible heart damage caused by Chagas over several years can cause heart failure.
·      Chagas-related digestive issues including constipation, abdominal pain and other disorders can ultimately affect the heart.
·      Damage to the esophagus that can result in swallowing difficulties or choking.

Chagas disease kills more people in Latin America than any other infectious disease, including malaria, tuberculosis and HIV. Now, doctors say it’s come home to the United States. A research term at Baylor says the diagnosis rate is low because of low awareness among US health professionals.

Map indicating presence of Chagas infections

Map Indicating reports of Chagas infections

According the CDC, about 300,000 people in the US with Chagas, were infected before they came to the US from Latin America. While only 23 cases have been reported in people who haven’t traveled outside the US since 1955, the epidemic of infections and the increase of travel plus the incubation period forecasts a possible spike in the number of cases here.

Prevention is the best defense.