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

#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!

Deadly Chagas disease in the U.S., affecting people and animals – primarily dogs. Watch out for “kissing bugs”, aka “love bugs”.

November 18, 2015 | by Robert Herriman | Outbreak News Today

Chagas disease, the parasitic infection caused by Trypanosoma cruzi, is found mainly in Latin America, where it is mostly transmitted to humans by the feces of triatomine bugs, known as “kissing bugs”.

The Triatoma or “kissing” bug. Image/CDC

However, in several areas of the United States Chagas is ever present, according to Dr. Peter Hotez, founding dean of the National School of Tropical Medicine at Baylor College of Medicine, who told me in 2013 the number of cases of Chagas disease in the United States to be somewhere between 300,000 and 1 million. The United States is ranked 7th among nations for the amount of cases.

Texas is definitely one state that is battling the neglected tropical disease. According to Texas health officials:

In Texas, approximately 45% of the collected triatomine bugs have tested positive for T. cruzi, and Chagas is considered an endemic disease in dogs. From 2013 to 2014, 351 cases of Chagas disease in animals, primarily dogs, were reported from approximately 20% of Texas counties, representing all geographic regions of the state. Locally-acquired human cases are uncommon, but some have been reported. From 2013 to 2014, 39 human cases of Chagas disease were reported: 24 were acquired in another country, 12 were locally-acquired, and the location of acquisition was unknown for 3.

Local transmission means that the kissing bugs in Texas are infected with the parasite, causing it to spread to humans.

Chagas disease is transmitted naturally in North, Central, and South America. In parts of Mexico and Central and South America, where Chagas disease is considered highly endemic, it is estimated that approximately 8 million people are infected.

Chagas in Texas/Texas Department of Health

The Triatoma or “kissing” bug frequently carry for life the parasite, Trypanosoma cruzi. T. cruzi is a comma shaped flagellated parasite and the cause of an acute and chronic disease called Chagas.

The triatoma bug can be found in poorly constructed homes, with cracks and crevices in the walls or those with thatch roofs. They can also be found in palm trees and the fronds.

Usually at night while sleeping, the insect feeds on people or other mammals. While feeding the insect defecates and the infected feces gets rubbed into the bite wound, eyes abrasions or other skin wounds.

The parasite invades macrophages at or near the site of entry. Here they transform, multiply and rupture from the cells 4-5 days later and enter the blood stream and tissue spaces.

Initial infection with Chagas is typically asymptomatic. Acute disease may manifest symptoms after a couple of weeks.

Reddening of the skin (Chagoma) or edema around the eye (Romana’s sign) may be seen, albeit uncommon.

Fever, malaise, enlarged liver and spleen are part of the acute syndrome. 10% of people develop acute myocaditis with congestive heart failure. This acute disease can be fatal.

After a latent period which may last for years, the infected person may develop chronic disease (20-40%). The most serious consequences are cardiomyopathy (in certain areas it’s the leading cause of death in men less than 45 years of age) and megacolon/megaesophogus.

Trypanosoma cruzi can also be transmitted via congenital transmission (mother to baby), through blood transfusions and organ transplants, and some cases of transmission through feces contaminated food.

About 150 mammals beside humans may serve as reservoirs of the parasite. Dogs, cats, opossoms and rats are among the animals.

Benznidazole and nifurtimox are 100 percent effective in killing the parasite and curing the disease, but only if given soon after infection at the onset of the acute phase, according to the WHO.

There is no vaccine for Chaga’s, so preventive measures should include insecticide spraying of infested houses.

#SayNOtoPESTICIDES!

California study examines genetic diversity of Kissing Bugs…concludes deadly Chagas disease may be underdiagnosed in U.S.

January 21, 2016 | MedicalXpress.com

Trypanosoma cruzi is a protozoan parasite that can cause an insidious onset of Chagas disease, a fatal cardiac disease in humans and dogs. The parasite is transmitted via triatomine insects, commonly called kissing bugs. In Latin America T. cruzi is recognized as an economically important parasite; however, there is limited research regarding its spread and virulence in the USA. As a result, while the genetic diversity of the T. cruzi parasite has been well studied in Latin America less is known about the strains endemic to the USA.

“Chagas disease should be considered as a potential cause of cardiac illness in humans and dogs.”

Researchers from the University of California, Davis, and the London School of Hygiene and Tropical Medicine assessed the prevalence of T. cruzi from northern and southern California regions. The researchers used a combination of methods to obtain triatomine insects, including active collection via black light traps and the enlistment of private property owners and public health officials in specimen submission. DNA was extracted from the specimens and screened for T. cruzi via molecular techniques. Positive samples were genetically typed into one of six recognized T. cruzi subgroups (TcI – TcVI). Finally, the researchers performed genetic analyses to examine the potential virulence of the California T. cruzi samples as compared to infective T. cruzi strains from Latin America.

Of the 29 specimens from northern California 55% were infected, while T. cruzi was detected in 34% of the 53 samples collected from one of the southern California locations. Two separate subtypes were found—with 20 parasites falling into the TcI subgroup and 2 into TcIV. The TcIV subgroup was not detected in the northern California region. Genetic analyses did not reveal any particular unique characteristics to distinguish the California samples from several Latin American strains known to infect humans.

This research suggests that the apparent rarity of locally-acquired Chagas disease in the USA is unlikely due to any genetic difference in the infectious capabilities of the parasite. Rather, the fact that local triatomine species (e.g. Triatoma protracta) do not frequently colonize human homes, likely translates to decreased T. cruzi transmission. Alternatively, locally-acquired Chagas disease may simply be underdiagnozed. At present only four states in the USA list Chagas disease as a reportable illness, and California is not among them. This means that the public, as well as physicians and veterinary practitioners, may have decreased awareness of the dangers posed by this disease.

Based on this research, in areas where Triatoma protracta populations are evident, Chagas disease should be considered as a potential cause of cardiac illness in humans and dogs.

The study is published in PLOS Neglected Tropical Diseases.

US and Mexico Must Jointly Combat Chagas Disease

Eureka

Rice University

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

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

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

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

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

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

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

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

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

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