Chagas Disease Warning

In a presentation at the American Society of Tropical Medicine and Hygiene’s 63rd annual meeting in New Orleans last Tuesday, a team of researchers warned that a parasite called Trypanosoma cruzi, or “the kissing bug” may be more prevalent in America than previously thought. This parasite causes Chagas disease, or American trypanosomiasis, a disease that can be deadly to humans and animals. Through treatable upon diagnosis, the disease can have serious implications for patients who are unaware that they have been infected.

Chagas, named after Brazilian physician Carlos Chagas, has been referred to as “a silent killer” because it is difficult to diagnose in the early stages. Left too late, the parasitic infection can result in intestinal and cardiac complications and in severe cases, death. The disease has also been termed the “kissing bug disease” due to the way that it is contracted. Blood-sucking insects called triatomine bugs attach themselves to the faces of people whom they are feeding off and turn them into parasite hosts. These insects are typically found in houses that are constructed out of materials such as palm thatch, mud and straw.

Once in the bloodstream of its host, the parasite makes its way to the heart, where it remains. Left untreated, damage can be caused to the heart muscle, resulting in cardiac complications.

According to the Centers for Disease Control and Prevention (CDC), Chagas can also be transmitted via infected blood transfusions, congenital transfer from mother to child, and organ transplants. It has been listed as one of the five parasitic diseases that the CDC considers to be Neglected Parasitic Onfections (NPI), and one that health officials believe needs more public awareness.

chagas
Romaña’s sign

Once present in a human host, Chagas disease has two distinct phases. The acute phase, which generally lasts a couple of weeks after the initial infection, is often symptom free. It is the lack of observable disease characteristics that causes patients to remain unaware of the parasite’s presence. Romaña’s sign, a swelling of the eyelids or facial areas where the parasite has bitten its victim, is sometimes present, and some patients display symptoms similar to those commonly experienced with influenza.

In the second stage, or chronic stage, Chagas may remain undetectable and can be present for decades within a human host. Some people, around 30 percent, develop cardiac and intestinal complications.

The insect vectors that spread the infection exist mainly in poorer areas of Latin America.  A 2012 review published in the journal PLOS ONE estimated that neglected tropical diseases are a common problem for the majority of people who live in America’s poorest regions. The CDC estimates that up to 8 million people in Central America, Mexico and South America have Chagas disease, the majority of which are not believed to know that they are infected.

Recently, the disease has become more widespread, expanding beyond the rural areas of Latin America due to large-scale population movements. Health officials say that control strategies should focus on preventing transmission through blood transfusion, congenital transmission and organ transplantation.

The assumption that Chagas disease will not become a global issue has recently been challenged. A team of researchers from Baylor College of Medicine in Houston, led by Melissa Nolan Garcia, observed 17 Houston residents who had been infected with Chagas. Six of the patients, who had not travelled to areas outside of the United States where the parasite is prevalent, were suspected to have been locally infected.

Forty triatomine bugs were collected by the researchers in rural areas in 11 central-southern Texas counties. Around half of the insects had been feeding on human blood, as well as animals like dogs, cats and raccoons. A blood donor analysis revealed that one in every 6,500 blood donors tested positive for Chagas, a figure fifty times higher than the CDC estimates.

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According to Nolan Garcia, the research team was also surprised by the high number of cardiac disease patients whose condition was a result of Chagas. The lack of physician knowledge about the disease is a significant problem. If detected in the early stages, the drugs benznidazole and nifurtimox are effective treatment. Increasing disease awareness is something that the Baylor team suggests for future public health programs.

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