Kissing bugs, the blood-sucking insects that spread Chagas disease, are getting attention from public health officials as new research shows they’re spreading across much of the United States. The insects, triatomine bugs, carry the parasite Trypanosoma cruzi, which causes lifelong and often fatal disease.
Chagas disease has historically been associated with Latin America, but recent studies show the parasite and the vector are established in the U.S. and human cases have been reported in several states. Transmission is simple. Kissing bugs are nighttime feeders and bite around the face. They defecate near the wound after feeding and if the feces with the parasite enters the body via the bite wound, a cut, or mucous membranes, infection can occur. The acute phase of the illness can produce mild or nonspecific symptoms like fever, fatigue, rashes, or swelling of the eyelids and many people never realize they were infected. Years can go by before the disease progresses insidiously, sometimes leading to severe complications like cardiomyopathy, arrhythmias, enlargement of digestive organs and even sudden cardiac arrest.
Statistics show kissing bugs are found in at least 32 states, mostly in the South. Autochthonous cases—locally acquired infections rather than travel-related ones—have been reported in Texas, Arizona, California, Louisiana, Mississippi, Arkansas, Tennessee and Missouri. Wildlife and domestic animals, especially dogs, are also affected which creates a reservoir that allows the parasite to become endemic in local ecosystems. Although the total number of confirmed U.S. cases is relatively low compared to Latin America, experts believe underdiagnosis and underreporting masks the true scope. These findings have prompted infectious disease specialists to call for the U.S. to be declared hypoendemic for Chagas disease. This would acknowledge low-level but ongoing transmission is occurring domestically which could prompt increased surveillance, physician awareness and testing.
As of now, Chagas is not on the radar of many physicians when they are making a diagnosis so diagnoses get missed until complications arise. Prevention is key: remove kissing bug habitats around homes, seal points of entry, screen windows and keep animal nests or woodpiles in check to limit exposure. Infection can be diagnosed with blood tests and antiparasitic medications like benznidazole or nifurtimox are most effective early on. For chronic cases, treatment is focused on the heart or digestive complications rather than trying to get rid of the parasite. As the numbers grow, researchers say Chagas is no longer an imported disease. It’s a neglected tropical disease that’s established in the U.S. and needs to be addressed by a change in public health policy and awareness before it becomes a full blown crisis.
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