Chagas Disease, Spread by Kissing Bugs, Now Endemic to the U.S.

American health officials are sounding the alarm about a previously obscure illness spread by blood-sucking insects called kissing bugs.

In a report recently published by the Centers for Disease Control and Prevention (CDC), scientists warned that Chagas disease — historically considered a nonissue in the United States — should now be regarded as endemic, or an ongoing hazard to public well-being.

“Although there’s no need to panic, our report is raising awareness about an illness that’s been here for a long time and may be more prevalent than suspected,” says one of the authors, Sarah Hamer, PhD, a veterinary ecologist specializing in wildlife disease at the Texas A&M University College of Veterinary Medicine and Biomedical Sciences in College Station.

The CDC estimates that about eight million people around the world have Chagas disease, most commonly in rural areas of Mexico and Central and South America. The agency estimates that about 280,000 people in the United States have it, often unknowingly.

Kissing bugs have been found in 32 U.S. states, mostly in the South, with human cases of Chagas disease reported in Texas, California, Arizona, Tennessee, Louisiana, Missouri, Mississippi, and Arkansas.

What Is Chagas Disease?

Formally called triatomines, kissing bugs are a family of multiple species of nocturnal insects. Adults have six legs and are about the size of a penny.

The name comes from their habit of biting people’s faces, often near the mouth.

“These blood feeders are lured to their host based on carbon dioxide [the gas we exhale], and the biggest concentration is by the mouth and nose,” says Dr. Hamer.

The insects can carry the Trypanosoma cruzi parasite that causes Chagas disease, which was named after the Brazilian doctor who discovered it, Carlos Chagas. The parasite enters the human body through the feces of the kissing bug, which typically bites and then defecates on a person who is sleeping at night.

If someone who is bitten by a kissing bug scratches or rubs their face, the parasite can get into the bloodstream through a break in the skin or via the eyes or mouth.

Chagas disease can’t spread through casual person-to-person contact, but it can pass from mother to fetus, and through organ transplant or blood transfusion.

Symptoms of Chagas Disease May Take Years to Appear

Most people with Chagas disease don’t experience any immediate symptoms — or if they do, the illness is typically mild and temporary.

Initial signs of Chagas infection, if they do appear, resemble the flu, which can make the disease difficult to diagnose. These symptoms may include:

Fever

Body aches

Fatigue

Headache

Rash around the bite

Severely swollen eyelid

The illness can lie dormant for many years before severe complications develop. About 20 to 30 percent of people with Chagas disease go on to develop serious health problems, according to the CDC.

“It truly is a silent killer,” says Norman Beatty, MD, an associate professor of infectious disease and global medicine at University of Florida Health in Jacksonville and a coauthor of the new report. “It can be several decades before a person develops symptoms, and these are often associated with the heart and can cause heart failure,” he says.

The parasite commonly settles in the heart muscle. Over time, this may lead to cardiomyopathy, a group of conditions that prevents the heart from pumping efficiently. Chagas disease may also cause irregular heartbeat, enlarged heart, or sudden cardiac arrest.

Heart-related symptoms from Chagas disease include:

Chest pain

Heart palpitations

Shortness of breath

Dizziness

Fainting

Fatigue

Chagas disease may also cause delayed digestive issues, including:

Difficulty swallowing (dysphagia)

Constipation

Chest pain

Bloating

The authors of the new report on Chagas disease caution that dogs are often susceptible to infection, and sometimes cats, too. In Texas, the only state where Chagas disease in animals has been a reportable condition, 431 canine cases were recorded between 2013 and 2015, in addition to 2 infections in cats and 1 in a horse.

Dr. Beatty says it’s unlikely that a pet will bring a kissing bug home on its body because the insects typically bite and then move on. They don’t linger on a body like a tick.

Treatment and Prevention of Chagas Disease

Chagas disease is treatable with antiparasitic medications. Blood tests can confirm the presence of infection.

Identifying Chagas disease promptly is vital, because treatment is most effective early in the course of the illness.

Unfortunately, Chagas disease often goes undiagnosed. By the time doctors link heart or digestive problems to Chagas, the underlying damage may be advanced, with no chance of a cure.

The CDC says that the best way to prevent Chagas disease is to avoid or limit contact with the kissing bug. For those living in areas where Chagas disease may be a problem, public health officials suggest:

Stay in air-conditioned and screened-in homes.

Seal cracks and gaps around windows, walls, roofs, and doors.

Remove wood, brush, and rock piles near your house where kissing bugs may dwell.

Keep yard lights away from your house, because lights can attract the bug.

Clean your home regularly.

Wear clothing that covers your skin and apply bug spray on exposed skin.

Consider sleeping under bed nets treated with long-lasting insecticide.

“The hope with this report is not to alarm people, but to recognize that we have a disease in the community that is consistently being transmitted to humans, so we can develop a plan to help prevent its transmission,” says Beatty.

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