A disease that's already endemic in more than 20 Latin American countries should be declared endemic in the United States as well. That's the message from a host of researchers in a paper published this month in Emerging Infectious Diseases, a peer-reviewed journal from the Centers for Disease Control and Prevention.
A principal investigator in the University of Cincinnati's Department of Biological Sciences echoes that call, saying doing so will increase awareness among doctors, veterinarians and the general public, which could improve diagnosis and treatment.
"The disease is what we call a silent but deadly disease because during the first years, most infected people are totally unaware. There are no symptoms, or mild symptoms, during the first days of the disease or months after infection," says Assistant Professor Noelia Lander, Ph.D., adding that it could take up to three decades for symptoms to appear. "At that point after when symptoms appear, it's probably too late to treat the disease."
'Kissing bugs' and Chagas disease
Chagas disease — and the threat of getting it from a parasite transmitted by Triatomine bugs, the so-called "kissing bugs" — isn't new. The bugs that carry it, however, are now found in 32 states, including Ohio, Indiana, and Kentucky.
The blood-sucking kissing bugs get the parasite Trypanosoma cruzi — T. cruzi — from biting infected mammals. The bugs then pass it to humans through feces. The nickname kissing bugs comes from the way they bite people's faces, typically while they're sleeping, and defecate in the bite wound, transferring the parasite. People also sometimes wipe it into their eyes or mouths.
There are nearly a dozen species of Triatomine bugs in the U.S. The bugs are mostly black or brown and some have orange or red markings. An adult insect can be up to an inch long.
Kissing bugs can be found indoors and outdoors, though the CDC says they rarely infest homes in the U.S. because house walls are well sealed here. They like rocky spaces, piles of brush, rodent nests and burrows, and the space in cracks of poorly sealed homes.
Symptoms are usually mild and flu-like. They can include: fever, feeling tired, body aches, headache, rash, loss of appetite, diarrhea, vomiting, and eyelid swelling. In the long run, it can cause serious cardiac and digestive issues, including: enlarged heart, heart failure, altered heart rate or rhythm, sudden death, and enlarged esophagus or colon leading to trouble eating or going to the bathroom.
"The person can be totally unaware of the infection, and then after one, two or three decades, symptoms appear," Lander says. "During this indeterminate phase, the parasite is basically invading all kinds of nucleated cells, but with a preference for cardiac muscle and digestive muscle. At that point, after when symptoms appear, probably it's too late to treat the disease."
Raise awareness
Lander and other researchers and health experts are pushing for Chagas to be declared endemic because they say it will bring awareness to the disease.
"I think it is mandatory to reclassify Chagas disease as an endemic disease in the U.S.," Lander says. "This will increase the awareness at the level of physicians and veterinarians about the possible infection of humans with this parasite."
She adds, "That will have consequences in terms of diagnosis, treatment, and reporting, and, also, it's going to be good in terms of research."
Lander has been studying T. cruzi, the parasite that transmits Chagas disease, for some 15 years. Her research focuses on finding ways to interrupt the parasite's lifecycle with the hope of developing a cure.
How long might it be from the current research stage to treatment?
"In terms of treatment, I would say within the next 10 years," she says. "In terms of identifying a good target for anti-parasitic interventions, I would say within the next five years."
Chagas disease in humans has been found in at least eight states, according to the paper in Emerging Infectious Diseases. However, since the symptoms are often mild and awareness is low, Lander estimates the numbers are largely under-reported.
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