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February 2015 | Read this issue and more at www.healthandwellnessmagazine.net |
Hidden Chagas
Disease Increasing
In United States
The traditionally Latin American ‘Kissing Bug’
disease has become increasingly prevalent in
the United States, and it can lie dormant for
decades before becoming deadly.
By Angela S. Hoover, Staff Writer
What It Is
Chagas (American trypanosomiasis) is a deadly disease spread by the
feces of a parasite nicknamed the
‘kissing bug’. The protozoan parasite
Trypanosoma cruzi, or triatomine
bugs, bites sleeping victims, ingests
the blood and defecates on them.
Patients then unknowingly rub
feces into open membranes. The
disease can also be spread through
blood and organ donation and from
mother to infant during childbirth.
Trypanosoma cruzi, which is related
to the African version (African
trypanosomiasis) that causes sleeping sickness, is endemic to Mexico,
Central America and South America,
where an estimated 8 million people
have the illness; most of whom do
not know they are infected. If left
untreated the infection is lifelong and
can be life threatening.
The kissing bugs live in the cracks
of walls in rural mud houses and in
thatched roofs. The bugs come out
at night to bite sleeping people. The
bite itself is painless, and many of
those bitten do not show any signs
of the disease until decades later. A
third of those with Chagas disease
develop heart disease or megacolon
and die of what appears to be a sudden heart attack. The WHO estimate
that 11,000 people die yearly from
the disease.
Sleeping, Silent Killer
Chagas disease is seen as a silent
killer because it can lurk in people’s
bloodstreams for up to two decades
before causing organ failure. Once
the parasite enters the bloodstream, it
travels to the heart and settles there,
damaging the heart muscle. Up to
30 percent of infected people have
chronic heart disorders and up to 10
percent get sick with other health
problems including digestive and
neurological disorders.
The initial stage of the tropical
illness, the acute phase, is mostly
symptom-free and lasts for the first
few weeks or months. If a patient
does show symptoms, they can easily be mistaken for another disease.
These initial symptoms include fever,
fatigue, body aches, headache, rash,
loss of appetite, diarrhea and vomiting. A physical exam can show mild
enlargement of the liver or spleen,
swollen glands, and local swelling (a
chagoma) where the parasite entered
the body. In most cases, though,
people do not normally feel sick so
they do not seek medical care.
The second, or chronic, phase of
Chagas is deadly. Patients can develop
cardiac complications, including an
enlarged heart (cardiomyopathy),
heart failure, altered heart rate or
rhythm, and cardiac arrest (sudden
death), as well as intestinal complications, such as an enlarged esophagus
(megaesophagus) or colon (megacolon), which can lead to difficulties
eating or passing a stool.
How It Arrived In the
United States
As recently as 2012, scientists
expressed concern about the globalization of Chagas. The CDC says
that most cases of Chagas in the
United States are from people who
have traveled to Latin America and
were infected there. But researchers
from Baylor College of Medicine
in Houston have challenged this
assumption. Epidemiologist Melissa
Nolan Garcia has been following 17
Houston-area residents who have
been infected. At least six of them
appeared to have been infected locally
as they had not travelled outside of
the U.S. The Baylor group also collected 40 kissing bugs near homes in
11 central-southern Texas counties.
Of these collected bugs, half had fed
on human blood as well as that of a
dozen kinds of animals ranging from
dogs to raccoons. They analyzed
blood donors in Texas between 2008
and 2012 and found that 1 in every
6,500 donors tested positive for exposure to the parasite – a figure that is
50 times higher than the CDC estimate. Additionally, 41 percent of this
presumably healthy blood donor population had heart abnormalities consistent with Chagas cardiac disease.
“We were astonished to not only find
such a high rate of individuals testing
positive for Chagas in their blood, but
also high rates of heart disease that
appear to be Chagas-related,” Garcia
said in a statement released by the
Tropical Medicine Society.
Where It Is In the United States
In addition to Texas, the disease
is also spreading just outside of
Washington, DC. Dr. Rachel Marcus,
a cardiologist, believes Northern
Virginia could be “ground zero” for
Chagas disease because of the volume
of immigrants from Bolivia, where
the disease is endemic. Bolivia has the
highest rates of Chagas in the world
and US Census Bureau estimates
show that Virginia is home to more
Bolivians than any other state in the
country. The first documented case in
the United States of a mother transmitting Chagas to her baby happened
in Northern Virginia in 2010. The
Baylor team suggests Chagas disease
is an emerging public health concern
for the U.S. in general, but especially
the