“Don’t let the bed bugs bite.” Many of us heard this phrase growing up and probably thought of it as simply a silly yet loving thing our parents said while tucking us into bed. But bed bugs are real, and they’re no laughing matter. And their larger cousins, the kissing bugs? Well, they’re real, too, and not nearly as sweet as they sound. That’s because both bed bugs and kissing bugs have the ability to spread Chagas disease (American trypanosomiasis).
So join us as we uncover the role bed bugs and kissing bugs play in Chagas disease and how you can protect yourself and your family from this potentially serious infectious disease.
What Is Chagas Disease?
Chagas disease is an inflammatory disease caused by the parasite Trypanosoma cruzi. The disease is commonly spread through the feces and urine of infected triatomine bugs, also known as kissing, or assassin, bugs. These bloodsucking insects pick up the T. cruzi parasite when they ingest the blood of infected animals (or people). Animals that have been known to contract Trypanosoma cruzi infection from kissing bugs include:
Kissing bugs can hide in the cracks and crevices of houses during the day, coming out only at night to feed. They’ve been given the moniker “kissing bug,” as they tend to bite exposed areas of skin, especially the face.
After a kissing bug has fed, it generally urinates or defecates. And because the kissing bug bite is almost painless, an individual may not know they’ve been bitten and may inadvertently rub the feces or urine—and thus the parasite—into the bite wound or the mucous membranes of the mouth or eyes.
Chagas disease was discovered in 1909 by Brazilian physician Carlos Chagas, after whom the disease is named. According to the Centers for Disease Control and Prevention (CDC), Chagas disease is found only in the Americas.
Moreover, the World Health Organization (WHO) estimates that approximately 6 to 7 million people are infected with Trypanosoma cruzi, with most cases occurring in the poverty-stricken rural areas of Latin America, especially the countries where the disease originated—Mexico, South America, and Central America.
In addition, the CDC estimates that more than 300,000 people in the United States may be infected, though most of these infections are thought to have originated in Latin America.
However, some cases of Chagas disease have been reported in the Southern United States as well—specifically in states that border Mexico—especially Texas, New Mexico, and Arizona.
Chagas disease has been grabbing more headlines in the United States in recent years, but you shouldn’t take that to mean the disease is new to the country. On the contrary, the CDC reports that kissing bugs were reported in Georgia as far back as 1855. However, it’s thought that rates of infection may be lower because the species found in the U.S. prefer wooded areas to people’s homes.
Nevertheless, the CDC has declared Chagas disease one of five neglected parasitic infections (NPIs) the agency is prioritizing for public health action due to the number of infections, the severity of the illness, and the ability to prevent and treat the disease.
But most troubling of all may be the recent studies indicating that the T. cruzi parasite has been found in a much more widely spread insect—the bed bug.
What Are Bed Bugs?
Like their cousins, the kissing bugs, bed bugs (Cimex lectularius) live in cracks and crevices during the day and come out at night to suck the blood of humans and other animals. While these pests have become the bane of modern travelers, many people may not even realize they have a bed bug infestation, as the insects are rarely seen, and their itchy bites may be attributed to mosquitoes.
Until recently, bed bugs were considered more of an irritation than a health concern. However, more and more studies are suggesting that bed bugs may share their larger cousins’ ability to transmit the parasite that causes Chagas disease.
Moreover, a 2018 study from New Mexico State University demonstrated that bed bugs infected with T. cruzi maintain levels of the parasite throughout the molting process. Researchers describe this as a particularly notable finding, as bed bug nymphs molt five times before they reach adulthood, and their ability to hold on to the parasite through this process could make them an even more important vector in the spread of Chagas disease.
Chagas Disease Symptoms
There are two phases of Chagas disease: acute and chronic. The acute phase of infection can last for weeks to approximately two months after infection. During the acute phase, an individual may experience mild symptoms or no symptoms at all. However, if symptoms are present, they may include:
|Swelling at the site of infection||Swollen lymph nodes|
|Eyelid swelling||Body aches|
|Headache||Liver or spleen enlargement|
Because these symptoms are common to a variety of conditions, diagnosing Chagas disease can be difficult—a reality that’s compounded by the fact that health care providers in the United States have little experience treating the disease. Moreover, the acute symptoms of Chagas disease usually resolve themselves, though they can be severe in young children and people with compromised immune systems.
But if left untreated, people with Chagas disease will advance to the chronic phase. Although the majority of people with chronic Chagas disease never display any symptoms, approximately 20% to 30% may develop serious complications—sometimes decades after initial infection. These serious and even life-threatening health issues may include:
- Sudden death from cardiac arrest
- Heart failure
- Arrhythmia (irregular heartbeat)
- Cardiomegaly (enlarged heart)
- Megaesophagus (enlarged esophagus)
- Megacolon (enlarged colon)
In addition to the potentially life-threatening cardiac complications, enlargement of the esophagus and colon can lead to difficulty swallowing and abdominal pain and constipation, respectively.
Diagnosing Chagas Disease
If you’re experiencing symptoms and think you may have been exposed to the parasite that causes Chagas disease, your health care provider will speak with you about your symptoms and risk factors and perform a physical exam. If your provider suspects Chagas disease, blood tests that can identify the parasite or the antibodies the body produces to fight it may be performed as well.
If blood tests come back positive, additional procedures may be conducted to determine whether you’re in the acute or chronic phase and if complications have occurred. These tests may include:
- Chest X-ray: This test can be used to evaluate the heart for signs of enlargement.
- Electrocardiogram: An EKG is used to measure the electrical activity of the heart and can identify abnormalities in heart rhythm.
- Echocardiogram: This test employs the use of sound waves to identify irregularities in the heart’s structure and motion.
- Upper endoscopy: An upper endoscopy uses a lighted, flexible tube with a camera on one end to look for anomalies in the esophagus.
- Abdominal X-ray: Similar to a chest X-ray, this procedure can identify abnormalities in the gastrointestinal tract.
Treatment of Chagas Disease
If you’ve received a diagnosis of Chagas disease, treatment will involve eradicating the parasite and/or managing symptoms. If caught in the acute phase, Chagas disease can be successfully treated with the following prescription antiprotozoal medications:
However, because cases of Chagas disease in the United States continue to be rare, these medications must be obtained from either the manufacturer (benznidazole) or through the CDC (nifurtimox). Nifurtimox is offered as an investigational drug by the CDC, as its use has not yet been approved by the Food and Drug Administration (FDA).
While antiprotozoals are most effective during the acute phase of T. cruzi infection, it’s now recommended that they be offered to all patients in the chronic indeterminate phase up to the age of 50. After that, the CDC recommends an individualized treatment plan based on symptom severity.
Preventing Chagas Disease
According to WHO, vector control is the single best way to avoid the parasite that causes Chagas disease. In the United States, where Chagas disease is not widespread, control strategies are more focused on preventing transmission via blood transfusions and organ transplantations as well as congenital transmission from infected mothers to their infants.
However, additional steps can be taken to reduce your risk of coming into contact with the T. cruzi parasite. These include:
- Spraying insecticides around the home to repel insects
- Sealing cracks around doors and windows
- Removing wood and rock piles around the home
- Using proper hygiene when preparing and cooking food
If you’ve been to areas where Chagas disease is endemic—or have noticed bed bugs or kissing bugs in and around your home—and are experiencing symptoms, don’t hesitate to contact your health care provider right away. While Chagas disease is most likely not to blame, if you do have American trypanosomiasis, early treatment can prevent the possibility of serious complications later in life.