Chagas disease is a fairly common disease in Latin America; as many as 8 million people have the disease, and many more don’t even know they’re infected. Chagas is not caused by a bacteria or virus, rather it’s caused by the parasite Typanosoma cruzi.
People can become infected in several ways. In Latin America, the most common way is through vector-borne transmission, particularly triatomine bugs, or “kissing bugs” because they’re known to bite people’s faces. Kissing bugs carry T. cruzi as a result of biting infected animals or people. Once infected, they pass the parasites through their feces; these bugs can be found all around people’s houses, particularly those made of mud, adobe, straw, or palm thatch.
During the day, kissing bugs hide in the crevices and shadows, but at night they become active. This may sound a bit gross, but after kissing bugs bite a person on the face, they can defecate (poop) on the person as well. The T. cruzi parasite is then able to enter the human through mucous membranes or breaks in the skin. When the sleeping person wakes up, rubs their face and eyes, etc., they may accidentally spread the parasite all around their face and mouth.
But, this isn’t the only way a person can become infected. The parasite can also be transmitted through blood transfusions, transmission from mother to baby, organ transplants, accidental laboratory exposure, or consumption of uncooked food contaminated with kissing bug feces.
What are the Signs and Symptoms of Chagas Disease?
There are two phases to Chagas disease: the acute phase and the chronic phase. Both phases can range in severity from symptom free to life-threatening.
Lasts for a couple weeks to a couple months
Common symptoms: fever, fatigue, body aches, loss of appetite, diarrhea, vomiting (similar to other diseases, making it hard to diagnose)
Other subtle symptoms: enlarged spleen, swelling at the site of the bite, swelling near the eye where the bug feces could have been rubbed in (Romaña’s sign).
Lasts for decades to life
Most people have no symptoms
In severe cases, it can lead to cardiac complications (enlarged heart, heart failure, altered heart rhythm, cardiac arrest, etc.) and/or gastrointestinal complications (enlarged esophagus and/or colon, problems eating and pooping).
Because Chagas can be hard to diagnose simply based off symptoms, it is officially diagnosed with a blood test that tests for T. cruzi. From there, antiparasitic medications are prescribed to kill the parasite, which often improves symptoms.
A Neglected Disease with Widespread Impact
The WHO classifies Chagas as a neglected disease. This designation implies that its transmission is heavily influenced by poverty and living in rural areas. Like mentioned earlier, kissing bugs are known to infest homes made of mud, adobe, straw, or palm thatch. These homes are often those of people in poverty, or who live in rural conditions, who cannot afford buildings that protect them from insect vectors.
Additionally, severe symptoms of Chagas disease can be preventable with early interventions of antiparasitics. However, for those who live in rural settings where Chagas disease is prominent, it may be difficult to find transportation or access to a doctor. There, it’s possible that, due to the lack of resources, finding antiparasitics is a challenge.
In order to prevent Chagas disease, and other vector-borne infections, it’s important that national, state, and local governments, as well as global public health programs, invest in providing bug nets to lower-income communities, as well as fund pest control programs in order to eradicate kissing bugs in communities where families cannot individually afford to hire pest services.
But, Chagas shouldn't be thought of as a disease only affecting those who live in Latin America. Now, the disease has made its way to the USA and Europe. For example, there's many Latin American immigrants in the USA who live with Chagas disease. But, it's vital to note that they do not "bring the disease" with them. Kissing bugs have long existed in the United States, particularly in California and Florida.
However, for those living with Chagas disease (especially Latin American immigrants), it can be challenging to get necessary access to healthcare in the United States. Luckily, there are programs that address this. In 2007, Dr. Sheba Meymandi founded the Center of Excellence for Chagas Disease (CECD) as the first major screening and treatment center of its kind in the US in order to ensure that patients living with Chagas, regardless of income, insurance, or healthcare status, can receive the care that they need. Their mission is to identify and treat Chagas disease early to prevent the severe cardiac complications that can occur.
Although you may not have heard of Chagas disease, it's important to understand that it's now prevalent in the United States, particularly among the Latin American immigrant population, and that it should no longer be considered an "exotic" disease.