- Chagas disease, aka “kissing bug” disease is now endemic in the US.
- The disease has been detected as far north as Pennsylvania.
- Chagas disease can be deadly if it’s left untreated.
A deadly “kissing bug” disease that was once limited to central and South America is now widespread in the U.S. Chagas disease has been detected in 32 states in America, according to a new report from the Centers for Disease Control and Prevention (CDC).
The disease, which is caused by a parasite spread through the droppings of the triatomine bug, can lead to deadly heart complications if it’s left undetected. But because the disease isn’t historically common in this country and can be asymptomatic, it can be tricky to get a proper diagnosis. “If you acquire this in the U.S., nobody is thinking of Chagas disease,” says Thomas Russo, M.D., a professor and chief of infectious disease at the University at Buffalo in New York.
Here’s where these “kissing bugs” have been detected, plus how to spot signs of Chagas disease.
Meet the experts: Thomas Russo, M.D., is a professor and chief of infectious disease at the University at Buffalo in New York; infectious disease expert Amesh A. Adalja, M.D., is a senior scholar at the Johns Hopkins Center for Health Security; Jody Gangloff-Kaufmann, Ph.D., is associate director of community & urban IPM at Cornell Integrated Pest Management; Norman L. Beatty, M.D., is an infectious disease specialist and assistant professor at the University of Florida College of Medicine
Where has Chagas disease spread in the U.S.?
The new CDC report calls Chagas disease “endemic,” which means that it’s now spreading regularly in the U.S. These are the states where human infections have been detected:
- Arizona
- Arkansas
- California
- Louisiana
- Mississippi
- Missouri
- Tennessee
- Texas
Chagas disease has also been detected in animals in these states:
- Alabama
- Florida
- Georgia
- Kentucky
- Maryland
- Nebraska
- New Mexico
- North Carolina
- Oklahoma
- South Carolina
- Virginia
And the triatomine bug has been detected in 32 states, including those as far north as Pennsylvania and Wyoming. Still, these kissing bugs are mostly in the southern US, according to Norman L. Beatty, M.D., an infectious disease specialist, lead author of the CDC report, and assistant professor at the University of Florida College of Medicine. “Certain regions have been known to have more impact from these vectors because of the species that is found in that area,” he says. “There are several species that tend to invade homes looking for a blood meal. This could from your dog or cat, or even the humans living inside.”
What is Chagas disease and how does it spread?
Chagas disease is caused by the parasite Trypanosoma cruzi, and it usually spreads through contact with triatomine bugs, per the CDC. The triatomine bug, which is also known as a “kissing bug,” bites and sucks blood from animals and people, and passes the parasite in its droppings.
“The parasite is actually not transmitted by the bite,” Dr. Russo explains. “They also defecate, and the bite area is itchy. You rub the area and inoculate the feces into that wound. That’s how you get infected.” (You can also get Chagas disease if the droppings get into your eyes or mouth, he says.)
Chagas disease symptoms
There are two phases of Chagas disease: The acute phase and the chronic phase. The acute phase happens in the first few weeks or months after you’re infected, per the CDC. Some people may not have symptoms at all, while others may have these signs of the disease:
- Fever
- Fatigue
- Body aches
- Headache
- Rash
- Loss of appetite
- Diarrhea
- Vomiting
- Eyelid swelling
Most people also have no symptoms during the chronic phase of the disease, but up to 30% of those who are infected develop serious health problems, per the CDC. Those include:
- Heart issues, like an enlarged heart, heart failure, altered heart rate or rhythm, or sudden death
- Digestive problems, like an enlarged esophagus or colon. That can cause trouble eating or going to the bathroom.
Why is Chagas disease deadly?
The chronic phase of the disease is the potentially deadly part, says Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security. “The concern with Chagas disease is its chronic phase, when it impacts the heart and diminishes its ability to function,” he says.
People in the chronic phase of Chagas disease can have strokes or central nervous system issues, Dr. Russo says. “The chronic phase is where the morbidity and mortality lies,” he says.
According to CDC estimates, about 280,000 people in the U.S. have Chagas disease and don’t know it.
What to do if you spot a kissing bug
Kissing bugs are usually between ½ inch and an inch long, according to Jody Gangloff-Kaufmann, Ph.D., associate director of community & urban IPM at Cornell Integrated Pest Management.
“They may be dark brown or black and may have reddish or orange markings,” she says. “They are hourglass-shaped with an abdomen much wider than the thorax and they have a long, cone-shaped head.” Adult kissing bugs have two pairs of wings folded neatly on the top of the abdomen, Gangloff-Kaufmann says.
“Kissing bugs in the United States look similar to several insects that we commonly know as ‘assassin bugs,’” Dr. Beatty says. “The head has a ‘cone-nose’ appearance with two big compound eyes and the rostrum or blood-sucking straw of the kissing bug is perfectly straight and held under the head when not feeding.” On the other hand, most assassin bugs have a curved blood-sucking straw, he explains. “Another important fact is that kissing bugs are rarely found during the day, especially sitting in a garden or exposed to the sun,” Dr. Beatty says.
These bugs typically come out at night and are attracted to light, according to the Texas Department of State Health Services (TDSHS). If you spot a kissing bug outside, Gangloff-Kaufmann recommends avoiding it. “If you find a kissing bug indoors…you can collect it in a jar and freeze it to kill it or squish it, but be careful not to contact the innards,” she says. “The risk of exposure to the organisms that cause Chagas disease is low but, especially in southern states, not zero.” (Dr. Beatty says that commercially-available pesticides seem to work well against kissing bugs.)
It’s also important to thoroughly clean all areas the bug came into contact with using a solution of 10% bleach and 90% water, per the TDSHS.
And, if you find that kissing bugs are making their way inside your home, Gangloff-Kaufmann recommends sealing openings around doors, windows, and wires and pipes to keep them out in the future.
Chagas disease treatment
There are anti-parasitic treatments available for Chagas disease, but Dr. Russo says they work best when they’re given early. Those include the drugs benznidazole and nifurtimox. Beyond that, doctors will usually treat the symptoms, Dr. Adalja says.
“The further north you go, the less common this bug is,” Dr. Rusos says. “But with climate change, we will probably see cases in more areas.”
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