Are ‘kissing bugs’ spreading disease in Virginia?

Chagas’ disease, also known as the “kissing bug disease,” is classified as endemic in 21 countries in the Americas.

The United States is not one of those countries. The Centers for Disease Control and Prevention says it should be.

Citing evidence, CDC officials said Chagas’ disease is consistently occurring in eight states and by reclassifying it, “The United States could improve surveillance, research and public health responses.”

Two University of Virginia experts are co-authors of the Chagas’ disease chapter in the Merck Manual, one of the world’s most widely used and researched medical references.

Infectious diseases expert Dr. William Petri and Chelsea Marie Braun, an associate professor of medicine, explain the disease, why it is spreading in the United States and how to protect yourself from becoming infected.

What is Chagas’ disease?

Petri: It is a parasite transmitted from kissing bugs, which are triatome bugs. They fly in duos, almost like they’re kissing when they’re flying, so that’s how you’ll recognize them. These kissing bugs, from global warming, used to be just in the far south of the U.S., like Florida and Texas, and now they’re making their way up to Virginia. So, there’s this potential that someone in Virginia could become infected with Chagas’ disease through these kissing bugs, but I’d say that that’s very rare.

How do people contract Chagas’ disease?

Petri: When it bites you, the kissing bug’s feces is where the parasite is. So, it deposits that on your skin and you itch the bite and then you could touch your eye and you inadvertently inoculate the parasite into your eye. You get edema around your eye and it almost looks like a black eye. That’s about the only way you can really recognize the initial infection, because otherwise there’s no symptoms at all.

Where has the disease surfaced in the United States?

Braun: It’s actually been identified in 32 states. The states where we believe there’s evidence for local infection are California, Arizona, Tennessee, Louisiana, Missouri, Mississippi and Arkansas, and then Texas. Texas is by far the biggest one, because of that big border with Mexico.

What is the best way to avoid contracting Chagas’ disease?

Petri: Avoid the kissing bugs. Part of that is being able to live in a well-constructed home where you don’t have insects in your house. Or if you do get insects, get an exterminator to fix that problem.

How many people in the United States are estimated to be infected?

Braun: We know there’s about 300,000 people with Chagas’ disease in the U.S. The vast majority of those have acquired it in an endemic country somewhere else in the Americas and have immigrated to the U.S., but now we’re finding increasing evidence of local infections of people actually being infected in the U.S.

We think this is probably for a variety of reasons. Probably, one is increased screening. The geographic range of the kissing bug is thought to be impacted by climate and may be increasing. And this increased surveillance, I think, has highlighted that this is an infection that we need to be paying attention to.

Do you think people in the United States should be afraid of contracting the disease?

Braun: It’s really low prevalence. I think it’s a bigger concern for veterinary disease. A lot of dogs in Texas have Chagas’ disease. We don’t really know how dogs are infected. It’s thought maybe it’s more of the oral route. People who spend a lot of time outdoors, in woodsheds, in these endemic states—those are known risk factors. But, generally speaking, I think it’s pretty low risk.

Petri: Where the infection becomes important is years later; it can infect the heart most commonly. It’s such a rare infection, and this is a relatively rare complication. But if it gets in the heart, it can cause conduction system abnormalities. The other complication is it can get into your intestines and affect the ability of your esophagus and intestines to contract normally, so that you can process food. Those are the two chronic complications of Chagas’ disease—heart and gut.