Secret kissing insects: Chagas disease management priorities

kissing bug conical nose bug; fenchuca. Tchibo. Barbero.

These English, Spanish and Portuguese names are local for nocturnal bloodsucking insects that bring an animal parasite to Latin America. In the last years, Trypanosoma cruziIts slow and insidious attack on human hearts and intestines, commonly called Chagas disease (CD), has been featured in the Latin diaspora. For example, experts estimate that here in the United States, Between 240,000 and 350,000 people currently injured T. Cruze.

But what about the insects themselves? Are strange, curious insects with lethal payloads on the move, too — or have they always been lurking in North America, hidden in plain sight?

According to Norman Petty, MD, an infectious disease specialist at the University of Florida who first studied it T. Cruze Vectors in the southwestern United States, there is no easy answer to this question. Today, however, kiss 10 types of insects that can get pregnant T. Cruze lives in 29 states In the southern half of the United States what does this mean? Do humans and animals now contract this “traditional” Latin American scourge right here at home? Although it’s hard to get an accurate count of cases because so many people are either undiagnosed or infected silently, the answer is most likely: yes.

For more ideas about kissing insect hideouts and hosts in North America, consider this recent data From Florida filed in November 2022 at 71St Annual meeting of the American Society of Tropical Medicine and Hygiene. This statewide study by Beatty and colleagues at the University of Florida and Texas A&M University between 2013 and 2022 used “community science” (an approach that allows local residents to help collect samples) to evaluate kissing bugs from 22 counties. All 298 captured triatomin vectors were in and near human habitation Triatoma sanguisuga (the most common disease vector east of the Mississippi River in the United States), and it harbors approximately 30% of parasites, which cause disease in humans.

Additionally, prior to their capture, the work of Nathan Burkett Cadena, Ph.D., at the Florida Entomological Medical Laboratory showed that infected insects stole blood from a wide variety of animals, from humans to land and domestic mammals to reptiles and amphibians. In short, at least in Florida, T. Cruze It inhabits many creatures, which tells us that it already has a large animal reservoir.

Recent transformations in Chagas disease

In 1998, when I published A.J story in explore magazine About a Mexican-American immigrant with end-stage Chagas cardiomyopathy who refuses a heart transplant that may have saved his life, the global spread of T. Cruze– The number of infected people reached about 15 million. Today, that estimate is down more than 50%. However, one thing has not changed. Wherever they are, the vast majority of infected human hosts still don’t know that they’re harboring a protozoan time bomb (as it can take years to decades to manifest clinically) that gives them a 1 in 3 chance of stealing their health and shortening their lives.

The good news? Recent years have seen more research on new diagnoses and medications, as well as a call for expanded screening of people who might benefit from benznidazole or nifurtimox – two currently available drugs that can prevent CD in some people, especially those newly or recently infected. younger The patients.

On the other hand, identifying or training qualified medical professionals to administer these drugs remains a challenge.

How many original disease?

In 2020, Beatty and a colleague from Arizona published a dossier provocative article Titled “Chagas Disease Indigenous to the United States: How Do People Get Infected?” Refer to nearly 100 T. Cruze The infection contracted in Arizona, Arkansas, California, Louisiana, Mississippi, Missouri, Tennessee, and Texas, among other states. latest modeling It suggests that the United States could have as many as 10,000 people infected within our borders. But leave with the exact number, and the question How do These people are equally infected with a germ.

While accepting that some infections indigenous to the United States are acquired in the traditional way (through contamination of kissing bug feces after a meal with blood from a bite or mucous membrane), Petit’s paper also demonstrates different “defecation behaviors” in northern versus Latin American kissing bugs. Such observations open the door to another mode of transmission: the accidental ingestion of food or drink contaminated with insects or their feces. It is hardly improbable. Not only are there outbreaks of foodborne worms among humans in Latin America, oral ingestion of bedbugs can. also leads to T. Cruze Infections in dogs.

modern states

If you’re anything like me, knowing that the United States has many undiagnosed CD patients raises one set of imperatives. In addition, knowing that domestic vectors infect the US population constitutes a second mandate. So, here’s what I’d like to see happen over the next five years.

First, I believe we need more community education about Chagas disease, especially for those whose geographic location, residence, or lifestyle increases their risk. One place to start? Associated school programmes community science.

Secondly, though US blood banks have begun testing to T. Cruze In 2007, several physicians—in both primary care and related specialties such as cardiology and obstetrics—failed to test some high-risk individuals. Routine serologic screening of women at high risk of childbearing age in particular can prevent 100 or more congenital infections annually. The strategic effort to educate many service providers is long overdue.

The third priority endorsed by the experts is the standardization of national pre-transplant practices Testing of organ donors and recipientssince the transmission associated with members T. Cruze In addition to the disease being reactivated in immunosuppressed hosts, it is a more recent development in the old enemy.

In short, continuous monitoring of infected bedbugs in the United States along with better education, patient screening, and access to qualified care are all necessary to tackle 21St Century issues about imported and indigenous diseases. Norm Petty left me these final thoughts: “Why is Chagas disease not being reported in all 48 states in the continental United States? Why don’t we have federally mandated funding and resources for people with Chagas disease? For parasites, we can help our patients live better, healthier lives.”

Claire Panosian-Donavan, MD, is a professor of medicine and infectious diseases at the David Geffen School of Medicine at UCLA and past president of the American Society of Tropical Medicine and Hygiene. You can read more of her writing atof parasites and epidemics” column.

Leave a Comment