Last week, the American Heart Association (AHA) issued a statement warning health care providers about Chagas disease, an infectious disease that can cause serious heart and digestive problems.
Chagas disease was once thought to only be found in Central America and South America, but at least 300,000 people in the U.S. now have it, the AHA says in the statement, pointing out that it can lead to heart failure, stroke, arrhythmia, and sudden death. “Health care providers and health systems outside of Latin America need to be equipped to recognize, diagnose, and treat Chagas disease and to prevent further disease transmission,” the statement reads.
Chagas disease is actually spread by triatomine bugs, aka kissing bugs. And the whole process is pretty gross.
Kissing bugs can carry the parasite Trypanosoma cruzi (T. cruzi), according to the Centers for Disease Control and Prevention (CDC), which causes Chagas disease. The bugs can transmit the parasite to people through a series of disgusting events. Buckle up, because this may give you nightmares.
According to the CDC, kissing bugs become infected with T. cruzi when they suck on the blood of an animal that’s already infected with the parasite. The bugs tend to hide out in crevices in homes during the day and come out at night when they feed on sleeping people. Oh, and the reason they're called kissing bugs is because they tend to snack on your face in the middle of the night.
Still with us? Cool, let's continue.
The bugs poop after they eat (naturally), which means they can leave T. cruzi-infected feces on your skin—most likely near your mouth. Those parasites can then get into your body through your eyes, mouth, a cut or scratch, or the wound from the bug’s bite. Scratching or rubbing the bite also helps the parasites get into your body, where they multiply and spread, according to the Mayo Clinic. And because you're typically sleeping during this whole horror scene, it's not really as simple as just not scratching after you get bit. “People usually inadvertently scratch in their sleep after they’ve been bitten,” infectious disease expert Amesh A. Adalja, M.D., senior scholar at the John's Hopkins Center for Health Security, tells SELF.
Nightmare fuel, right? People can also become infected by eating uncooked food that’s been contaminated with poop from T. cruzi-infected bugs, being born to an infected woman, having a blood transfusion that contains infected blood, getting an organ transplant from someone who had T. cruzi, and spending time in a forest that contains infected animals like raccoons and oppossums, the Mayo Clinic says, but infection from kissing bugs is the most common.
It's important to note that not all kissing bugs carry the T. cruzi parasite, but if you live in an area where they're particularly prevalent, it's worth keeping an eye out for them and talking to your doctor about the risk of infection from these little guys.
Since catching a kissing bug in the act sounds pretty unlikely, it's important to know the signs and symptoms of Chagas disease.
There are two phases of Chagas disease. The first is the acute phase, which happens for the first few weeks or months after you’ve been infected, the CDC says. During this time, you may have a fever, fatigue, body aches, headache, and rash, along with a mild enlargement of your liver or spleen, swollen glands, and local swelling (called a chagoma) where the parasite got into your body. You can also have what’s called Romaña’s sign, which is swelling of your eyelids on the side of your face near the bite wound or where the bug’s poop was accidentally rubbed into your eye. However, this phase can also be symptom-free in some people, the CDC says. The symptoms usually go away on their own, but if the infection isn't treated it will continue on to the chronic phase.
The chronic phase can surface a whopping 10 to 20 years after you’ve been infected, the Mayo Clinic says. This phase can still persist without symptoms, or it can cause complications like an irregular heartbeat, congestive heart failure, sudden cardiac arrest, an enlarged esophagus that makes it hard to swallow, or abdominal pain or constipation due to an enlarged colon. Fortunately, only about 30 percent of people who contract Chagas actually develop these complications from the chronic phase, the CDC says.
According to the CDC, treatment is most effective earlier in the infection, so if you think you may have Chagas disease get to your doctor for a blood test to confirm the diagnosis. If you do have Chagas disease, your medical team might request a cardiac and gastrointestinal workup to see if you have any signs of complications. Untreated Chagas disease can eventually progress into Chagas heart disease (or Chagas cardiomyopathy), which is what the AHA statement was primarily warning patients about. According to the AHA statement, Chagas cardiomyopathy can lead to sudden death, heart failure, or embolic events.
While Chagas disease can be fatal, most people in the U.S. aren't at risk.
The AHA paper notes that the majority of Chagas disease cases in the U.S. are in people who immigrated from affected areas in Latin America, so the risk of infection happening in the U.S. is still low. “It has up to this point been rare in the U.S. but is seen in immigrants from those regions," Richard Watkins, M.D., an infectious disease physician in Akron, Ohio, and an associate professor at Northeast Ohio Medical University, tells SELF. There have also been some reports of people being infected in Texas, where the kissing bug lives, Dr. Adalja says. But outside of that, transmission of Chagas disease is pretty “geographically limited,” he says.
Again, your overall risk of contracting Chagas disease is pretty low, but if you live in an area where there are kissing bugs or are traveling to an area where they’re present, you want to do what you can to avoid being bitten by them, Dr. Watkins says. That means avoiding sleeping in a mud, thatch, or adobe house (they’re most likely to have kissing bugs), using an insecticide-soaked net over your bed when you sleep, using insecticides to remove bugs from your place, and wearing insect repellent if advised, according to the Mayo Clinic.
Still, it's important for people to realize that the AHA's statement was addressed to doctors to let them know that they should be aware that Chagas disease can surface in their patients—not that people should panic over this.
“This is more about recognizing that Chagas is in the U.S.,” Dr. Adalja says. “It’s less about individual risk.”