Chagas Disease Has The Potential To Become A ‘Slow Burn’ Pandemic

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Chagas disease isn’t something you hear much about…but it should be on everyones radar. Named after Brazilian physician Carlos Chagas, it’s a parasitic disease caused by an unfriendly little swine known as Trypanosome cruzi. Currently it’s only found in the Americas, both North and South and can also be known by the name American trypanosomiasis. The parasite is present in some species of Reduviid bugs, also known as kissing bugs which are part of the Reduviidae family. There are 11 species of these kissing bugs and they can be found in spread across 28 states in North America and almost anywhere in South America but in particular in rural areas. The bugs themselves are bloodsuckers that feed at night. Other Reduviid species look similar and can give a nasty nip but only kissing bugs spread Chagas and scientists estimate that 50% of the bugs carry the parasite.

According to The World Health Organisation 6-7 MILLION people are already infected with Chagas and most of them are in Latin America, though cases are spreading in North America.

What is frightening about Chagas disease is that it begins with an acute phase, with symptoms that include fever and malaise. There may also be a swollen red area at the site of an insect bite. After this phase passes, though, the disease goes into remission and no symptoms may appear for many years. When Chagas “returns,” and this may take 20 years, it afflicts the heart and digestive organs and symptoms include: constipation, digestive problems, heart failure, pain in the abdomen, and swallowing difficulties. At this point, a person may die suddenly and in an instant. Chagas may be the literal drop dead disease. By some estimates, there are already about 300,000 cases in the U.S., by other estimates up to one million.

Experts believe this disease could become a pandemic.

The acute phase symptoms are:

  • Swelling and/or redness at the skin infection site (termed chagoma)
  • Rash
  • Swollen lymph nodes
  • Fever
  • Head and body aches
  • Fatigue
  • Nausea
  • Vomiting and/or diarrhea
  • Liver and/or spleen enlargement
  • The Romana sign – this is a painless swelling in the tissues surrounding the orbit of the eye. It usually affects just one eye.

According to the CDC

There are two phases of Chagas disease: the acute phase and the chronic phase. Both phases can be symptom free or life threatening.

The acute phase lasts for the first few weeks or months of infection. It usually occurs unnoticed because it is symptom free or exhibits only mild symptoms and signs that are not unique to Chagas disease. The symptoms noted by the patient can include fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting. The signs on physical examination can include mild enlargement of the liver or spleen, swollen glands, and local swelling (a chagoma) where the parasite entered the body. The most recognized marker of acute Chagas disease is called Romaña’s sign, which includes swelling of the eyelids on the side of the face near the bite wound or where the bug feces were deposited or accidentally rubbed into the eye. Even if symptoms develop during the acute phase, they usually fade away on their own, within a few weeks or months. Although the symptoms resolve, if untreated the infection persists. Rarely, young children (<5%) die from severe inflammation/infection of the heart muscle (myocarditis) or brain (meningoencephalitis). The acute phase also can be severe in people with weakened immune systems.

During the chronic phase, the infection may remain silent for decades or even for life. However, some people develop cardiac complications, which can include an enlarged heart (cardiomyopathy), heart failure, altered heart rate or rhythm, and cardiac arrest (sudden death); and/or intestinal complications, which can include an enlarged esophagus (megaesophagus) or colon (megacolon) and can lead to difficulties with eating or with passing stool.

The average life-time risk of developing one or more of these complications is about 30%.

Treatment

To kill the parasite, Chagas disease can be treated with benznidazole and also nifurtimox. Both medicines are almost 100% effective in curing the disease if given soon after infection at the onset of the acute phase including the cases of congenital transmission. The efficacy of both diminishes, however, the longer a person has been infected.

Treatment is also indicated for those in whom the infection has been reactivated (for example, due to immunosuppression), and for patients during the early chronic phase. Infected adults, especially those with no symptoms, should be offered treatment because antiparasitic treatment can also prevent or curb disease progression. In those cases the potential benefits of medication in preventing or delaying the development of Chagas disease should be weighed against the long duration of treatment (up to 2 months) and possible adverse reactions (occurring in up to 40% of treated patients).

Benznidazole and nifurtimox should not be taken by pregnant women or by people with kidney or liver failure. Nifurtimox is also contraindicated for people with a background of neurological or psychiatric disorders. Additionally, specific treatment for cardiac or digestive manifestations may be required. (source)

Chagas disease will spread as long as the Reduviid bugs that spread it are not controlled. Those suffering from poverty and living in poor housing are shown to have a higher incidence of chugs than the general population.

More porous  borders and downward economic trends will exacerbate the problem of Chagas in North America and it’s likely the case count will continue to rise. Chagas is expensive to treat and the additional costs of illness and absence from work will further damage the economy in the long term.

You can read more about Chagas Disease at http://kissingbug.tamu.edu/found-a-bug/

Take Care

Liz

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