A Cause for Alarm- The Emerging Chagas Infection

You're probably wondering why we are publishing a blog on an insect in a pet pig website and that's a great question! Although the "kissing Bug" or Triatomine insect has been around hit or miss since the 1850's, it is becoming a widespread concern in all the southern United States. It hides and lurks in common places like uncleaned dog beds, kennels, pig beds and pet housing. Life catches up to us and some days the last thing we can fathom doing is cleaning the pet's beds and enclosure. With this new emerging concern, skimping on cleanliness is not something you should take lightly.

People contract Chagas protozoan disease from insects of the family Reduviidae, in the suborder Heteroptera. These bugs are often called "kissing bugs" because they tend to bite skin where it is thinnest, around the mouth and eyes. The parasite develops over a few weeks within the kissing bug's intestine. When an infected bug bites a person, contaminated feces may enter the body through the wound or other areas of broken skin. Secondary means of of contracting the disease include blood transfusions, maternal transfer, organ transplants, and undercooked food that contain feces of an infected bug. Domestic and wild animals can also act as carriers, although this is not as common a pathway of disease transmission.

Where can I find this insect? These bugs are nocturnal, they typically only appear at night. They can live indoors but are usually found in substandard housing or very unclean areas of the home. They can be found in dirty enclosures and kennels, and would most likely hide under mattresses and nightstands. However, there are many places out doors where they can reside! For instance: Under porches, in rocks, structures built with rocks, wood piles, brush/burn piles, in landscape bark, rodent nests, animal burrows, chicken coops, outdoor dog houses, kennels, pet bedding and even under cement.

They are found in the most southern United States, Mexico, Central America and South America as far south as Argentina. See the CDC map below of the triatomines reported by state. Prevention is the best measure and keeping your home and property clean, mowed, vacuumed and free of debris is a grand first step. Keeping tabs of the insects you see on your property and working closely with a professional pest control service, can prove to be invaluable in the southern states.

The symptoms of Chagas disease have both an acute and and chronic phase. In most situations the patient will be asymptomatic (will not show or realize they even have symptoms). Thus, this can be a very tricky disease to treat and diagnosis. To be successfully treated for the disease, it must be caught in the acute phase which is the first 4 to 8 weeks, or first few months. In this acute phase, one may appear to have mild like flu symptoms with a mild grade fever and headache. It can also present with loss of appetite, fatigue, major swelling at the kissing bug bite site and swollen glands or lymph nodes. Swelling at the bite site is very common and the bites typically occur in areas where the skin is thin, around the mouth and eyes (hence the "kissing" name/reference). Once the disease enters a chronic phase, where some patients can go even decades without suspicion, it can cause cardiac disease that can result in an aneurysm or thrombus formation and even total heart failure. It can also cause a dilated heart that in turn, causes the heart to not pump well. Patients can also show signs of a dialed colon that leads to difficulties in eating and passing stool. These patients are also at an increased risk for stroke due to insufficient blood pumping abilities. In immunocompromised patients, the disease can prove deadly. In the chronic phases, treatment can be attempted but is not always successful and all one can do is try and manage the symptoms with treatment and medication.

To properly diagnosis, one would need to go to their primary care physician and request a serum draw which can be sent to the lab. The physician will also need to take clinical findings and history in to consideration. Once sent to the lab a diagnosis is made by testing with at least two different serologic tests; the indirect florentine antibody (IFA) and a commercial enzyme immuno assay (EIA). Both are available through the CDC as well. There are two drugs that work well for acute treatment, benzidazole and nifurtimox both of which are standard anti-parasitic treatments.

Positive IFA test

The bite of the kissing bug.

So what about our pets or animals!? The disease has been seen in dogs and dogs do appear to get symptoms. They will have the same symptoms as a human: fever, sluggishness, and also an unkept hair or coat. Signs of heart failure may show up after an extended period of time. If you suspect that your dog may have Chagas, head to your veterinarian for diagnosis and treatment options! In regards to other domestic animals including pigs/swine, they tend to be asymptomatic and have no lasting effects of the diseases as long as they are properly dewormed biannually. Remember though, many other animals can serve as carriers or "reservoirs" including cats, rabbits, raccoons and rodents. Dogs again, are the only animals that seem to present with problem from the infection at this time. Further testing is being done though. Keeping your pets living area clean and debris free is absolutely paramount in prevention of disease to your dogs and human family!

There are some other bugs that we want to introduce you to because they are widespread and commonly confused with the "Kissing Bug" or triatomine bugs. One is the Assassin Bug and the other is the Wheel Bug. Neither of these insects are carriers or vectors of the Chagas disease.

The Assassin Bug

The Wheel Bug (On right)

Even the news stations and the president have been commenting on the recent wide spread cases and appearance of the kissing bug. Do not be surprised to see even more growing reports! ABC news even just reported a new article regarding the insects migrating behavior within the states, it was only posted hours ago. What we need to take away from all these reports is the need to be diligent in our watch for the insect and "house keeping" practices. If we refuse to make an inviting home for these pests, we will never have the fear of coming in to contact with them. Like most things in life, prevention is the best method!

Resources

CFSPH Technical Fact Sheets. Chagas (Trypanosomiasis-American) at: http://www.cfsph.iastate.edu/diseaseinfo/

CDC website. Chagas' disease at http://www.cdc.gov/parasites/chagas

PetMed website. Chagas Disease in Dogs at: http://www.petmd.com/dog/conditions/infectious-parasitic/c_dg_chagas_disease

ABC New Reports. Kissing Bug Can Lead to Dangerous Parasite Infection While You Sleep at: http://www.abcnews.go.com/health/dangerous-chagas-infection-kissing-bug-found-states/story