The "Kissing Bug" and Seniors

Earlier this year, we did a blog on the dangers of ticks and mosquitoes for the senior population here in southern New England. As the summer draws to a close, some of these concerns are coming to fruition.

In Rhode Island, officials have warned that they have found the presence of West Nile virus in mosquito sampled from Providence, Warren, Pawtucket and the Tiverton area.

In Massachusetts, public health officials have now identified a fourth person who tested positive for West Nile virus -- all have been older adults. As a result, officials there have raised the risk level to moderate in 11 communities including Boston, Cambridge and Somerville.

Connecticut officials have also reported that mosquitoes caught in multiple towns have tested positive for West Nile virus. This includes New Haven, Stamford, Bridgeport and Waterbury.

As these viral concerns were being reported, the American Heart Association released a policy statement (which has been under reported to date) stating that “if American doctors don't become better at recognizing, diagnosing and treating Chagas disease, it could result in a devastating outbreak.”

Chagas disease? What is Chagas disease?

Chagas is a parasitic illness spread by an insect called the “kissing bug” (the

Triatominae) because it likes to bite its victims on the face, particularly around the soft skin area of the mouth and eyes.

Kissing bugs are insects that may be infected with Trypanosoma cruzi, the parasite that causes Chagas. They are commonly known as cone-nose bugs or chinches. Like bedbugs, Kissing bugs feed on blood during the night.

Chagas, like Lyme disease, causes damage in the body that shows up as people age. In fact, this illness has been implicated in strokes and heart failure, prompting the American Heart Association’s concerns.

Unlike tick or mosquito bites, this disease is not spread by the bugs saliva but through its feces. The parasite that causes the disease lives in the gut of the insect and after it feeds, it tends to defecate immediately. If the feces is rubbed into the victim’s eyes or into an open wound (usually scratching after feeling the bite), an infection can result.

The Centers for Disease Control reports that Chagas is a disease that has two phases – the acute phase and the chronic phase.

The acute phase lasts anywhere from a few weeks to a couple of months after the infection. Despite a high number of parasites present in the blood stream, there are either mild or no symptoms present. If symptoms do appear, it is usually includes a fever, headache, fatigue, rash, or swelling near the bite wound or where the feces were deposited or rubbed into the eye.

If the infection is identified as Chagas during this phase, there is a handful of medications that have been somewhat effective in treating the disease, sporting a 60 to 90 percent success rate.

If Chagas progresses to the chronic phase, the parasites have now entered vital organs. Symptoms of chronic Chagas disease vary according to the organs most affected and in most cases, it is either the heart or the gastrointestinal tract (or both) that show the most serious symptoms.

Chronic Chagas disease symptoms may include the following:

  • Irregular heartbeats

  • Palpitations (abnormal heartbeat sensations)

  • Fainting (syncope)

  • Cardiomyopathy (chronic disease of the heart muscle)

  • Congestive heart failure (dilated heart)

  • Shortness of breath (dyspnea)

  • Emphysema

  • Stroke

  • Sudden death

  • Chronic abdominal pain

  • Chronic constipation

  • Dilated esophagus and/or colon

  • Difficulty swallowing

These symptoms are due to organ damage caused by the persistent presence of the parasites within the tissues of these organs over a long period of time. Chronic inflammation develops as the body reacts to the parasites; it affects the nerve cells or neurons in these tissues, causing electrical conduction changes in the heart (arrhythmia's) and poor muscle tone in the intestines.

Two drugs can treat the disease: benznidazole (Alunbrig) and nifurtimox (Lampit), which kill the parasite. They work well if taken soon after infection. The longer someone's had Chagas disease, the less likely the drugs are to work. Pregnant women can’t take them, but infected newborns can.

Here in the United States, the only way to get the drugs is through the CDC, since they’re not approved by the FDA. The drugs must be taken for up to 2 months. They can cause serious side effects, especially in older people.

Unfortunately, these medications won't cure Chagas during the chronic stage, but they can help slow down the disease's progression in those age 50 and under. By the way, there is no vaccine for Chagas.

So just how prevalent is Chagas?

The CDC estimates that as many as eight million people in Mexico, Central America and South America have Chagas but are unaware of it. It has become much more common in countries such as Italy, Spain, France, Japan, the UK and Australia.

Further, the CDC states that as many as 300,000 in the United States has Chagas. That is not an insignificant number. So far, 27 states, mostly in the south and the west, have reported cases, including Florida, Louisiana, Texas, Arizona and California - although cases have been spotted as far north as Pennsylvania.

But let's be clear, many of the cases in the United States come from traveling to other countries where the infections occur. However, the bug itself, according to experts, continues moving northward.

Dr. Sheba Meymandi, who is the Director of the Chagas Center at UCLA, has his own concerns about the disease.

“Less than 1% with the infection are receiving treatment for Chagas disease,” said Dr. Meymandi. “Without treatment many Chagas patients are at risk of a ‘silent death’ due to heart failure. Our study demonstrates the need for similar research in other states, and underscores the critical importance of early detection and treatment to tackle this public health challenge in the United States.”

Public health officials who study parasitic infections consider Chagas to be a neglected disease that if it continues to spread, could cause illnesses and premature deaths among unknowing seniors who may be harboring the parasite for decades. Many say that if these issues aren't addressed soon, the number of cases — and severe heart problems related to those cases — could continue to climb.

Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.

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