The "Kissing Bug" Marches Toward New England

Is the “Kissing Bug” closing in on Southern New England? It certainly appears so, at least according to the Centers for Disease Control (CDC).

The CDC reports that the insect has been sighted in Delaware and less than a year ago, was responsible for biting a young girl who was watching television in her home in Kent, Delaware. Fortunately, all blood testing on the girl for the disease spread by this bug were negative. However, this case now brings the number of states to 29 where the “kissing bug” has been confirmed.

Before we start sounding the alarms, there is no immediate health crisis surrounding this insect in our area, but, if health officials are correct, problems could be right around the corner. And, for those seniors who are planning on moving south after retirement, the specter of the “Kissing Bug” looms large.

The kissing bug is a disease-carrying-blood-sucking insect that at one time

was isolated to the warm climates of Asia, Africa, Australia, Latin America and the southern United States. But as we said earlier, it is migrating north.

Triatomine bugs (their real name), are also known as cone-nosed bugs, vampire bugs, assassin bugs and blood suckers and gets its name for its propensity for biting humans on their faces and lips. Adult kissing bugs can range in size but are usually about the size of a quarter.

Most species have a characteristic band around the sides of the body that is either orange or red. The legs of kissing bugs are long and thin; unlike similar insects, the legs are thin throughout the whole leg. Kissing bugs have noticeable mouth-parts that appear as a large black needle attached to the head and when tucked under the body, the needle-like mouth-part is completely straight.

Stink bugs, which are seen throughout New England in large numbers, and look similar to the kissing bug, has been mistaken for it on some occasions, however one can see the difference when placing them side by side.

The kissing bug chooses to do its deed during the night and most of the time, the victim doesn’t even feel the bite. The bugs may bite anywhere on the body, including the face, head, arms, and feet. They have earned the name kissing bug because they like to bite around the mouth or eye area.

If a person is bitten by one of these creatures, they will see 2-15 bite marks in one area and perhaps some redness and swelling. Because the victims usually don't feel the bite or witness the bug in action, it is difficult to differentiate their bites from other bug bites, minor skin irritations, or infections.

Although the bug is fond of humans it also feeds on other mammals, birds and even reptiles. They live in a wide variety of environmental settings but like to stay where their food is located. They also can be found in wooded areas, beneath porches, under cement, between rocky structures, in outdoor dog houses or kennels, in rock, wood and brush piles or beneath bark.

Unlike other insects, its not the bite of this insect that causes the disease. The problem actually occurs on the back end of this bug, in its feces.

The bug can transmit a parasite known as Trypanosoma cruzi (T. cruzi), which can lead to Chagas Disease, a parasitic illness that can cause serious cardiac and gastrointestinal complications long term, and, like Lyme Disease, can become a chronic issue.

Chagas is transmitted through the bug's waste and if it defecates near an

open bite, the infected feces can then be accidentally rubbed into the open wound. It can also infect humans through mucus membranes, including the eyes, nose or mouth. It can also be contracted by eating unwashed foods that contain the feces of this insect and can be transmitted from a pregnant woman to her child in the womb.

Chagas is so prevalent across the globe that blood transfusions account for a large number of person-to-person transfers of the parasite, forcing most blood banks around the world to test donated blood for antibodies to the parasite. If a blood sample is positive, the blood is discarded, and the donor usually is notified and requested not to donate blood in the future. Similar situations occur with organ donors.

But should we be concerned in the United States about the increasing presence of the kissing bug?

Apparently so, at least according to the American Heart Association (AHA). In 2018, the AHA issued a statement about their concerns regarding Chagas, saying in part, “if American doctors don't become better at recognizing, diagnosing and treating Chagas disease, it could result in a devastating outbreak.”

In humans, Chagas disease manifests in two phases: acute phase and chronic phase. After becoming infected with the parasite, the acute phase can last for a few weeks or months. Some people may never develop acute disease.

Acute phase Chagas disease may be difficult to diagnose because the symptoms are common for many types of sicknesses, as the symptoms include fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting. Of those who are infected with the parasite, approximately 30% are at risk of developing chronic Chagas disease.

These numbers, by the way, are not insignificant if you consider that one in three people could be sick over their life span. The costs on the public health system could be massive.

Treatment of Chagas disease can be difficult, and drugs are available only through the CDC, since they are not FDA approved, after consultation with a physician – and are only effective in the early phases of the disease. The medication must be taken for up to 2 months and can cause serious side effects, especially in older people.

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.

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.

Because this is a relatively new disease in this country, there is no public health requirements in most states for recording the number of confirmed human cases. However, most experts place the numbers of Chagas from 300,000 to over 1 million, with most cases occurring in the southern portion of the country.

To date, most cases reported come from those immigrating from Mexico and Central America however there are increasing reports of Americans contracting the illness in this country.

It is the chronic stage of Chagas that carries implications for seniors. In this stage of the disease cardiac complications and/or intestinal complications begin to appear, and these signs may not be apparent until decades after the initial infection.

Cardiac signs include enlarged heart, heart failure, altered heart rate, and/or cardiac arrest. Intestinal signs include an enlarged esophagus or colon, which can cause difficulties with digestion. Concerned individuals should discuss testing options with their physicians but the only treatment at this point are addressing the symptoms as they appear.

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.”

The recent publicity around Chagas by medical professionals and organizations like the American Heart Association is not without its detractors, with some health researchers saying that the hype is really aimed at securing funds and research money. Given that, it is important to point out that similar concerns about the long term dangers of Lyme Disease were also once dismissed by some in the public health sector.

To date, the major concern regarding kissing bugs in the United States has been anaphylactic reactions to their bites that have resulted in frequent emergency department visits, especially in areas of the Southwest. Still, most 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 in seniors related to those cases — could climb to unprecedented numbers.

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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