Chagas and the Kiss of Death

This spring, Congress and the White House again failed to pass any new laws on immigration, and therefore, the problems of illegal immigrants and porous borders will continue. Most of the illegal immigrants apparently come from South and Central America, and Mexico. Many of these poor people sneaking across the border into “El Norte” also are sneaking across with a parasitic disease common to the rural regions of the southern hemisphere. The disease is called Chagas and the parasite is Trypanosoma cruzi. You might think some of these infected individuals are coming north looking for better medical care, but most people with Chagas disease don’t even know they have it. Chagas is largely a silent infection, persisting for years or decades, and patiently destroying the heart, or choking off the esophagus and the bowels. There may be ten to twelve million people in South and Central American with Chagas disease. They are mostly poor and mostly children. There is no cure. The disease is transmitted by a blood-sucking insect called the “kissing bug” though its other common name—the “assassin bug”—might be more appropriate. The bugs come out at night, bite their sleeping victims and then, adding insult to injury, defecate. Parasites in the feces enter through the bite site or the person’s mucous membranes. The T. cruzi parasite causes infection in two phases. The acute phase is seldom noticed because the symptoms are mild and nonspecific. The chronic phase can remain similarly silent for decades until cardiac symptoms or intestinal complications send a victim to a doctor. Chagas is the most common cause of congestive heart failure in Central and South America. An anti-parasitic drug called nifurtimox is helpful in the acute stages of the infection.

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Treatment in the later stages is likely to include cardiac drugs, and in extreme cases, pacemakers and heart transplants. Chagas is not a contagious disease, but in the U.S. it is possible to contract it from blood transfusions and organ transplants. In 1996, the Red Cross found one case of Chagas among 9,850 blood donors in Los Angeles. In 2006 the ratio was one case per 3,800 donors. So things are getting worse. More immigrants mean more cases of Chagas and more opportunities for transfusion-related infections. The increasing rates of Chagas disease in the U.S., however, should not become another excuse for xenophobia or isolationism. Unfortunately, the U.S. has a long history of “infectious xenophobia” when it comes to immigrants and disease. My Irish ancestors were blamed for cholera outbreaks. East Europeans were blamed for polio, West Coast Chinese were blamed for plague, and, more recently, Haitians were seen as a major source of AIDS. Alan Kraut’s 1995 book, Silent Travelers: Germs, Genes, and the Immigrant Menace, provides an interesting historical perception of the foreigner as a source of contagion. About a 100,000 people in the U.S. are estimated to be Chagas carriers. That is probably an underestimate, but so far, less than a dozen cases of transfusion-acquired Chagas have been documented in the U.S. and Canada. In February of this year, the Food and Drug Administration licensed a new assay to screen donated blood for T. cruzi parasites. Canada, with an increasing influx of Latin American immigrants, is expected to begin screening its blood supply too. On July 4, the World Health Organization announced a new public health campaign to eliminate Chagas disease by the year 2010. The effort is being supported by Bayer HealthCare, which donated money and 2.5 million free tablets of nifurtimox. That should be enough medication for about 30,000 patients over a five-year period. (An estimated 40,000 to 50,000

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people die each year from the disease.) That will certainly help. But Latin American countries also will have to devote more resources to screening blood banks in order to prevent new infections. Long-term efforts to control the main source of Chagas, the kissing bug, also have to be instituted. Currently, primitive housing in rural Latin America allows these bugs to hide in cracked walls and thatched roofs. Indoor insecticides, bed nets to protect sleepers, and long-lasting insect repellents will be important preventive measures against these disease-carrying bugs. Chagas disease was once an obscure, far off illness known only to a few parasitologists and public health officials. Now, because of modern transportation and open borders, both its fame and its range are spreading. It’s another reminder that infectious diseases like to travel.

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