During her childhood, Emiliana Rodríguez remembers observing friends engage in a nighttime game of soccer, when suddenly one of the participants collapsed lifeless on the field. Not comprehending what had taken place, the Bolivian native Rodríguez developed a fear of the night, terrified of the silent assassin known as Chagas, the “creature” she was informed only emerges after sunset.
Chagas represents a distinct kind of creature, a “quiet and hushed illness,” transmitted by nocturnal insects that infect up to 8 million individuals each year, with Rodríguez’ friend being one of the 12,000 victims annually.
At the age of 42, Emiliana Rodríguez relocated from Bolivia to Barcelona 27 years ago and came to the realization that she couldn’t evade Chagas, which she describes as a “creature.”
“The anxiety usually struck at night. Occasionally, I couldn’t sleep,” she expressed. “I was fearful of falling asleep and not waking up.”
It was eight years in the past when, while expecting her first child, Rodríguez underwent some examinations that disclosed she was a carrier of Chagas. “I was stunned and recalled all those tales my relatives narrated regarding individuals abruptly passing away,” she recounted, also reliving the demise of her friend. “I questioned, ‘What will happen to my baby?’”
However, Rodríguez received treatment to prevent the parasite from reaching her unborn child through vertical transmission. Following the birth of her daughter, she tested negative.
Concurrently, in Mexico, Elvira Idalia Hernández Cuevas had never encountered Chagas until her 18-year-old was diagnosed with the silent assassin.
Idalia, 18, was contributing blood in her place of residence, near Veracruz in Mexico, when her sample was assessed, culminating in a positive diagnosis for Chagas, an illness caused by a blood-sucking parasite, triatomine bugs that are commonly recognized as kissing or vampire bugs.
“I had never been informed of Chagas so I started investigating it on the internet,” Hernández stated in an interaction with the Guardian. “I was terrified upon seeing it characterized as a silent assassin. I didn’t know what to do or where to turn.”
She isn’t the sole individual, numerous individuals are oblivious to the vectorborne malady caused by these pesky pests.
Chagas is named after Carlos Ribeiro Justiniano Chagas, a Brazilian doctor and researcher who detected the human case in 1909. Throughout several decades, Chagas sickness is acknowledged to be prevalent in Latin America, North America, Europe, Japan, and Australia.
Kissing bugs mainly reside in the walls of low-income residences in rural or suburban regions and are most active at night when people are at rest. The bug transmits the T. cruzi infection by biting an animal or human, then defecating on the skin of its victim, who might inadvertently scratch the area and break the skin, or transfer the feces into the eyes or mouth.
As per the Centers for Disease Control and Prevention (CDC), in Mexico, Central America, and South America, around 8 million individuals–6 to 7 million worldwide as indicated by the World Health Organization (WHO)–have Chagas sickness, the majority being oblivious of their infection. If left untreated, the lifelong infection can be fatal. Roughly 12,000 individuals succumb to Chagas annually, taking the lives of “more individuals in Latin America than any other parasitic illness, including malaria,” states the Guardian.
Though these bugs have been identified in the U.S.–almost 300,000 individuals are infected–it isn’t regarded as endemic.
Some individuals never display symptoms but the CDC reports that after decades, 20 to 30% endure cardiac complications that can culminate in death, or gastrointestinal complications, which can lead to severe distress.
Furthermore, the global case detection rate stands at only 10%, rendering treatment and prevention highly challenging.
Seeking assistance, Hernández and her daughter Idalia consulted various medical practitioners who possessed minimal knowledge–if any–about Chagas, or how to manage it. “I was startled, terrified, and saddened because I assumed my daughter was going to perish. Above all, I couldn’t acquire any reliable information, and this heightened my anxiety,” Hernández disclosed.
Eventually getting assistance from a family member in the health sector, Idalia received the essential treatment.
“In Mexico, the authorities claim that there are not numerous individuals affected by Chagas and that it’s under control, but that’s not the reality,” according to Hernández. “Healthcare professionals don’t undergo any training and mistake Chagas for other heart conditions. The majority are unaware that Chagas exists in Mexico.”
Chagas is classified by the World Health Organization (WHO) as a disregarded tropical ailment, indicating it’s not receiving attention from the global health policy agenda.
Chagas sickness treatment
Colin Forsyth, a research manager at the Drugs for Neglected Diseases Initiative (DNDi), elucidated that Chagas is disregarded in part because “it’s a silent illness that remains concealed for a lengthy duration in your body … owing to the asymptomatic aspect of the initial phase of the infection.”
Citing the impoverished populations, Forsyth proceeded, “The impacted individuals merely lack the influence to impact healthcare policy. There’s this convergence of biological and social problems that keep it concealed.”
However, as Chagas spreads to other continents, its visibility is increasing and it’s now recognized that it can be transmitted through blood transfusions and organ transplants, as well as from mother to child during pregnancy or childbirth.
Professor David Moore, a consultant at the Hospital for Tropical Diseases in London, established the Chagas Hub, a UK-based facility with the primary objective of having “more individuals tested and treated, and to manage the risk of transmission, which in the UK is from mother to child,” he stated.
Moore conveyed that progress in eradication of Chagas is “glacial,” and addressing the goal set by WHO for a 2030 disease elimination, he stated, “I can’t fathom that we’ll be remotely close by 2030. That appears highly improbable.”
Chagas can be treated with two medications, benznidazole and nifurtimox, both existing in the market for over 50 years, which Moore describes as “toxic, unpleasant, not particularly effective.”
It can cure an infant but there’s no certainty that the medications can prevent or mitigate disease progression in adults.
Regarding severe side effects, Rodríguez recollects breaking out in hives, feeling lightheaded and nauseous. She successfully completed treatment and undergoes yearly check-ups.
Moore emphasizes that more effective medication for Chagas is crucial in curbing its spread but presently, there’s no financial incentive for pharmaceutical companies to invest.
Until there’s a greater market appeal to evolve additional treatments, Hernández is on a mission to give the silent malady a louder voice, holding the position of president of the International Federation of Associations of People Affected by Chagas Disease (FINDECHAGAS).
What should I do if I discover a triatomine bug?
Meanwhile, Rodríguez is in Spain, battling the “creature,” by promoting awareness about Chagas through a campaign led by the Barcelona Institute for Global Health.
“I’m fed up with the prevailing silence,” Rodríguez proclaims. “I desire people to discuss Chagas, and to be informed about it. I want people to undergo testing and receive treatment.”
And, their messages are resonating.
The WHO instituted World Chagas Disease Day, celebrated annually on April 14, the day in 1909 when Carlos discovered the initial human case. WHO states that “Global aims for 2030 and milestones are defined to prevent, control, eliminate, and eradicate a varied assortment of 20 illnesses and disease categories.” This encompasses Chagas.
To avert potential infestation, the CDC suggests that you:
- Seal crevices and openings around windows, walls, roofs, and doors
- Eliminate wood, brush, and rock piles near your residence
- Utilize screens on doors and windows and mend any holes or tears
- Seal openings and crevices leading to the attic, to crawl spaces beneath the residence and to the outside
- Have pets sleep indoors, particularly during the night
- Maintain your residence and any outdoor pet resting zones clean, alongside intermittently inspecting both areas for bug presence
If you encounter a kissing bug, it is advised by the CDC not to squash it. Instead, you should cautiously place the bug in a receptacle and fill the container with rubbing alcohol or freeze it in water.
Subsequently, it is recommended that you bring the container with the bug to your local health department or a university laboratory for identification.
It’s quite alarming to consider that these bugs inhabit the walls of residences—it’s akin to those scary anecdotes you hear as a child to be cautious of the creature that dwells within the walls.
We sincerely hope the WHO fulfills its pledge to eradicate Chagas, and other Neglected Tropical Diseases.
