Some of us travel to Central and South America for various reasons. Some go to volunteer at a medical hospital or to help out in a poor rural community. Others go for jungle and environmental adventures.
While in rural areas of Central and South America, there lurks a danger found in the trees or maybe the housing you are staying in, it’s called the Triatoma or “kissing” bug.
These insects frequently carry for life the parasite, Trypanosoma cruzi. T. cruzi is a comma shaped flagellated parasite and the cause of an acute and chronic disease called Chagas.
The triatoma bug can be found in poorly constructed homes, with cracks and crevices in the walls or those with thatch roofs. They can also be found in palm trees and the fronds.
Usually at night while sleeping, the insect feeds on people or other mammals. While feeding the insect defecates and the infected feces gets rubbed into the bite wound, eyes abrasions or other skin wounds.
The parasite invades macrophages at or near the site of entry. Here they transform, multiply and rupture from the cells 4-5 days later and enter the blood stream and tissue spaces.
Initial infection with Chagas is typically asymptomatic. Acute disease may manifest symptoms after a couple of weeks.
Reddening of the skin (Chagoma) or edema around the eye (Romana’s sign) may be seen, albeit uncommon.
Fever, malaise, enlarged liver and spleen are part of the acute syndrome. 10% of people develop acute myocaditis with congestive heart failure. This acute disease can be fatal.
After a latent period which may last for years, the infected person may develop chronic disease (20-40%). The most serious consequences are cardiomyopathy (in certain areas it’s the leading cause of death in men less than 45 years of age) and megacolon/megaesophogus.
Trypanosoma cruzi can also be transmitted via congenital transmission (mother to baby), through blood transfusions and organ transplants, and some cases of transmission through feces contaminated food.
About 150 mammals beside humans may serve as reservoirs of the parasite. Dogs, cats, opossoms and rats are among the animals.
Diagnosis for Chaga’s is by finding the parasite in a blood sample or by antibody detection.
There is no vaccine for Chaga’s, so preventive measures should include insecticide spraying of infested houses.
Insecticide-impregnated bed nets may reduce the risk of infection for travelers who cannot avoid camping, sleeping outdoors, or sleeping in poorly constructed houses in endemic areas.
Nifurtimox or benznidazole is used to treat in the acute phase. These drugs are available in major hospitals in endemic areas.
Heart failure and arrhythmias in Chagas’ disease are treated as they are in other patients with similar cardiac problems.
It is estimated that at least 100,000 people are infected with T.cruzi in North America, mainly immigrants from endemic countries.