The spread of Chagas disease, a potentially fatal parasitic disease transmitted by the triatomine bug, colloquially known as the “kissing bug,” has been linked to corrugated cardboard boxes, according to new findings published in the American Journal of Tropical Medicine and Hygiene.


This is the first clinical case report- spearheaded by San Francisco-based physician and Stanford Lecturer Dr. Eduardo Dolhun, MD, to evidence that commonly-used cardboard boxes provide ideal breeding environments for the disease-transmitting insect, thus facilitating their spread to non-endemic areas in the United States and beyond. The wide-reaching findings could lead to a potential sea-change in how the Chagas disease is managed and diagnosed worldwide.

Chagas an endemic disease in Latin America, where thatched roofs and other forms of substandard housing provide nesting environments for the Chagas-transmitting “kissing bugs.” The alarming spread of kissing bugs to the United States has puzzled scientists and public health officials, because according to the CDC “most indoor structures in the United States are built with plastered walls and sealed entryways to prevent insect invasion, triatomine bugs rarely infest indoor areas of houses.” The new report’s findings show that cardboard boxes left indoors could provide a means of transmission independent of housing standards. This is the first documented case that provides circumstantial evidence that corrugated cardboard boxes may be an inadvertent and unrecognized factor in the spread of Chagas disease.

“This study has potentially significant implications for public health in all 50 states,” said Dr. Eduardo Dolhun. “Essentially it means that the conditions for Chagas are present anywhere there are cardboard boxes left around. Practically speaking, it means that physicians as far north as Canada should consider testing for this infectious disease once thought to belong exclusively to tropical climates.”

The Triatoma or “kissing” bug. Image/CDC
The Triatoma or “kissing” bug.

Confirming the importance of the study’s findings, Salvador Alvarez, MD of The Mayo Clinic in Jacksonville, Florida, said that “This report illustrates the unforeseen risk of transmission of unusual parasites from other countries via a popular commercial system that is widely used in this and other western countries.”