“Kissing Bugs”: Potential Disease Vectors and Cause of Anaphylaxis

Abstract

Physicians in the United States should familiarize themselves with "kissing bugs" endemic to their area of practice and appreciate the medical implications of their bites. Bite victims often seek advice from physicians about allergic reactions as well as the risk of contracting Chagas disease. Physicians are generally knowledgeable about the role of kissing bugs in the transmission of Trypanosoma cruzi in Latin America. However, they may be unaware of (1) severe allergic reactions to kissing bug salivary antigens, (2) the widespread occurrence of T. cruzi amongst vertebrate hosts of kissing bugs, and (3) the incidence of T. cruzi among kissing bugs (T. cruzi may infect >50% of sampled bugs). Despite the potential for Chagas disease transmission, the major concern regarding kissing bugs in the United States is anaphylactic reactions to their bites resulting in frequent emergency department visits, especially in areas of endemicity in the Southwest.

Trypanosoma cruzi and Chagas' Disease in the United States

“…T. protracta has also been reported as frequently entering houses in other areas of California, New Mexico, and Arizona (187,273,304,332,336). First reported as a pest of humans in Yosemite Valley, CA, in the 1860s, T. protracta continues to be an important cause of severe allergic reactions in humans who are bitten (152,198). This species was implicated in a human case of Chagas' disease in north-central California (203).…”

“…Early reports describe T. recurva as a pest of humans, primarily in the Alvardo Mine area of Yavapai County, AZ, where it was a common invader of houses and tents of mining employees (332,336). Recent reports describe home invasions and hypersensitivity reactions due to bites that occurred in and around houses in Pima and Cochise Counties, AZ (152,237). Although the species has been collected occasionally from woodrat nests, the woodrat is not considered the primary host of T. recurva (96,255,321).…”

“…Both the U.S. and Mexican study areas had experienced disruption of previously undisturbed environments considered suitable habitats for both triatomine and T. cruzi vertebrate hosts. Human bite encounters, including hypersensitivity reactions due to T. rubida, continue to be a public health issue in Arizona (152,226,237). This species has been frequently collected from woodrat nests throughout its range (96,256,321,332,336).…”

“…It has been collected from diverse natural settings across its range, in association with many different vertebrate hosts, including woodrats, cottonrats, armadillos, raccoons, opossums, frogs, dogs, chickens, horses, and humans (120,150,212,215,332,348). Human annoyance and allergic reactions to T. sanguisuga bites were reported as early as the mid-1800s in Georgia, Kansas, Oklahoma, and Florida and recently in Louisiana (116,147,152,161,215). This species was found inside the residences of human Chagas' disease patients in Tennessee and Louisiana and in the vicinity of the home of a T. cruzi-seropositive blood donor in Mississippi (54,90,134).…”

“…Severe reactions are generally systemic and may involve angiodema, urticaria, difficulty breathing, nausea, diarrhea, and/or anaphylaxis (152,226). Although allergic reactions to triatomine bites have been reported from states throughout the southern United States, the incidence is highest in the southwestern states, with T. protracta and T. rubida most frequently implicated (106,152,204,226,237). The most common scenario involves invasion of an adult bug into a human dwelling, where it bites a sleeping individual.…”