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A Call for More Research Into a ‘Highly Overlooked’ Infection That May Pose a Growing U.S. Threat

CU Department of Medicine faculty member Andrés Henao-Martínez, MD, says ‘urgent action’ is needed to better understand Chagas disease.

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by Mark Harden | June 4, 2024

Chagas disease – a parasitic infection that affects an estimated 8 million people worldwide, mostly in Latin America – is drawing concern in the United States as well. The infection can lead to serious heart problems. And yet, the disease remains “highly overlooked” in the U.S., and “urgent action is required to implement national and local programs, bolstering health care responses and advancing research efforts,” a University of Colorado Department of Medicine faculty member says.

Andrés Henao-Martínez, MD, an associate professor in the CU Division of Infectious Diseases, is co-author of a viewpoint article published in May in The Lancet Regional Health Americas. The article was written on behalf of the U.S. Chagas Research Consortium, a group of clinicians and researchers who advocate on behalf of people nationwide living with the disease.

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The article calls for “focused research and public health initiatives, with U.S. research institutions playing a crucial role in developing new treatments and identifying biomarkers” for Chagas disease. It also says that infected people in the U.S. have “limited access to diagnosis and treatment.”

Chagas disease is a vector-borne disease caused by a parasite, Trypanosoma cruzi. It usually spreads through contact with the feces of infected triatomine bugs, also known as kissing bugs. In some cases, infected mothers pass on the disease to their children. In other cases, the disease is transmitted through contaminated food, water, or blood transfusions.

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Various species of kissing bugs have been reported in most U.S. states that are primarily in the southern half of the nation, including Colorado.

Henao-Martínez has published many research papers on Chagas disease. To learn more, we spoke with him about Chagas disease and his recent article.

Photo at top: A triatomine bug, also known as the kissing bug. Photo by U.S. Centers for Disease Control and Prevention.

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Who is at greatest risk of Chagas disease?

It usually affects marginalized populations, people living in poverty, mostly in Central and South America.

What symptoms do infected people experience?

When it first happens, the infection may go unnoticed for a long time because it causes mild symptoms, maybe like the flu. But if it goes untreated and unrecognized, it can cause heart disease. Two out of 100 people start developing some sort of heart disease every year after infection. That can manifest as heart failure, arrhythmia, or strokes.

How prevalent is Chagas disease in the U.S. at this point? And are there concerns that the numbers could increase?

Unfortunately, that’s under study, and we don’t have solid numbers. There are estimates that close to 300,000 people may be living with Chagas disease in this country. One consideration is that there could be a potential expanded geography of the kissing bug vector further northward due to climate change, and that can increase the risk to people in the U.S.

At this point in the U.S., it mostly affects migrants coming into this country from Latin America. Many of them don’t have health insurance and they haven’t been linked to health care services, so there is no way for us to assess all those patients.

In your article, you call for increased research into Chagas disease. Why isn’t that research happening now at the level that’s needed?

This is a disease of the poor, so the investment from government agencies and pharmaceutical companies is very limited. Any potential technology that can be developed to address the disease will not have a huge impact on revenues.

Fortunately, we have some medical people here in this country who are interested and passionate about the disease. We have formed the U.S. Chagas Research Consortium to develop insight into how to improve health outcomes related to the disease.

What do you think should be the focus areas of the stepped-up research effort you’re calling for?

We need to close the knowledge gap about what’s going on with the disease in the United States – how many people are affected, what’s happening with them, how we can develop new diagnostic and prognostic biomarkers, how we can improve the way we diagnose the disease, and how we can develop new therapeutics.

What precautions should we take to avoid infection?

If you’re traveling to areas abroad where the disease is endemic, you could contract it there and come back with the infection. So, consulting with a travel clinic is essential before planning trips abroad.

Recognizing what the kissing bug looks like can be important so you can avoid them, especially in rural areas, where you might have a higher chance of encountering them. There are several different species throughout the country, although many of them aren’t as efficient in transmitting the disease.

Also, the disease can be transmitted through contaminated food and water. The kissing bug is attracted to dwellings. So, insecticide spraying of the exterior of houses and surrounding areas and keeping your food safe and away from contamination is essential.

What got you interested in this field in your research?

I’m from Colombia, and during my medical-school training there, I did a social service year in a rural town, Restrepo Valle, Colombia, where I saw many suffering from neglected tropical diseases. That attracted me to study them. Once I moved to the States to continue my training, I wanted to continue that focus.

The passion comes from how these diseases affect the most vulnerable populations – people living in poverty who lack access to education and health care. These diseases are a perpetuator of poverty. Once you get infected, it impairs your capacity to work or get educated, becoming a vicious cycle.

So, in a way, combating these neglected tropical diseases is also combating poverty.

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Andrés Henao-Martínez, MD