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Chagas Disease: Poverty, Immigration, and the ‘New HIV/AIDS’
May 30, 2012 3:26 PM   Subscribe

What if a deadly epidemic was burgeoning and almost nobody noticed? In the latest issue of PLoS Neglected Tropical Diseases, a distinguished group of virologists, epidemiologists and infectious-disease specialists say that’s not a hypothetical question. They argue that Chagas disease, a parasitic infection transmitted by blood-sucking insects, has become so widespread and serious — while remaining largely unrecognized — that it deserves to be considered a public health emergency.

Extending the metaphor, they liken Chagas’ stealth spread to the early days of AIDS:
"Both diseases are health disparities, disproportionately affecting people living in poverty. Both are chronic conditions requiring prolonged treatment courses… As with patients in the first two decades of the HIV/AIDS epidemic, most patients with Chagas disease do not have access to health care facilities. Both diseases are also highly stigmatizing, a feature that for Chagas disease further complicates access to … essential medicines, as well as access to serodiagnosis and medical counseling."


Hotez PJ, Dumonteil E, Woc-Colburn L, et al. (2012) Chagas Disease: “The New HIV/AIDS of the Americas”. PLoS Negl Trop Dis 6(5): e1498. doi:10.1371/journal.pntd.0001498

Tanowitz HB, Weiss LM, Montgomery SP (2011) Chagas Disease Has Now Gone Global. PLoS Negl Trop Dis 5(4): e1136. doi:10.1371/journal.pntd.0001136

Sarkar S, Strutz SE, Frank DM, et al. (2010) Chagas Disease Risk in Texas. PLoS Negl Trop Dis 4(10): e836. doi:10.1371/journal.pntd.0000836
posted by Blasdelb (31 comments total) 21 users marked this as a favorite

 
Maybe now they can change the journal's name to PLoS Finally People Are Paying Attention To These Tropical Diseases.
posted by theodolite at 3:32 PM on May 30, 2012 [2 favorites]


In case anyone was wondering what the symptoms are and why this disease is bad, here is the Mayo Clinic's info.
posted by bearwife at 3:33 PM on May 30, 2012 [4 favorites]


I live in the tropical Americas, read this yesterday, and am really really hoping somebody can give me a reason not to worry about it. I'll even take half a reason.
posted by two or three cars parked under the stars at 3:35 PM on May 30, 2012 [2 favorites]


two or three cars: Chagas is almost exclusively transmitted during sleep. Sleep under a mosquito net, and you needn't worry. Malaria protection is a bonus.
posted by zug at 3:45 PM on May 30, 2012 [1 favorite]


...and just like HIV, nobody is going to care until folks of European descent start suffering from it.
posted by Renoroc at 3:47 PM on May 30, 2012 [1 favorite]


I live in the tropical Americas, read this yesterday, and am really really hoping somebody can give me a reason not to worry about it. I'll even take half a reason.

I've done field work in Central America and this was a big scare among new researchers. Chagas is only a serious concern for people who sleep outside without mosquito nets, or people who live in rural houses with low quality roofing where assassin bugs can hide out. If neither of these apply to you, then your changes of contracting Chagas are very low.
posted by special-k at 4:02 PM on May 30, 2012 [1 favorite]


The "Prevention" page on the Mayo Clinic site advises the following:
If you live in a high-risk area for Chagas disease, these steps can help you prevent infection:

Avoid sleeping in a mud, thatch or adobe house. These types of residences are more likely to harbor triatomine bugs.
Use insecticide-soaked netting over your bed when sleeping in thatch, mud or adobe houses.
Use insecticides to remove insects from your residence.
Great advice, unless you're, you know, poor, and have no choice but to sleep in a mud, thatch or adobe house.

On the "bright" side, the parasites which cause it can be killed if detected during the early acute stages, and interestingly, the drugs which do so - benznidazole and nifurtimox - are, according to the Mayo Clinic, "available in the regions most affected by Chagas disease. In the United States, however, the drugs can be obtained only through the Centers for Disease Control and Prevention."
posted by Marisa Stole the Precious Thing at 4:02 PM on May 30, 2012 [2 favorites]


Alarmist article is alarmist
posted by memebake at 4:15 PM on May 30, 2012


Christ, first it was that bug that made you itch and wire grow out of your hands, then there were those bugs in the brain, and now this. Think I'll go lie in the road for a bit.
posted by marienbad at 4:16 PM on May 30, 2012


Unfortunately, the online edition of one of the UK newspapers has gone for possibly the most alarmist headline possible.
posted by Wordshore at 4:17 PM on May 30, 2012 [2 favorites]


The Daily Mail? Alarmist?!
posted by Marisa Stole the Precious Thing at 4:19 PM on May 30, 2012 [8 favorites]


Gosh, I was almost out of things to worry about, so thanks. I note that despite how far Oregon is from Central and South America, chagas is here.
posted by Cranberry at 4:20 PM on May 30, 2012


Unfortunately, the online edition of one of the UK newspapers has gone for possibly the most alarmist headline possible.
posted by Wordshore at 4:17 PM on May 30
I don't know where to go to apologize for possible insensitivity, but when I followed Wordshore's link, my hearto did not explode, but I burst out laughing.
posted by Cranberry at 4:23 PM on May 30, 2012


Chagas. Now there's a disease that, once knowing a little, I NEVER EVER WANTED TO LEARN ANY MORE ABOUT! THANK YOU! LALALALA!
posted by toodleydoodley at 4:28 PM on May 30, 2012


Christ, first it was that bug that made you itch and wire grow out of your hands, then there were those bugs in the brain, and now this. Think I'll go lie in the road for a bit.

See, I want to know, and yet I don't want to know....
posted by AdamCSnider at 5:05 PM on May 30, 2012


So I was swimming at lake Anza a couple years ago, and a beautiful woman in a bikini (Renee Asteria) plonks herself down and starts playing a Cuatro and singing Vinchuca, a song she'd made up about Chagas and the Assassin Bug.
posted by BrotherCaine at 5:06 PM on May 30, 2012


memebake: "Alarmist article is alarmist"

Because when diseases affect poor people we shouldn't be alarmed?
posted by Blasdelb at 5:07 PM on May 30, 2012 [1 favorite]


So that's what really killed Bill.





(Sorry. Couldn't resist.)
posted by St. Alia of the Bunnies at 5:15 PM on May 30, 2012 [3 favorites]


On a more serious note why are we just now hearing of this?
posted by St. Alia of the Bunnies at 5:16 PM on May 30, 2012


Because it's a neglected tropical disease?
posted by gingerest at 5:17 PM on May 30, 2012


St. Alia of the Bunnies: "On a more serious note why are we just now hearing of this?"

The most straightforward and honest answer is that the 10 million people who with it tend to be both poor and non-white. It is a reasonably fatal combination.
posted by Blasdelb at 5:22 PM on May 30, 2012 [8 favorites]


Chagas?! Holy shit. I remember reading an article in Life (which means it was decades ago) about the great nephew or someother of Teddy Roosevelt trying to cover Roosevelts footsteps from when he tried to find the mouth of the Amazon. There were amazing pictures side-by-side with photos from the original expedition. The modern expedition was also a scientific one, and they had a team of scientists of various specializations. One was studying the insect life, and at night, they set up a white sheet and put a light on it, which attracted all sorts of things.

In that article, they said one of the bugs they found was a Chagas beetle (bug?), and that it carried a lethal disease with no known cure. I remember being absolutely terrified by that, but thinking, well, as long as I never go anywhere near a rainforest, I'll be fine. This shit is spreading? Gah. If you need me, I'll be re-duct-taping the windows and doors in my clean-room.
posted by Ghidorah at 5:32 PM on May 30, 2012 [1 favorite]


Man, I get squicked out by this stuff, even if I know it's alarmist.

I still remember in 4th grade watching the killer bee scare "documentary" on the news that showed how killer bees were spreading in the US and were going to kill everyone, including the cute robotic dog they marched into a killer bee hive on the base of the tree. SCARED ME FOR WEEKS. This has a greater squick factor, but a lesser overall FEAR OF DEATH factor.
posted by shortyJBot at 6:00 PM on May 30, 2012 [1 favorite]


The Internet really doesn't want me to go to central America next month :(
posted by empath at 6:23 PM on May 30, 2012 [1 favorite]


I spent this afternoon at the doctor's office with a suspicious rash and a worry about bedbugs. The doctor said that the rash was not bugs but that it would get worse and spread over more of my body, especially as the daytime temperatures spent more time above 100F, and I would feel itchier and maybe a bit feverish and fatigued, but that I shouldn't scratch and it would subside on its own in 3 weeks as long as I left it alone.

So now I read this and I'm itching even more and I'm going to have to get a ton of bags of frozen peas to pile all over myself*.


THANKS, METAFILTER.




* (Also, to count my blessings and give thanks that I am not in danger of Chagas and am fantastically privileged to have a home and Internet and a way to freeze all these bags of peas.)
posted by subbes at 6:50 PM on May 30, 2012 [2 favorites]


On a more serious note why are we just now hearing of this?

I don't know what the technical term for it is, but I call it intractable problem fatigue. When something's broken or a crises for so long that people think it's unfixable I think people just get tired of ringing the alarm bell (or tired of hearing it). Part of the relentless callousness of human nature in some ways, but I'm sure someone is always working on fixing the problem even so.
posted by BrotherCaine at 7:03 PM on May 30, 2012


On a more serious note why are we just now hearing of this?

Maybe because you don't read newspapers much? It has been mentioned many times in places like the NY Times over the last 25 years or so. There was speculation that Darwin had Chagas disease. Not news, more like "olds".
posted by jcworth at 7:53 PM on May 30, 2012


jcworth: "Maybe because you don't read newspapers much? It has been mentioned many times in places like the NY Times over the last 25 years or so. There was speculation that Darwin had Chagas disease. Not news, more like "olds"."
"Evidences against the Chagas hypothesis are numerous, however:

-Darwin died at a relatively old age for his time (73 years old);
-The symptoms abated as he aged, which is not typical for the disease, where age exacerbates the symptoms;
-He did not seem to have several of the pathological damages present at chronic Chagas -disease, such as megacolon and megaesophagus;
-Some of the symptoms, such as tachycardia, fatigue and tremors, were already present before the Beagle voyage;
-The numerous partial exacerbations and remissions are unusual in Chagas disease;
-The incidence of trypanosome-infested benchucas in Mendoza, Argentina (which has a colder climate), where Darwin reported the bite, is very low;
-No other members of Beagle's crew who accompanied Darwin in his land trip showed signs of a similar disease
"*
posted by Blasdelb at 8:38 PM on May 30, 2012


We used to do experiments with Rhodnius prolixus (the "kissing bug" that transmits the parasite) in our undergrad physiology labs. This was a parasite-free lab population. They start out very flat when they are hungry, and then gorge when presented with a food source to the point where they look like little grapes. Immediately after feeding, they begin peeing out all the excess water. They're called 'kissing bugs' because they often feed on people's lips, as they are attracted to exhaled carbon dioxide.
posted by sevenyearlurk at 9:26 PM on May 30, 2012


I know it's gruesome, but they fed them on rabbits - they had a special cage that would allow the bugs to bite the rabbit's ears through the mesh of the cage. One of our profs said that in fact they'd accidentally bred a variety of rabbit that didn't mind having its ears pierced, because they just got rid of any rabbits that wouldn't hold still - "evolution in action".
posted by sneebler at 9:35 PM on May 30, 2012 [1 favorite]


memebake: "Alarmist article is alarmist"

Blasdelb: Because when diseases affect poor people we shouldn't be alarmed?


Of course we should, but thats not really how Wired frames the story, they dont mention the poverty aspect until the fifth paragraph.

Wired introduces the story as "What if a deadly epidemic was burgeoning and almost nobody noticed?". More accurate would be "What if there was a tropical disease that was thriving in poor areas and compounded the problems of poverty but posed little risk to the general US readership of Wired?"

Sadly, I guess they didn't word it that way because it would get less clicks. They are trying to draw attention to this important issue - thats good - but via a watch-out-for-the-bugs alarmist route.
posted by memebake at 12:46 AM on May 31, 2012


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