A kiss you would not want again

While choosing whether to write a commentary about the latest election-related murder in Bacoor, Cavite or something about solar energy, my attention was distracted by a persistent itch on my left elbow.

Thinking it was an ant or a mosquito; I brushed it aside and went on reading. Everything stopped when after feeling a sting on my elbow and turning to have a look, I saw a black insect crawl away in haste. It had been underneath my elbow all the while and the source of the itchy stings as it had little sips of my blood. Alarms went off inside my mind as I seemed to have recognized the fugitive insect.

After a frantic search under the couch, I found it and after a good look my fears were confirmed, it was a kissing bug! 

Triatoma rubida
Triatoma rubida” by nmoorhatch is licensed under CC BY 4.0.

Triatoma rubida belongs to a group of insects which are also known as conenose bugskissing bugsassassin bugs or triatomines. Most of the 130 or more species of this subfamily are haematophagous, which means they feed on vertebrate blood, which tonight was my blood. They are mostly found in the Americas with a few species found in Asia, Africa and Australia.

Among the common names of this bug, the one that strikes me and most other people the most would be “kissing bug.” This is derived from its feeding habit in which the bug comes out at night, visits your bedroom and crawls up to your face, which is usually the only exposed part of your body while you are asleep and uses its long thin proboscis to draw blood near your mouth. This is because the insect is attracted by chemicals in our breath.

If you think that was dreadful enough, here is something worse; after the kissing bug has bloated itself with your blood, it does its nasty habit of defecating near the site of the bite. Their feces contain the flagellate protozoan Trypanosoma cruzi which enters the body through the bite wound once it is scratched or it is rubbed into the eyelids. Once inside the protozoan causes Chagas disease.

Just what is Chagas disease? It’s an infection caused by the T. cruzi parasite and it has two phases:

the acute phase and the chronic phase. Both phases can be symptom-free or life-threatening.

The acute phase lasts for the first few weeks or months of infection. It usually occurs unnoticed because it is symptom-free or exhibits only mild symptoms and signs that are not unique to Chagas disease. The symptoms noted by the patient can include fever, fatigue, body aches, headache, rash, loss of appetite, diarrhea, and vomiting. The signs on physical examination can include mild enlargement of the liver or spleen, swollen glands, and local swelling (a chagoma) where the parasite enters the body. The most recognized marker of acute Chagas disease is called Romaña’s sign, which includes swelling of the eyelids on the side of the face near the bite wound or where the bug feces were deposited or accidentally rubbed into the eye. Even if symptoms develop during the acute phase, they usually fade away on their own, within a few weeks or months. Although the symptoms resolve, the infection, if untreated, persists. Rarely, do young children (<5%) die from severe inflammation/infection of the heart muscle (myocarditis) or brain (meningoencephalitis). The acute phase also can be severe in people with weakened immune systems.

During the chronic phase, the infection may remain silent for decades or even for life. However, some people develop:

  • cardiac complications, which can include an enlarged heart (cardiomyopathy), heart failure, altered heart rate or rhythm, and cardiac arrest (sudden death); and/or
  • intestinal complications, which can include an enlarged esophagus (megaesophagus) or colon (megacolon) and can lead to difficulties with eating or with passing stool.

The average life-time risk of developing one or more of these complications is about 30%.

Though the disease is generally endemic to Mexico and Southern American countries, large-scale human movement has brought the disease in other countries worldwide. And to be honest, I am a bit worried.

As far as I can remember, this is the first time I’ve been bitten by a kissing bug though I’ve seen a couple lurking around in our house in the last three years. Each one I’ve crushed on the spot.

According to what I’ve read and know so far and basing on my first-hand experience, I have a very low risk of contracting Chagas disease based on the following circumstances:

I was bitten at the elbow, far away from my mouth or eyes

The kissing bug never engorged itself with my blood as it never had the chance to have a good sip because my arm always moved about every time I felt a sting, and

Since it never had a ‘full meal’ it didn’t have the chance to defecate on my skin thereby preventing it from leaving behind its dangerous load of Trypanosoma cruzi parasites.

Lastly, my research has shown that the types of kissing bugs here in the Philippines are not known for being vectors or carriers of Chagas disease.

But since I’m no medical doctor, the only way to be sure is to undergo blood tests and a medical checkup. Something I’m seriously considering if the itch from my elbow doesn’t go away after four days.

Hopefully, my very low chances of contracting Chagas disease stay that way. As of now though, I have officially declared war on the kissing bugs and will hunt each one that dares to enter our house.

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