introduction

Kissing Bugs &

Chagas Disease
What You Need to Know

1
introduction
What is Chagas disease? FACTS ABOUT CHAGAS

C hagas disease, also called

American trypanosomiasis,
is a potentially deadly disease
• The World
Health
caused by the parasite Organization
Trypanosoma cruzi (or T. cruzi estimates as
for short). This parasite is many as 6 to 7 million
spread to people and animals people throughout North,
by the feces of insects called Central, and South America
triatomines, also more are infected with the
commonly known in the United parasite that causes
States (U.S.) as kissing bugs. Chagas disease.
These insects are found all
• Many people
around the world including
with Chagas
the southern half of the U.S.,
disease may not
but the parasite that causes
Triatoma protracta be aware that
Chagas disease is only found Triatoma sanguisuga Triatoma they are infected.
in the Americas. Chagas gerstaeckeri
disease is found in many parts
Three species of kissing bugs found in the southern U.S. • Most infections
of Latin America, especially
occur in Latin
where people live in poor housing
America, but
conditions that result in close contact with the insects. Although rare, it is also possible to get the
Chagas disease
disease in the U.S. An estimated 300,000 people with Chagas disease are living in the U.S. However,
is present in the United
this is an estimate from infections that originate from Latin America and does not take into account
States. As of 2017, five
people who may have been infected in the U.S.
states (Arizona, Arkansas,
Chagas disease is a neglected tropical disease, or an illness that has not received much attention from Louisiana, Tennessee, and
research or medical communities, despite the fact that it affects millions of people. Chagas disease can Texas), require doctors to
be difficult to identify, and many of the people who have the disease do not have symptoms until years report cases of Chagas
or even decades after being infected. disease to their state health
department.
Chronic, or long-term effects of Chagas disease can result in significant heart or digestive system
problems. The most commonly reported signs of advanced Chagas disease are cardiac problems, such • Most U.S. blood
as heart failure, an enlarged heart, altered heart rate/rhythm, and cardiac arrest (sudden death). If left banks have
untreated, the infection is lifelong and life threatening. If you have been in close contact with kissing been screening
bugs, especially in areas of Mexico, Central America, or South America, or if you have a family member first-time blood
who has tested positive for T. cruzi infection, you should contact your health care provider to determine donors for T. cruzi infection
if you should be tested for Chagas disease. since 2007.

How do you get Chagas disease? • The parasite that

causes Chagas
C hagas disease is spread mainly by the feces of an infected kissing bug. The feces contain the parasite
that causes Chagas. When the blood-feeding kissing bug bites a person or animal, it may defecate
and leave its feces near the bite site or near an eye, mouth, or nose. Because the parasite is in the
disease can be
transmitted by
the feces of a kissing bug,
bug feces, when the person or animal scratches the area, the parasite enters the body though the
through blood transfusion,
bloodstream, causing infection. Chagas disease can also be spread through blood transfusion, organ
organ transplantation, from
transplantation, from an infected pregnant mother to her unborn baby, or (in rare cases) by eating
pregnant mother to baby,
contaminated food or drinks that contain the kissing bug feces.
or rarely by contaminated
Chagas in Texas food or drink.

I n Texas, cases of Chagas disease are reported to the Texas Department of State Health Services so
that the numbers can be tracked. From the years 2013-2016, 91 cases of Chagas disease were reported
in Texas. Of those cases, 20 people were infected while in Texas, and the other cases were probably
acquired outside of Texas or the U.S. While there are not very many cases, many people may be living
with the disease and not know it.
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Kissing bugs
What are kissing bugs? PROMINENT KISSING
BUG CHARACTERISTICS
K issing bugs are insects that can
carry Trypanosoma cruzi, the
parasite that causes Chagas disease.
Kissing bugs are also known as
triatomines, cone-nose bugs, or

.75 inch
chinches. Kissing bugs usually feed
on blood during the night, when
animals or people are asleep or
inactive. They are called kissing bugs
because they sometimes bite people
on the face. • Size – adult kissing bugs
Kissing bugs are found across the southern US. All of the orange states have at
are one half to one-and-a-
Where are kissing least one report of kissing bugs. Hawaii is not included in this map, but Hawaii
has also had reports of kissing bugs. quarter inches long
bugs found?
• Head shape –

K issing bugs are found in the Americas including the U.S., Mexico, Central America, and South America.
In the U.S., kissing bugs live in many southern states. There are 11 different kinds of kissing bugs in the
U.S. Most of the reports of the different kissing bugs have come from Arizona, California, New Mexico,
kissing bug heads
are long-thin
(cone-shaped);
and Texas. Kissing bugs have been found and documented in the U.S. as early as the mid-1800s. They are narrow at the tip
not a new species of bug in the U.S. and widen slightly
The orange counties have cases
of reported Chagas disease, from to where they attach to the
TEXAS: Characteristics of 2013-2016. Only 20 of the 91
cases were aquired in Texas.
body

kissing bugs found in Texas • Legs –

kissing
T here are seven species of kissing bugs found in
Texas. They are found across the state, with the
most variety of species found in central Texas.
bug legs
are long
and thin,
Adult kissing bugs range in size, with no
Kissing NOT a
but are usually about the size of a bulging bug kissing
bug
U.S. quarter. Most species have a parts.
characteristic band around the sides of
the body that is either orange or red. The • Color – all kissing bugs are
legs of kissing bugs are long and thin; unlike dark brown and/or black;
similar insects, the legs are thin throughout the they are not grey and they
do not have tiny spots; most
whole leg. Kissing bugs have noticeable mouthparts that
United States species of
appear as a large black needle attached to the head; when tucked
kissing bugs have orange/red
under the body, the needle-like mouthpart is completely straight.
stripes or solid orange/light
Kissing bugs are slightly flat and have very long, thin brown around the outside
heads when compared to other similar related bugs. part of their bodies.
Kissing bug nymphs (immature, young insects) are
Kissing bug NOT a kissing bug
smaller than adults, and range in size from the size
of a poppy seed to almost 1 inch long. They have
a ‘tear-drop’ body shape, with a pointy head and
rounded bottom.
• Mouthparts – a kissing
A kissing bug at any stage in its lifecycle can spread bug’s mouthparts are usually
T. cruzi infection; however, kissing bug nymphs are kept hidden underneath its
much less likely than adults to be infected. Not all head; the mouthpart is long
kissing bugs are infected with the parasite; however, and thin (like a needle); but
research out of Texas A&M University suggests not thick or curved.
that one in two kissing bugs in Texas are infected
with the parasite. A nymph (young) kissing bug Adult kissing bug
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Kissing bugs
KISSING BUG HABITATS

Kissing bugs typically come

out at night and are attracted
to lights. They can be found
indoors or outdoors, and prefer
hiding places such as cracks
and openings of buildings and
homes. They live in a variety
of outdoor settings during the
Kissing bugs develop through five day, including:
stages of nymphs before becoming
adults. Nymphs do not have wings, • Beneath porches
so they can walk, but they cannot fly.
Only adult kissing bugs can fly.
• Between rocky structures

Kissing bug life cycle

A dult kissing bugs are mostly active in the warmer months, from May to October. Kissing bugs
develop into adults after a series of five life stages as nymphs, and both nymphs and adults feed
on blood. Kissing bugs feed on humans as well as wild and domestic animals and pets. They can live
between one to two years
from when they hatch out of 90

the egg, through all five of 80

• In spaces under cracked
the immature nymph stages, 70
cement
until they become adults and Number
60

of live 50
eventually die. Kissing bugs kissing
bugs 40
take many blood meals from collected
various hosts throughout 30

their lives. These hosts 20

may include humans, dogs, 10

wildlife, chickens, and more. 0

Jan. Feb. Mar. Apr. May Jun. Jul. Aug. Sep. Oct. Nov. Dec.

Month
Adult kissing bugs are more
likely to be found walking than flying, Chart showing kissing bug activity by months in the year
but they can fly, and may be able to
fly distances of up to 3.5 miles. • In rock, wood, or brush
piles

Look-alike bugs

K issing bugs are members

of a group of insects also
known as ‘true bugs.’ Many
other true bugs look similar
to each other but do not feed
on humans or other animals.
Instead, these look-alike
bugs feed on plants or other
insects. These look-alike bugs • In rodent nests and animal
occasionally bite humans, and Commonly known as a Microtomus purcis — common Another type of assassin
burrows
their bites may be painful, but leaf-footed bug, Coreidae name assassin bug — is NOT bug, Pseudozelurus
is NOT a kissing bug. a kissing bug. arizonicus is NOT a
bites from look-alikes do not kissing bug. • In dog houses and kennels
pose a risk for transmission of
T. cruzi. Only kissing bugs are • In chicken coops
known to transmit the parasite
that causes Chagas disease.
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Kissing bug control
Kissing bug control KISSING BUG DEFENSE

K issing bugs mainly come out

at night and are attracted to
outdoor lights. A single kissing bug
A few tips to help reduce the
places kissing bugs might be
living in or around your home
may be attracted to house lights
or pets:
and enter a home, but a single bug
is not necessarily cause for alarm.
However, the presence of nymphs or
a large number of adults in a house
suggests that a breeding population
may have formed nearby. Under
such circumstances, insect or vector
control may be justified. Integrated
Pest Management (IPM) strategy
is a good approach to controlling
• Remove piles, excess
unwanted insects, such as kissing
leaves, and animal nests or
bugs. IPM is a method used to
burrows around the home
address the problem in multiple
to reduce the areas where
ways that may include the use of
kissing bugs might find
chemicals, cleaning, plugging up
blood or shelter.
holes, etc.
Kissing bug found in camping barracks
Kissing bug infestations are more • Keep woodpiles away from
common in older, poorly constructed, or damaged homes; cleanliness and tight building construction the house and, if possible,
can limit infestations. place above the ground.

Insecticides can effectively control kissing bugs when used appropriately and with other IPM practices. • To protect pets such as
Consider using a licensed pest control professional for kissing bug control. There are no household dogs or cats, bring them in
insecticides labeled specifically for use against kissing bugs; however, some products labeled for indoor at night or keep them in a
use against other indoor pests may be used. Some pesticides require an applicator’s license and should well-sealed place.
only be used by pest professionals or other licensed individuals. Treat windows and doorframes, room
corners and edges, pet houses, and other suspected places with a pesticide labeled for these sites. • Get rid of pests, such as
Sticky traps can also be effective in animal housing, buildings, or areas with high infestations. wild rodents and birds
living under or in the house,
in consultation with pest
management professionals.

• Seal outside cracks or

openings into buildings and
homes, especially around
windows and doors leading
inside from outside, and any
openings from crawl spaces
into the house sub-flooring.
Use silicone sealant, caulk,
steel wool, copper mesh, or
other similar items.

Kissing bug on side of home Kissing bug hiding inside crack of siding • Keep chimney flues closed
when not in use.

• Examine pet bedding for

kissing bugs.

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Kissing bug control
What to do if you suspect you have found a kissing bug? SAFE KISSING BUG
COLLECTION METHODS
If you find a kissing bug that has bitten a person or is inside your home, contact your local health
department. In Texas, the State Health Department can help you get kissing bugs tested if found in
your home or are suspected to have bitten someone. If you find a kissing bug but no one has been bitten
Never touch a kissing bug with
bare hands and avoid crushing
by it (for example, the bug was outside your home or in a dog kennel), and would like to have it tested,
it. The parasites they may have
see the box below for more information.
in their gut can be transmitted
Contact? — talk to your doctor to humans and other animals.
If you see a bug you believe is

I f you have had contact with a kissing bug or think you may have Chagas disease, you should discuss
your concerns with your doctor, who will examine you and ask you questions (for example, about your
health and where you have lived). Chagas disease is diagnosed by blood tests. If you are found to have
a kissing bug and would like
confirmation of the species
identity and to submit it for
Chagas disease, your doctor may recommend follow-up monitoring of the heart (electrocardiogram), testing, please use careful
even if you feel healthy. You might be referred to an infectious disease specialist for more tests and/or for methods to collect it:
treatment. Because the disease is rare in the United States, many doctors may not be familiar with Chagas • A glove
disease. It may be helpful to share this document with your provider as well as any details of when and or small
where you may have been in contact with a kissing bug. The Texas Department of State Health Services plastic
has developed some useful guidelines and information about Chagas Disease for doctors that is available bag may
online at: https://ww.dshs.texas.gov/IDCU/disease/Chagas/humans/. be used
to catch the bug to avoid
direct contact. The bug
WHERE TO SEND A KISSING BUG FOR TESTING may be stored in a sealed
• Many state health departments accept kissing bugs for testing for the parasite that causes Chagas. plastic bag, in an empty
However, they must have been found inside the home or be suspected of having bitten someone. In medicine vial, or other small
Texas, kissing bugs should be sent to Texas Department of State Health Services (TDSHS). Information container.
about how to submit can be found at this website: https://www.dshs.texas.gov/idcu/health/
zoonosis/Triatominae/ • All surfaces with which
the kissing bug came
• If the kissing bug was found outside the home and/or NOT suspected of biting a human, it may be sent into contact should be
to Texas A&M University Kissing Bug Citizen Science Program. Information about how to submit can be thoroughly cleaned with a
found at this website: http://kissingbug.tamu.edu/Contact/ 10% bleach and 90%
water solution.
• Harris County Public Health Mosquito and Vector Control: (713) 440-4800
When submitting a bug, let
the testing lab know:

Resources to learn more about Chagas disease and kissing bugs • Exactly where it was found
(inside or outside, city or
• Your State or Local Health Department county)
Texas-based resources:
• Your doctor for questions about Chagas disease • Texas Department of State Health Services: • Date it was found
and testing options http://dshs.texas.gov/idcu/disease/chagas/
• Time of day it was found
• The Centers for Disease Control and • Texas A&M Kissing Bug Citizen Science
Prevention (CDC): program: • If it was alive when found
https://www.cdc.gov/parasites/chagas/ http://kissingbug.tamu.edu
• What it was doing at the
• For PHYSICIANS interested in more information • Texas A&M Kissing Bug Control: time it was found
on diagnosis and treatment: http://citybugs.tamu.edu/factsheets/biting-
https://www.cdc.gov/parasites/chagas/ stinging/others/ent-3008/
health_professionals/index.html
• Texas Chagas Taskforce
• Center of Excellence for Chagas Disease: (website coming Summer 2018):
http://www.chagasus.org/ http://texaschagas.org
• Chagas Coalition:
http://www.coalicionchagas.org/en
6
Acknowledgements
T his document comprises the work of numerous authors and contributors and was developed under
the technical supervision of Dr. Paula Stigler Granados from the UTHealth School of Public Health in
San Antonio, Texas. We would like to thank the many scientists, public health professionals, and all of
the Texas Chagas Taskforce members for their contributions and in particular the following authors who
helped to draft the various sections of this document.

Content expertise and review:

Sarah A. Hamer, DVM, PhD Rachel Curtis-Robles, PhD

Gabriel Hamer, PhD, MS Wizzie Brown, MS, BCE

Mustapha Debboun, PhD, BCE Kathryn S. Aultman, PhD

Susan P. Montgomery, DVM, MPH William Courtney, DVM, MPH, MA

Kelly K. Stimpert, MPH Paula E. Stigler Granados, PhD, MSPH
Bonny C. Mayes, MA Gerardo J. Pacheco, MPH, MS
Justin Bejcek, BS, MS

Photographs and images:

Texas A&M — Gabriel Hamer, Rachel Curtis-Robles, Justin Bejcek, & Rachel Bardin

Edward Wozniak, MPH, PhD, DVM

Walter D. Roachell, MS

We would like to thank the following organizations:

Harris County Public Health Department

Texas Department of State Health Services

Texas A&M Veterinary Medicine & Biodmedical Sciences

Texas A&M AgriLife Extension

This document was supported by the Cooperative Agreement Number, 1U2GGH001640-01, funded
by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the
authors and do not necessarily represent the official views of the Centers for Disease Control and
Prevention or the Department of Health and Human Services

@TexasChagasTaskforce @ChagasTexas