Yikes. What’s in That Drink?

Animals and humans most commonly acquire Chagas disease through the bite of a kissing bug infected with Trypanosoma cruzi (T. cruzi). But that’s not the only way to become infected. In a new study, authors warn of outbreaks of orally acquired Chagas disease in Brazil, Venezuela, Colombia, Bolivia, and French Guyana. In these cases, people became infected through beverages or foods contaminated by kissing bug feces. Orally transmitted infections are acute and potentially fatal.

Drinks or foods can be contaminated when a kissing bug is attracted to, and gets into, a fruit drink or food. When a human host drinks or eats the food, it might contain an entire insect, a crushed one, or its feces, and the T. cruzi protozoa can survive many hours at room temperature or even when refrigerated. The result is a whopping dose of T.cruzi flagellates—more than 600,000—able to infect whoever eats or drinks the substance.

Orally transmitted Chagas has more severe symptoms than vector-transmitted Chagas disease. It has a much shorter incubation period and it bypasses the body’s skin-level defenses. The skin’s dendritic cells induce a primary immune response by capturing antigens from invading bodies. They also move to lymph tissue to help shape the body’s adaptive response. Oral ingestion allows the protozoa to completely bypass dendritic cells and move into the bloodstream directly from the GI tract.

Often, there is a cluster of cases in a single household from sharing contaminated food. Victims experience early heart disease including cardiac arrhythmias, congestive heart failure, buildup of excess fluid around the heart, and excess fluid in the lungs. In vector-transmitted cases, when a bug bites the patient, the mortality rate ranges from 5-10%. In orally transmitted cases the mortality rate is 8-35%. There is often swelling of the face and lower extremities, accompanied by symptoms similar to gastroenteritis.

Travellers to South America should avoid risky beverages, like fruit juices including guava juice, bacaba, babaçu and palm wine (vino de palma), açai pulp, and sugar cane juice, as well as wild animal meats that may be contaminated with T. cruzi. Even when you’re not planning to travel, pay close attention to products containing these substances and be sure to keep containers sealed.