A new night stalker: Beware the kissing bug, the stealthy 6-legged menace to health

By Liz Meszaros, MDLinx
Published July 17, 2018

Key Takeaways

Kissing bugs? Chagas disease? Chances are if you've heard of this insect and the relatively rare disorder it transmits, you live in the southern United States.

Updated with new photo July 24, 2018.

Chagas disease—also known as American trypanosomiasis—is a potentially fatal disease carried by triatomine bugs, also known as kissing bugs, reduviid bugs, or assassin bugs. These blood-sucking insects harbor a parasite, Trypanosoma cruzi, which they transmit to their victims. The disease is considered a "silent killer" because its symptoms are often subtle.

"There's still a widespread lack of knowledge about the insects that carry the parasite and this neglected disease, which often at first shows no signs whatsoever. Most people aren't even aware of Chagas, let alone that it exists here in the United States," said Paula Stigler-Granados, PhD, assistant professor at UTHealth School of Public Health in San Antonio, TX. "We aim to change that by telling people all about it because early diagnosis and treatment are absolutely vital to avoid its potentially debilitating, even deadly, effects."

Kissing bugs were named after their proclivity for biting victims around the mouth or eyes while they sleep. They can, however, bite anywhere on the body. They transmit T. cruzi through their feces, which can contaminate the bite wound, especially when scratched. Transmission can be congenital as well, or occur through contaminated blood products, transplants, and more rarely, contaminated food and beverages.

Once infected, people may have no symptoms or signs that they have contracted the disease for years or even decades. In those who do show symptoms, they are often centered on the cardiac or digestive systems.

"This mysterious disease itself does not present with a lot of symptoms initially, if any at all. You may have a spot or a welt from the bite, or you experience mild flu-like symptoms," said Dr. Stigler-Granados said. "Ultimately Chagas can progress to the chronic symptomatic phase, which typically manifests itself as heart disease, although gastrointestinal disease is also possible."

Although it is treatable if caught early, Chagas disease can cause heart failure, an enlarged heart, or even stroke if it goes undetected.

Far ranging effects

Experts estimate that Chagas disease affects more than 7 million people worldwide and is most prevalent in Latin America. In the United States, however, an estimated 300,000 people are affected. The US Food and Drug Administration (FDA) has classified Chagas as a neglected tropical disease. Benznidazole and nifurtimox are used to treat infection with T. cruzi.

Dr. Stigler-Granados is head of the Texas Chagas Task Force, which recently published a new image-based guide to help raise awareness of Chagas disease and the kissing bugs that spread it. The guide was sponsored by a grant from the Centers for Disease Control and Prevention to conduct outreach and education on Chagas disease in Texas.

According to Dr. Stigler-Granados, everyone should be able to recognize the kissing bug and be aware that if they have been bitten or exposed to one, they must seek testing immediately.

Kissing bugs are active from May to October. These bugs tend to come out at night and are attracted by lights. Their habitats include underneath porches, under cracked cement, under rocks, dog houses/kennels, chicken coops, and rodent nests. These insects should never be handled with bare hands or crushed because of the T. cruzi it carries within its gut.

Clinicians and veterinarians also play a critical role in spreading awareness.

"Everyone, especially in Texas, should know what these insects look like, how to avoid them, and what to do if they happen to find one in or around their homes. It's a complete myth that they are only found in mud huts. We see them everywhere, including million-dollar homes," said Dr. Stigler-Granados. "This is an important guide, not only for the general public but also for physicians and veterinarians who are often on the frontline of talking with the public about the disease."

What are kissing bugs?

Photo: UTHealth, Gabriel Hamer.

  • Kissing bugs feed on humans and wild and domesticated animals, including dogs, wildlife, and chickens.
  • They are members of the "true bug" group of insects.
  • Kissing bugs can be large or small, with adults ranging from 0.5 to 1.25 inches long; most are about the size of a quarter.
  • All are brown and/or black, and most species found in the United States have orange or red stripes or solid orange or light brown around the outside of their bodies.
  • Their mouthparts look like a large needle and are tucked under the body when at rest.
  • Kissing bugs have long thin legs, with no bulges.
  • They are slightly flat, with long, thin heads.

Where are kissing bugs found in the United States?

  • Kissing bugs were found and documented in the United States as early as the mid-1800s.
  • Chagas disease was named after the Brazilian physician Carlos Chagas, who discovered it in 1909.
  • In the United States, there are 11 different species of kissing bugs, and most have an orange or red band around the sides of the body.
  • Beginning in 2017, five states in the United States required physicians to report Chagas cases to their state health department: Arizona, Arkansas, Louisiana, Tennessee, and Texas.
  • Since 2007, most US blood banks have been screening first-time blood donors for T. cruzi infection.

What to do with kissing bugs?

  • Never touch or crush kissing bugs.
  • Use a glove or small plastic bag to collect it and store it in a sealed plastic bag, an empty medicine vial, or a small container.
  • Clean surfaces where kissing bugs may have been in contact with a solution of 10% bleach/90% water.
  • Record where it was, the date, the time, whether the bug was alive or dead, and what the bug was doing when you found it.
  • Submit it to your state health department for testing. Bugs will only be tested if they were found inside the home or are suspected to have bitten someone.
  • In Texas, if the bug was found outside the home and not suspected of biting anyone, send it to Texas A&M University Kissing Bug Citizen Science Program.

How can you eradicate kissing bugs?

Photo: UTHealth, Rachel Curtis-Robles.

  • Seal cracks and openings in the home, particularly around windows and doors.
  • Elevate all woodpiles and keep them away from your home.
  • Remove all piles, excess leaves, and animal nests/burrows from your property.
  • Keep your chimney flues closed when not in use.
  • Take measures to eradicate rodents that may live under or near your home.
  • At night, bring your pets indoors, and check their bedding regularly.


Chagas Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/parasites/chagas/index.html. Accessed July 9, 2018.

Kissing Bugs & Chagas Disease: What You Need To Know. UTHealth, School of Public Health, San Antonio, Texas A&M University. https://drive.google.com/file/d/1reLPQ9LOm2Z7dbC3UPVKfuYNzwkYXwPF/view. Accessed July 3, 2018.

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