WEBVTT - Ep 81 Chagas disease: The Reverse Triple Discovery 0:00:02.320 --> 0:00:06.439 My name is Daisy Hernandez and I'm an associate professor 0:00:07.080 --> 0:00:10.720 at Miami University in Ohio. And I'm also the author 0:00:10.880 --> 0:00:14.120 of a book about Shaga's disease called The Kissing Bug, 0:00:14.200 --> 0:00:16.919 A true story of an insect, a family, and a 0:00:17.000 --> 0:00:21.280 nation's neglect of a deadly disease. I first learned about 0:00:21.320 --> 0:00:24.880 Shaga's disease when I was about five years old. My 0:00:25.000 --> 0:00:28.880 auntie was diagnosed with Shagas in New York City actually, 0:00:29.520 --> 0:00:33.600 and she was from Colombia where around the time that 0:00:33.680 --> 0:00:36.400 she was twenty nine, she started to get really seriously 0:00:36.520 --> 0:00:40.559 sick and the doctors in Colombia were able to do 0:00:40.640 --> 0:00:44.479 some exploratory surgery, which is how they found out that 0:00:44.640 --> 0:00:48.680 her large intestine was under some kind of attack. They 0:00:48.680 --> 0:00:52.440 actually did not diagnose her with Shaga's disease. It was 0:00:52.479 --> 0:00:55.640 in New York City that that happened. And my auntie 0:00:55.800 --> 0:00:59.400 was very lucky that she was diagnosed and she was 0:00:59.440 --> 0:01:04.080 able to to receive some interventionist kind of treatment at 0:01:04.080 --> 0:01:08.080 that point. But you know, she had chronic Shagas disease 0:01:08.480 --> 0:01:11.520 for the next almost three decades of her life, and 0:01:11.560 --> 0:01:14.520 so she well, I was growing up, she was in 0:01:14.560 --> 0:01:18.240 and out of hospitals over the years, and sometimes she 0:01:18.319 --> 0:01:21.399 was in the hospital for one night or two nights, 0:01:21.600 --> 0:01:24.080 and some years she was in the hospital for a 0:01:24.120 --> 0:01:28.160 month or two. The parasite ended up not only affecting 0:01:28.200 --> 0:01:31.880 her large intestine but also her esophagures. She had multiple 0:01:31.920 --> 0:01:37.600 surgeries during these years, and I grew up thinking that 0:01:38.240 --> 0:01:43.280 Shaga's disease was a very rare or unusual illness. I 0:01:43.280 --> 0:01:47.800 thought my Auntie had just been extremely unlucky. And it 0:01:47.960 --> 0:01:53.080 was not until twenty ten when she became very very 0:01:53.120 --> 0:01:57.720 ill and actually died from this disease. That was the 0:01:57.760 --> 0:02:01.680 point at which I started asking questions about Shaga's disease. 0:02:02.280 --> 0:02:05.520 I think because I had grown up without knowing anyone 0:02:05.560 --> 0:02:09.360 else who had this disease except my Auntie, I thought 0:02:09.360 --> 0:02:11.880 it was rare, and I was really surprised to find 0:02:11.919 --> 0:02:14.959 out that there were that there are an estimated three 0:02:15.000 --> 0:02:18.480 hundred thousand people in the United States who have Shaga's disease, 0:02:18.560 --> 0:02:21.400 and they're like my Auntie's. They're immigrants from South America, 0:02:21.560 --> 0:02:25.560 Central America, and Mexico. And that number was very shocking 0:02:25.639 --> 0:02:30.240 to me, and it made me wonder who these families were. 0:02:30.960 --> 0:02:34.000 And that's how I ended up starting my book actually 0:02:34.200 --> 0:02:37.880 was that I wanted to meet other LATINX families in 0:02:37.919 --> 0:02:41.440 the United States to find out what their experiences with 0:02:41.560 --> 0:02:45.720 Shaga's disease were like, and what obstacles they were facing, 0:02:46.000 --> 0:02:50.120 and just how they were navigating the medical system in 0:02:50.160 --> 0:02:53.239 this country, given that, as far as I knew, was 0:02:53.280 --> 0:02:58.160 a very neglected disease, and something that I discovered while 0:02:58.160 --> 0:03:00.200 working on the book that I did not know know 0:03:00.240 --> 0:03:04.520 about when I was a child was the issue of 0:03:04.560 --> 0:03:09.000 congenital Shaga's disease. I met an incredible woman in the DC, 0:03:09.200 --> 0:03:13.840 Maryland area named Janet, who is from South America and 0:03:14.240 --> 0:03:17.960 her second son was born here in the United States 0:03:18.840 --> 0:03:23.160 with congenital shagus She herself knew about the disease. Similar 0:03:23.200 --> 0:03:26.280 to me, she thought that it was an affliction of Actually, 0:03:26.320 --> 0:03:28.400 in her case, she thought it was the elderly because 0:03:29.080 --> 0:03:31.480 she knew her father had Shaga's disease. She knew her 0:03:31.520 --> 0:03:35.280 older sister had Shaga's disease. She comes from a part 0:03:35.280 --> 0:03:38.600 of South America where the disease is pretty common, but she, 0:03:38.880 --> 0:03:41.480 even though it's common, she did not know about congenital 0:03:41.520 --> 0:03:45.320 Shagas disease and her son was born already having cardiac 0:03:45.400 --> 0:03:49.800 complications due to the disease. I'm happy to share that 0:03:49.880 --> 0:03:54.000 the baby is now gosh now five or six years old, 0:03:54.080 --> 0:03:58.120 and is very much is doing well. But he was 0:03:58.160 --> 0:04:01.000 a very unusual case. He ended up being only the 0:04:01.120 --> 0:04:05.600 second documented case of congenital Shagas disease in the United States, 0:04:06.120 --> 0:04:08.960 and he was unusual just in that he showed symptoms. 0:04:09.720 --> 0:04:15.760 Her situation, though, also really touched me because she herself 0:04:16.120 --> 0:04:20.680 did not have health insurance. She was not working, she 0:04:20.760 --> 0:04:22.920 had a toddler and a new baby, and she was 0:04:23.000 --> 0:04:26.520 home and her husband worked in construction, and she did 0:04:26.680 --> 0:04:30.279 qualify for the Affordable Care Act or for Obamacare, but 0:04:30.400 --> 0:04:31.960 she had not signed up for it, and it's an 0:04:31.960 --> 0:04:35.479 additional expense that the family would have to bear, and 0:04:35.600 --> 0:04:41.320 so she really struggled to actually find a medical provider 0:04:41.360 --> 0:04:44.039 who could diagnose her, who could work with her. It 0:04:44.240 --> 0:04:48.760 was a series of obstacles that I kept hearing over 0:04:48.800 --> 0:04:50.719 the years that I worked on this book, while I 0:04:50.760 --> 0:04:54.120 was talking to both families and medical providers. Is this 0:04:54.279 --> 0:04:59.120 constellation of obstacles not having health insurance, not being fluent 0:04:59.200 --> 0:05:04.000 in English, sometimes being fluent in English, but really struggling 0:05:04.520 --> 0:05:07.360 to advocate for yourself with a medical provider who doesn't 0:05:07.400 --> 0:05:11.919 know about the disease and doesn't understand or isn't being proactive. 0:05:13.200 --> 0:05:17.200 And also something else which came up often, which is 0:05:17.240 --> 0:05:21.919 that you know, if patients aren't experiencing symptoms, they have 0:05:22.040 --> 0:05:24.760 so many other things that feel more urgent and are 0:05:24.800 --> 0:05:28.359 more urgent in some ways in their lives. Like in 0:05:28.480 --> 0:05:31.760 Janet's case, she was, you know, very concerned about her 0:05:31.880 --> 0:05:35.640 child's welfare before her own. She was concerned obviously about 0:05:35.640 --> 0:05:40.880 her family's financial life. She herself has a legal residency, 0:05:41.040 --> 0:05:44.640 but was trying to learn English to work towards citizenship. 0:05:45.400 --> 0:05:48.040 Other families that I interviewed, you know what felt more 0:05:48.160 --> 0:05:51.880 urgent in their lives were the immigration status of different 0:05:51.960 --> 0:05:56.919 family members and job security always comes up, and so 0:05:57.000 --> 0:06:00.800 it's easy it becomes easy to actually ignore or Shaga's 0:06:00.880 --> 0:06:03.640 disease in a way because they're not having symptoms and 0:06:03.960 --> 0:06:09.080 it's not the most pressing concern in their lives. Although 0:06:10.000 --> 0:06:12.480 I knew about this disease from a very young age, 0:06:12.520 --> 0:06:15.400 there was a kind of stigma in my family around it. 0:06:15.480 --> 0:06:19.240 My auntie never wanted anyone to know about this. 0:06:19.200 --> 0:06:20.600 Disease, that she had it. 0:06:21.360 --> 0:06:26.000 She was really afraid, I think, as an immigrant, to 0:06:26.040 --> 0:06:29.720 be rejected in some way by her coworkers, by this country, 0:06:29.839 --> 0:06:33.360 by you know. Just she wanted so much, I think, 0:06:33.440 --> 0:06:38.359 to be the perfect immigrant turned citizen, and in so 0:06:38.440 --> 0:06:41.200 many ways she was. She got her teaching degree, she 0:06:41.360 --> 0:06:45.000 taught Spanish in a public school system in New Jersey. 0:06:45.080 --> 0:06:49.440 She got her master's degree as well. She traveled, she 0:06:49.520 --> 0:06:53.080 married an incredible man. She had such a wonderful life 0:06:53.080 --> 0:06:57.440 in so many ways, and she didn't want to have 0:06:57.480 --> 0:07:00.880 this disease and felt like it tarnished I think when 0:07:00.880 --> 0:07:04.359 I was growing up, I thought it was very normal 0:07:04.440 --> 0:07:06.880 that we did not talk about Shaga's disease. We did 0:07:06.880 --> 0:07:08.960 not tell anyone that my Auntie hadd We did not 0:07:09.120 --> 0:07:11.960 mention it. It definitely felt like something that we were 0:07:11.960 --> 0:07:16.720 supposed to have shame around. And now I look back 0:07:16.760 --> 0:07:19.360 on that was so much sadness because it was just 0:07:20.080 --> 0:07:22.920 a lack of information for my own family. It was 0:07:22.920 --> 0:07:25.440 a lack of information of course, in the healthcare community 0:07:25.440 --> 0:07:28.600 in the United States. The one sadness that I have 0:07:28.880 --> 0:07:31.800 is that I do wish my auntie had lived so 0:07:31.840 --> 0:07:33.360 that I could tell her a lot of what I 0:07:33.440 --> 0:07:36.280 learned about the disease, you know, even the difficult parts 0:07:36.320 --> 0:07:39.480 of this, you know, even the learning about congenital shaugus, 0:07:39.480 --> 0:07:41.520 Like I wish I could have told her that. I 0:07:41.560 --> 0:07:44.560 wish that I could have told her more about just 0:07:44.840 --> 0:07:47.920 all these you know, species of this insect, of the 0:07:47.960 --> 0:07:50.720 triotomine insect. I wish I could have told her about that. 0:07:50.760 --> 0:07:53.920 Even though she hated insects, she would not have wanted 0:07:53.960 --> 0:07:57.600 to probably hear that much detail. But I do wish, 0:07:57.640 --> 0:08:00.440 and I do have sadness that I could have told her, 0:08:00.480 --> 0:08:05.280 because I think that ultimately she died knowing very little 0:08:05.320 --> 0:08:08.560 about her disease. And so for me, part of working 0:08:08.600 --> 0:08:10.960 on the on the book was also a desire that 0:08:11.200 --> 0:08:15.280 people who have shagas and their families have a chance 0:08:15.320 --> 0:08:18.640 to know what they're really facing, you know, and and 0:08:18.720 --> 0:08:20.600 so that you know, no one else should have to 0:08:20.680 --> 0:08:25.280 die without knowing about their own disease and what's happening 0:08:25.320 --> 0:08:26.120 to their bodies. 0:09:11.600 --> 0:09:14.360 Thank you so much, Daisy for taking the time to 0:09:14.800 --> 0:09:17.319 come on the podcast and chat with us. We really 0:09:17.320 --> 0:09:18.079 appreciate it. 0:09:18.280 --> 0:09:22.199 Yeah, thank you. Hi. I'm erin Welsh and I'm erin 0:09:22.240 --> 0:09:23.920 Allman Updike and this. 0:09:23.880 --> 0:09:25.920 Is this podcast Will Kill You. 0:09:26.600 --> 0:09:33.840 And today we're talking about shaugust disease shawgust disease. I okay, listen, erin, 0:09:35.520 --> 0:09:38.160 how do you feel right now? I'm feeling a lot 0:09:38.200 --> 0:09:44.000 of different feelings, like I'm just I'm full of feelings. Okay, okay, listeners. 0:09:44.840 --> 0:09:48.640 You probably don't know this, but I technically did my 0:09:48.760 --> 0:09:57.600 PhD research on shaugust disease technically technically. Yeah, So it 0:09:57.679 --> 0:09:59.839 feels like I feel like I'm just gonna feel like 0:09:59.840 --> 0:10:01.880 I didn't do a good job on this no matter what, 0:10:02.040 --> 0:10:03.400 Like I just don't know enough. 0:10:04.440 --> 0:10:07.640 I mean, well, first of all, you do, you literally 0:10:07.679 --> 0:10:13.200 have a PhD in different aspects of shaugas disease. Yeah, 0:10:13.240 --> 0:10:16.400 And secondly, you know we are It's like we say 0:10:16.480 --> 0:10:18.800 every episode we are not experts. 0:10:19.040 --> 0:10:19.720 No, we're not. 0:10:20.360 --> 0:10:22.920 And this is a really big one to cover, like 0:10:23.040 --> 0:10:24.280 it massive. 0:10:24.280 --> 0:10:27.880 It is, it's so it's so big. I'm excited about it. 0:10:27.920 --> 0:10:29.079 But it's gonna be big. 0:10:29.320 --> 0:10:31.720 Yeah. But also, Aarin, you're gonna do a great job. 0:10:31.800 --> 0:10:33.040 I know what you always do. 0:10:33.320 --> 0:10:41.840 Oh, Aaron, You're so nice. I'm serious, I think before 0:10:41.880 --> 0:10:45.319 we really get into it, though, it's definitely quarantin any time. 0:10:45.640 --> 0:10:49.080 It is it is. What are we drinking this week? 0:10:49.480 --> 0:10:51.760 We're drinking the Kiss good Night. 0:10:52.320 --> 0:10:58.960 And it's It's called this because shaugas disease is transmitted 0:10:59.040 --> 0:11:01.679 by what are commonly called, or one of the names 0:11:01.679 --> 0:11:04.880 for them are is kissing bugs. And what they do 0:11:05.280 --> 0:11:09.679 is they feed on you and animals, mostly while you're sleeping, 0:11:09.720 --> 0:11:13.800 and they suck your blood and that's how you get 0:11:13.800 --> 0:11:14.680 shagas disease. 0:11:15.040 --> 0:11:19.000 It sure is so aarin. What's in a kiss goodnight? 0:11:20.280 --> 0:11:27.200 In the kiss goodnight is tequila, of course, canalope mm hmm, 0:11:27.559 --> 0:11:32.079 agave syrup, lime and orange liqueur. 0:11:32.800 --> 0:11:36.760 Yum. Yeah, that sounds fantastic. We'll post the full recipe 0:11:36.760 --> 0:11:39.480 for that quarantine as well as our non alcoholic plusy 0:11:39.480 --> 0:11:41.719 berta on our website This podcast will Kill You dot 0:11:41.760 --> 0:11:44.240 com and all of our social media channels. 0:11:44.200 --> 0:11:50.000 Yeah other business, let's see. You can check out our 0:11:50.000 --> 0:11:52.960 website This podcast will Kill You dot com. It's got 0:11:53.040 --> 0:11:57.040 lots of great stuff, like transcripts, like the sources for 0:11:57.160 --> 0:12:00.800 all of our past episodes. It's got links to do music, 0:12:00.960 --> 0:12:05.080 to merge, to our Patreon, to our bookshop dot org 0:12:05.080 --> 0:12:10.280 affiliate account, to goodreads list, and so on. Definitely check 0:12:10.320 --> 0:12:14.839 out our website, And also remember that you can listen 0:12:14.880 --> 0:12:17.760 to this episode and all of our past and future 0:12:17.800 --> 0:12:22.640 episodes on Amazon Music, Apple, Stitcher, or wherever you get 0:12:22.640 --> 0:12:23.719 your podcasts. 0:12:24.160 --> 0:12:27.640 Before we get into this episode, speaking of the fact 0:12:27.720 --> 0:12:31.120 that we are not experts, I have a correction to make. 0:12:33.840 --> 0:12:37.240 Bartonella was an episode that came out a few episodes ago. 0:12:37.320 --> 0:12:43.200 Now I want to hugely thank multiple listeners that have 0:12:43.320 --> 0:12:46.040 reached out to help us solve the mystery of cat 0:12:46.080 --> 0:12:50.080 scratch disease that we were postulating about during that episode. 0:12:51.080 --> 0:12:53.000 In that episode, we were trying to figure out how 0:12:53.080 --> 0:12:56.760 bartonella makes it from a cat's blood onto their claws 0:12:56.880 --> 0:12:59.040 or their teeth and then into our bloodstream after a 0:12:59.040 --> 0:13:02.760 bite or a scratch. Okay, multiple people have written in 0:13:03.200 --> 0:13:06.800 It turns out, unsurprisingly when you really think about it, 0:13:06.800 --> 0:13:11.080 it is largely flea feces that are to blame. So 0:13:11.679 --> 0:13:16.680 infected flea feces or in some cases, just infected cat's 0:13:16.760 --> 0:13:21.600 blood itself, can contaminate a cat's claws during grooming, which 0:13:21.679 --> 0:13:24.600 then can introduce the bacteria via a scratch into our 0:13:24.679 --> 0:13:29.760 skin or a bite wound. Fe flee flea feces can 0:13:29.800 --> 0:13:31.680 contaminate a bite wound, et cetera. 0:13:32.400 --> 0:13:37.200 So mystery solved, Darren, flea feces say that three times fast. 0:13:36.800 --> 0:13:39.440 I can't. I couldn't even say it one. 0:13:39.920 --> 0:13:43.400 I also learned with the people who sent in those corrections, 0:13:43.440 --> 0:13:46.679 which was very helpful. Thank you that it's called flea dirt. 0:13:47.200 --> 0:13:47.360 Two. 0:13:47.559 --> 0:13:48.839 I blee dirt, flee dirt. 0:13:49.040 --> 0:13:49.520 I like it. 0:13:49.559 --> 0:13:52.199 It's easier to say than flea feces. Yeah, but it's 0:13:52.240 --> 0:13:54.480 also I know either way. 0:13:54.559 --> 0:13:59.000 Again, but thank you so much. Honestly, like we are 0:13:59.040 --> 0:14:01.640 not experts, so we know ever get everything one thousand 0:14:01.679 --> 0:14:04.560 percent right, So thank you. I appreciate getting to learn 0:14:04.559 --> 0:14:04.840 from you. 0:14:05.040 --> 0:14:11.040 Yeah, okay, okay with that, should we get started. 0:14:11.640 --> 0:14:13.959 I'm so nervous. Okay, let's take a break and then 0:14:14.000 --> 0:14:42.280 get into it. So. Shagus disease Shagus is a severely 0:14:42.400 --> 0:14:48.160 neglected tropical disease, historically very much considered a disease of poverty. 0:14:48.360 --> 0:14:52.320 Like many, if not all, neglected tropical diseases, and like 0:14:52.400 --> 0:14:55.680 you mentioned up top aarin, it's a vector born disease. 0:14:56.360 --> 0:15:00.720 For the most part, it's caused by a protozoan parasite 0:15:00.800 --> 0:15:06.880 called tripanasoma, cruisy or cruise. I take your pick, uh, 0:15:07.520 --> 0:15:11.880 Trypanosoma cruise ie. Tea cruiseye. It's a very cute little parasite. 0:15:12.320 --> 0:15:14.400 It has a little like looks kind of like a 0:15:14.520 --> 0:15:19.240 comma with like wavy flagella. Okay, okay, picture it's cute. 0:15:20.040 --> 0:15:23.400 So Tea cruise I has a shall we say, relatively 0:15:23.480 --> 0:15:26.840 complex life cycle. So we're gonna go through the life 0:15:26.840 --> 0:15:29.680 cycle and then from there we can understand the different 0:15:29.720 --> 0:15:33.240 ways that we as humans can get infected. So we'll 0:15:33.280 --> 0:15:36.800 start the life cycle in the bug, the insect vector 0:15:36.840 --> 0:15:40.040 that transmits it. So Tea cruise ie gets picked up 0:15:40.120 --> 0:15:43.640 during blood feeding by bugs like you mentioned aaron called 0:15:43.760 --> 0:15:48.080 kissing bugs aka triatomines. They have a lot of different 0:15:48.160 --> 0:15:52.240 names in different countries. Kissing bugs are a type of 0:15:52.240 --> 0:15:57.760 what's called true bug in the order amypdura. Okay, already, 0:15:57.760 --> 0:16:02.640 I'm on tangents. These are blood feeding insects. I think 0:16:02.680 --> 0:16:04.680 a lot of people might not know what they look like, 0:16:04.760 --> 0:16:08.440 so let me paint you a visual. They're pretty large bugs. 0:16:08.480 --> 0:16:11.520 The adults are like between three and four centimeters so 0:16:11.600 --> 0:16:15.040 a good inch inch and a half long, and they 0:16:15.120 --> 0:16:18.080 look like they have like a flat oval body with 0:16:18.160 --> 0:16:22.680 a pointy head and a long curved preboscis. That's the 0:16:22.760 --> 0:16:25.360 straw that they use to drink blood. So these are 0:16:25.720 --> 0:16:30.160 big honkin bugs. They're big, right, Like, way bigger than ticks, 0:16:30.480 --> 0:16:32.840 way bigger than mosquitoes, way bigger than most things that 0:16:32.960 --> 0:16:33.320 bite you. 0:16:33.440 --> 0:16:36.200 I would say, like, well, I mean, cockroaches are a 0:16:36.280 --> 0:16:39.560 whole different a whole bunch of different sizes. But yeah, 0:16:39.720 --> 0:16:43.000 like you know about the size of your average cockroach. 0:16:43.240 --> 0:16:46.840 Yeah, like your house, your US house cockroach. Yeah, definitely, 0:16:46.960 --> 0:16:52.120 if not bigger. Now, both males and females drink blood, 0:16:52.560 --> 0:16:55.280 as do all of the nymphal stages. So these are 0:16:55.320 --> 0:16:58.560 bugs that have multiple in star stages and they all 0:16:58.640 --> 0:17:02.400 blood feed. They often have like a nest that they 0:17:02.480 --> 0:17:05.000 stay near, but then the adults can fly, so they 0:17:05.000 --> 0:17:07.800 can fly farther from home base to look for blood meals. 0:17:08.280 --> 0:17:11.640 They have a nest, family nest or individual nest. 0:17:12.440 --> 0:17:16.560 Like little families or even like multi generation little families. 0:17:16.640 --> 0:17:18.360 Just like a lot of bugs will often hang out 0:17:18.400 --> 0:17:21.160 together in like a palm tree or whatever. 0:17:21.280 --> 0:17:22.320 Ooh, that's interesting. 0:17:22.840 --> 0:17:25.960 Yeah, so like a bunch of nymphs a bunch of adults, 0:17:26.000 --> 0:17:28.440 you might find a lot kind of living together. Okay, 0:17:28.440 --> 0:17:31.240 depending on the species. We'll I'll get into that later. Okay. 0:17:32.400 --> 0:17:36.240 So this bug takes a blood meal from someone, picks 0:17:36.320 --> 0:17:40.639 up a whole bunch of parasites. These parasites travel through 0:17:40.760 --> 0:17:47.400 the bugs guts, they differentiate, they replicate, and then when 0:17:47.400 --> 0:17:50.919 that bug gets hungry again and goes to take another 0:17:51.000 --> 0:17:55.959 blood meal, that bug will poop, and in that poop 0:17:56.480 --> 0:18:01.080 or frasts are a whole bunch of parasites, not unlike 0:18:01.119 --> 0:18:02.480 the fleas in Bartonella. 0:18:02.560 --> 0:18:03.520 Hey. 0:18:03.640 --> 0:18:08.760 Yeah, And then these parasites that are now pooped onto 0:18:08.800 --> 0:18:11.480 your skin have to find their way either into that 0:18:11.600 --> 0:18:14.760 bite wound that the bug just made or some other 0:18:14.880 --> 0:18:17.879 mucus membrane like your eye or your mouth, et cetera. 0:18:19.080 --> 0:18:22.639 And from there they make it into our bloodstream. You 0:18:22.680 --> 0:18:24.520 look like you have a questionnairein. 0:18:24.119 --> 0:18:25.159 I do have a question. 0:18:25.320 --> 0:18:25.760 Okay. 0:18:26.200 --> 0:18:31.320 So they're pooping while they're eating, or shortly thereafter or 0:18:31.359 --> 0:18:34.040 shortly after. And so the poop that they have that 0:18:34.080 --> 0:18:37.520 they're pooping out is from the fresh meal or from 0:18:37.600 --> 0:18:38.600 the previous meal. 0:18:39.040 --> 0:18:41.160 Great question, It's from the previous meal. 0:18:41.280 --> 0:18:44.679 Yeah, And how often do they have to feed? 0:18:46.200 --> 0:18:49.800 Great question? Totally varies by species and by life stage, 0:18:49.880 --> 0:18:53.600 so at least once per nymphl stage, and then as adults, 0:18:53.600 --> 0:18:55.760 like the females have to feed every time that they're 0:18:55.760 --> 0:18:57.520 going to make a clutch of eggs. So it kind 0:18:57.520 --> 0:19:02.320 of just depends. Okay, gotcha, Yeah, good questions, Aaron. Okay, 0:19:03.480 --> 0:19:06.040 So now this parasite is inside of us, that made 0:19:06.080 --> 0:19:10.240 it into our bloodstream. Inside of us, these parasites penetrate 0:19:10.320 --> 0:19:14.159 our cells. They actually can penetrate a pretty wide variety 0:19:14.320 --> 0:19:17.920 of cells, and what cells or what tissue type they 0:19:17.960 --> 0:19:22.760 infect can then lead to different symptoms of disease. They replicate, 0:19:22.800 --> 0:19:27.400 they differentiate again inside our cells, they replicate a whole bunch, 0:19:27.840 --> 0:19:32.040 and then they burst out from our cells to travel 0:19:32.040 --> 0:19:36.400 through our bloodstream and either infect another cell and start 0:19:36.440 --> 0:19:39.199 a new replication cycle to just keep going, or in 0:19:39.240 --> 0:19:42.720 the bloodstream they can be picked up by another kissing bug, 0:19:43.440 --> 0:19:46.960 thus completing their life cycle. So that's just like the 0:19:47.000 --> 0:19:48.679 life cycle of tea cruise eye. 0:19:48.920 --> 0:19:51.560 Yeah, I mean it's a complicated one. 0:19:51.680 --> 0:19:53.640 Yeah, it's part one of complication. 0:19:54.240 --> 0:19:55.600 Yeah. 0:19:56.160 --> 0:20:02.080 But what I'm in my very bias opinion. What's also 0:20:02.240 --> 0:20:05.919 very important and interesting about the Shagas disease story is 0:20:06.000 --> 0:20:11.640 how complex the ecology of this disease is I'm biased, 0:20:11.680 --> 0:20:14.440 but I think listeners will agree once I get into it. 0:20:16.119 --> 0:20:20.679 So this is one parasite, right, Tripanosoma cruisy, But it 0:20:20.760 --> 0:20:25.240 has like six different clades within this species. And these 0:20:25.240 --> 0:20:29.440 different clades vary in terms of virulence, so how sick 0:20:29.480 --> 0:20:33.280 they make you and disease manifestations, what tissues there may 0:20:33.320 --> 0:20:36.120 be more likely to infect, or how likely they are 0:20:36.160 --> 0:20:41.040 to cause more chronic disease. And these different clades can 0:20:41.160 --> 0:20:46.040 vary in geography, they can vary by vector. There's a 0:20:46.080 --> 0:20:49.639 lot of variation in these different clades of T. Cruizy. 0:20:51.280 --> 0:20:54.080 Then there's the vector. And I hinted at this already, 0:20:54.960 --> 0:20:58.080 so I said that it's a triatomine a kissing bug, 0:20:58.320 --> 0:21:00.840 but aarin is it just one bug? 0:21:01.480 --> 0:21:03.800 No, Aaron, it's many bugs. 0:21:03.880 --> 0:21:05.760 It is many bugs. 0:21:07.000 --> 0:21:08.680 So it's a lot, Yeah, it is. 0:21:09.000 --> 0:21:11.680 So there's like one hundred and thirty eight. I think 0:21:12.160 --> 0:21:19.959 maybe more species of triatomine everyone could potentially transmit Tripanosoma crusy. 0:21:20.960 --> 0:21:25.240 There's at least three species that are often cited as 0:21:25.280 --> 0:21:30.720 being the most important. One in particular, Triatoma infestins is 0:21:30.720 --> 0:21:35.520 a species that's most closely associated with human dwellings. It 0:21:35.560 --> 0:21:40.440 has adapted to live its entire life cycle within human dwellings, 0:21:40.480 --> 0:21:45.040 so in walls, in roofs, inside of our homes. So 0:21:45.440 --> 0:21:49.280 historically that's been the one considered kind of the biggest deal. 0:21:49.760 --> 0:21:53.439 But there's a lot of other species in a whole 0:21:53.440 --> 0:21:58.119 bunch of different genera of triatomine that are capable of 0:21:58.359 --> 0:22:03.679 and potentially important of Shaugus disease. Spoiler, that was like 0:22:03.760 --> 0:22:07.160 my whole dissertation. So like I could go on and on, 0:22:09.400 --> 0:22:13.280 but I think I can pause there. Okay. Each of 0:22:13.320 --> 0:22:16.639 these species has differences in terms of their ecology, so 0:22:16.760 --> 0:22:19.040 like where they like to live. Do they live in 0:22:19.080 --> 0:22:22.200 palm trees or do they live under rocks, et cetera. 0:22:22.760 --> 0:22:24.840 They have differences in terms of who they like to 0:22:24.880 --> 0:22:27.800 feed on, and like you asked Aaron, how often they feed, 0:22:28.800 --> 0:22:31.440 they have differences in how long they feed for, how 0:22:31.560 --> 0:22:34.800 soon after feeding they take a poop, and where they 0:22:34.840 --> 0:22:39.200 take a poop after feeding. It's really really complicated. 0:22:39.880 --> 0:22:42.200 Yeah, I mean, all of this just kind of serves 0:22:42.240 --> 0:22:47.280 to like underline how difficult this is to control or 0:22:47.320 --> 0:22:50.879 to prevent or to like reduce the numbers of it's 0:22:50.960 --> 0:22:52.640 It's sort of like you have to hit it from 0:22:52.720 --> 0:22:54.640 so many different angles and right. 0:22:55.200 --> 0:22:58.360 Yeah, yeah, and to throw one last angle on their 0:22:58.520 --> 0:23:01.720 erin this isn't a human in specific disease. This is 0:23:01.720 --> 0:23:05.159 a parasite that infects over one hundred and fifty species 0:23:05.200 --> 0:23:10.160 of mammal h all right, So that's the lot that's 0:23:10.200 --> 0:23:15.679 really complicated. So we know that in general, this is 0:23:16.160 --> 0:23:20.439 a group of insects and therefore parasite and disease that 0:23:20.960 --> 0:23:24.639 was typically considered endemic to the New World, so North 0:23:24.720 --> 0:23:28.440 Central and South America and mostly just the southern part 0:23:28.440 --> 0:23:31.480 of North America because it's really restricted to more tropical 0:23:31.520 --> 0:23:36.240 type latitudes. But as we'll see when we talk about 0:23:36.280 --> 0:23:39.000 the clinical picture of disease, which I promise I'm about 0:23:39.040 --> 0:23:42.040 to get to, because of the way that Shaugus disease 0:23:42.080 --> 0:23:46.359 manifests clinically, it is a global disease today. It is 0:23:46.440 --> 0:23:49.639 not limited to South America or even just the Americas. 0:23:49.720 --> 0:23:55.280 So let's talk symptoms in humans. Shagas disease has two forms, 0:23:55.720 --> 0:23:59.280 the acute disease like you get sick shortly after getting infected, 0:23:59.640 --> 0:24:04.240 and then a chronic disease. This parasite can lay dormant 0:24:04.240 --> 0:24:09.000 in our bodies for decades ten twenty thirty years and 0:24:09.080 --> 0:24:13.000 then pop up and cause disease very long down the road. 0:24:13.520 --> 0:24:16.119 So we'll go through those one by one. In the 0:24:16.160 --> 0:24:22.240 acute phase. Honestly, shacus is mostly asymptomatic, and by mostly 0:24:22.280 --> 0:24:25.560 I mean ninety ninety five percent of the time completely asymptomatic. 0:24:26.800 --> 0:24:29.920 So you get bit, you scratch this parasite into your bloodstream, 0:24:29.960 --> 0:24:33.200 and you don't know about it at all. If people 0:24:33.320 --> 0:24:35.639 do have symptoms, so that five to ten percent of 0:24:35.680 --> 0:24:39.320 people that do have symptoms, they're often quite mild and 0:24:39.440 --> 0:24:44.040 consist of something like maybe some fever, maybe inflammation wherever 0:24:44.119 --> 0:24:48.520 the parasites entered. And because it's common for the parasites 0:24:48.560 --> 0:24:51.440 to enter via something like your eye, there's a classic 0:24:51.520 --> 0:24:55.280 sign that's called Romagna's sign, which is when one eye 0:24:55.359 --> 0:24:59.120 whichever i the parasites win in from, gets really swelling 0:25:00.400 --> 0:25:04.480 swelling of your eye and eyelid. But it could be anywhere. 0:25:04.520 --> 0:25:06.800 So let's say it happened on your arm, then maybe 0:25:06.840 --> 0:25:11.560 your arm swells up. Occasionally you might also get some 0:25:12.000 --> 0:25:16.879 hepatosplenomegaly one of our favorite, oh my words. Yeah, so 0:25:17.000 --> 0:25:20.960 that's swelling of your liver and spleen from the parasite 0:25:21.000 --> 0:25:26.920 and inflammation and immune response associated with it, or swelling 0:25:26.960 --> 0:25:31.240 of any various lymph nodes. Potentially it can cause things 0:25:31.320 --> 0:25:34.680 like anemia if it gets more severe, and in very 0:25:34.800 --> 0:25:39.119 rare instances, like I think, usually only one to five 0:25:39.200 --> 0:25:41.440 percent of the time, although one paper I read said 0:25:41.520 --> 0:25:44.360 five to ten percent. It can be a little bit 0:25:44.359 --> 0:25:47.960 more severe, and the specific symptoms depend on which organ 0:25:48.119 --> 0:25:51.040 is infected severely. So if it's the heart, we can 0:25:51.080 --> 0:25:55.040 see things like myocarditis or pericarditis, inflammation of the heart 0:25:55.119 --> 0:25:59.639 muscle or lining very rarely. If it infects the brain, 0:25:59.800 --> 0:26:03.760