Jesica López (left) with her mother, Gladys / © Paula Trolliet
A Day in the Life: Jesica López
Battling Chagas in ArgentinaFourteen-year-old Jesica López has a curable disease that one day may kill her. In 2009, the strong, healthy-looking teen tested positive for Chagas—a tropical parasitic disease that can cause heart failure and sudden death. Jesica was one of 12 infected students, out of 43, at her school in the small rural village of Cancha Larga, in the province of Chaco, Argentina.
After finding out she was positive for Chagas, she started taking Benznidazole, an antiparasitic drug that would likely have cured her in two months. After 30 days of treatment, Jesica stopped taking her medicine, which is provided free at a local clinic. “I ran out of pills and never went to get more,” she says with a shy smile.
Jesica’s decision to stop taking those pills is a serious one. Chagas treatment is highly successful in children, but much less so in adults. Chagas is the most important endemic parasitic disease in Argentina: approximately two million people are infected and about 15 die each week. In Pampa del Indio, a town near Cancha Larga, up to 30 percent of the population has Chagas. Most patients, however, don’t know they carry the disease, and those who do are largely unconcerned.
Jesica doesn’t know how she got infected. She likely acquired the parasites from a vinchuca, or kissing bug, the blood-sucking Triatomine insect that typically transmits the disease. Although her family’s mud-floored, thatched house is now free of vinchucas, this type of construction favors vinchuca infestation. Or she could have caught Chagas from her mother while she was still in the womb. The Trypanosoma parasites that cause the disease easily cross the placenta.
Once inside the host, the parasites travel in the bloodstream and colonize muscle and neural cells, where they reproduce rapidly and go on to infect more cells. In the heart, they can cause abnormal beating and cell death, leading to heart disease.
Chagas is a silent disease, and that’s the root of the problem. In the “acute phase,” shortly after infection, Chagas rarely has symptoms. In the “chronic phase,” which develops decades later, middle-aged people can die suddenly. “They are walking, running, playing, and boom, that’s it,” says Héctor Freilij, a coordinator of the National Chagas Program, at the Argentine Ministry of Health. This lag time between infection and severe symptoms seems to be the main reason why people—even those who know they are infected—ignore Chagas.
Jesica’s stepgrandmother Emilia, who has had Chagas for years, feels the chronic symptoms. “My heart hurts,” she says. “They told me it’s enlarged and full with liquid.” She can’t lie on her side and she has trouble breathing. Remarkably, nobody in this family is pushing Jesica to take the drugs that would rid her of the parasites.
Policymakers seem to ignore Chagas too, but for a different reason. “It’s a disease of the poor,” says Freilij. The government devotes little money to fight Chagas. “The poor don’t complain; they are not organized,” notes Freilij. “They don’t have NGOs to take care of them. They don’t have a voice.”
Even the medical profession in Argentina seems to ignore Chagas. “Many physicians in this country are not even aware that Chagas is curable,” says Freilij. “It’s a disease that’s generally excluded from the medical thinking.”
In the early 1990s, Freilij became interested in placental—or congenital—Chagas. He created the Parasitology and Chagas Disease Service at the Children’s Hospital, a tiny but still-thriving office in Buenos Aires, in which over 500 children with Chagas have been treated. Today, pregnant women are screened for Trypanosoma parasites, babies born to infected mothers are treated immediately after birth, and infected children are also treated and followed for 10 or more years.
But this pattern is not reproduced at the national level. Although a law was approved in 2007 that requires all newborns from infected mothers and all pregnant women to be screened, it is not enforced.
According to Ricardo E. Gürtler of the Laboratory of Eco-Epidemiology at the University of Buenos Aires, the way to stamp out Chagas is to combine vector control programs—insect detection and insecticide spraying—with diagnosis and treatment, both with the full participation of local communities.
Vectorial transmission has been interrupted in a few countries in Latin America, but house reinfestation, vector resistance to certain insecticides, and the reemergence of transmission via vectors, contaminated food, blood transfusions, and from mother-to-fetus, are still serious risks.
Jesica leads a normal life, going to school, playing sports, and helping with housework. She doesn’t feel sick and, like any teenager, she can hardly imagine she ever will. To date, she hasn’t resumed her treatment. She says she will but, even if she does, it’s anyone’s guess as to whether she would finish it this time.
Author Bio:
Graciela Flores is a freelance science writer and editor based in New York City. She writes about science, health and the environment. As a biologist, she studied the behavior of kissing bugs in her home country, Argentina.
Photo: Jesica López (left) with her mother, Gladys / © Paula Trolliet
