Venezuela: the hidden Chagas disease

CARACAS, Venezuela — It was just a glass of guava juice. But now Emily Cordova is undergoing treatment with such harsh side effects that many compare it to cancer chemotherapy.

Three years ago, Cordova and some 100 other children and teachers at a school in the middle-class Caracas neighborhood of Chacao were infected with Chagas disease after drinking juice at the school canteen.

“It’s difficult because you are used to living a different life,” said Cordova, now 16, while waiting to take treatment at the Institute for Tropical Medicine in Caracas. “When I was small my grandmother used to take me to the beach every weekend but now I can’t go because when taking the treatment the sun stains your skin.”

The outbreak of Chagas at the Andres Bello college in Chacao in 2007 is one of three major incidents to have occurred in Venezuela in the past three years. The latest was in Antimano, western Caracas, affecting at least 19 people and killing one.

Such outbreaks are strong indicators that this much-neglected disease is on the rise in Venezuela. The Venezuelan Parasitological Society calculates that cases of Chagas have tripled in the past two decades, from affecting 0.5 percent of the population to 1.6 percent.

It’s a worrying trend for a little-known illness that nonetheless affects more than 8 million people in the Americas and kills more people in the region than malaria. Chagas is now spreading to the United States and Europe, carried by unsuspecting immigrants in their blood.

The Chagas parasite is carried by a forest-dwelling insect known as the kissing bug, which bites victims and transmits the parasite by defecating on the wound. It typically manifests itself in two stages, acute and chronic, and its symptoms can lie dormant for years before it is diagnosed.

Some 30 percent of those infected die from heart attacks caused by the blood-borne virus, while in some cases it can cause an acute form of meningitis or swelling of the brain.

Chagas is increasing steadily in Venezuela, said Dr. Oscar Noya of the Institute of Tropical Medicine, who blamed human encroachment on the kissing bug’s environment. More worrying still is that the kissing bug appears to be adapting to human habitats, he said.

“What has happened in Caracas?” he said. “The kissing bug, which used to live by feeding off animals, has started to adapt itself to homes now that the number of animals has diminished through forest fires, deforestation and through land grabs.”

For critics of the government, the increase in cases of Chagas is not only a sign of neglect of a previously successful program of control through fumigation, but also an indicator that President Hugo Chavez’s socialist government’s assertion that it has dramatically reduced poverty is not as watertight as it claims.

"All those control programs have really been abandoned," said Dr. Julio Urbina, professor emeritus at the Venezuelan Institute of Scientific Research, who has developed Prosaconazole, a drug that in trials in Spain has proved to be one of the most effective treatments for the chronic stage of Chagas. "A fumigation program has to be extensive, sustained and managed by well-trained people – and this is what is not happening."

The government appears to be sensitive to such accusations. It has been secretive about the details of the recent outbreak in Antimano which is located less than 10 miles from the Presidential Palace. The new cases appeared to hit home that the disease, which was previously believed to be under control, is once again on the rise.

Last month, the local government health authority in Anzoategui state said it would be charging Dr. Antonio Morocoimo of the Center for Investigation of Tropical Medicine at the University of the East with spreading fear and panic after he published details of an investigation that found 60 percent of the kissing bugs studied in the wild carried the Chagas parasite.

Yet amid accusations of neglect, Venezuela is seen internationally as a pioneer in the prevention and treatment of Chagas. A control program begun in the 1950s involving coordinated fumigation has been emulated elsewhere on the continent.

Urbina’s treatment, meanwhile, is undergoing clinical trials in Brazil and Argentina, though the Venezuelan government has yet to grant a license in his home country.

Many of the problems causing the spread of Chagas can be related to the difficulties of diagnosing the disease, said Guido Nunez-Mujica, a molecular biologist from Merida, who is developing an instrument that he believes could dramatically decrease the prevalence of diseases such as Chagas.

The LavAmp is a cheap, portable “DNA Xerox machine” that Nunez-Mujica hopes will allow doctors in rural areas to be able to diagnose patients without having to wait for test results from Caracas.

Up until now the DNA-testing technique the LavAmp uses has not been widely available because of the size and cost of the equipment. Nunez-Mujica has managed to shrink the size of the LavAmp and hopes to bring the cost down from $3,000 to $300 with each test costing $0.25. “This machine at this price and being portable it would be possible to have one of these if not in every laboratory at least in every large hospital.”

In the meantime, however, sufferers of Chagas in Venezuela will have to contend with the drugs that are available. Emily Cordova already has her 11-year-old brother Alejandro as an example of how harsh the treatment can be.

He was hospitalized for 15 days in January 2009 after the treatment appeared not to have worked. He also suffers from violent mood swings, fevers and inflammation of the face, she said.

Cordova said that initially she felt angry with the school and with the cook who had prepared the guava juice (who also contracted the disease) but had now come to terms with her fate. “At first I didn’t want to tell people,” she said, describing how she had been teased at school. “Now I say it with pride.”