It's like "Sleeping Beauty" with a dose of nightmare fuel: A flat-bodied, six-legged insect moves toward you as you slumber, bound for the blood that surges around your eyes and lips. It crawls on your face. And the poop it leaves behind can be deadly.
The triatomine bug, also known as the notorious "kissing bug," has been an obscure threat in the United States, with the highest density in Latin America and some Western states.
But the insect has marched north, and health officials in Delaware recently confirmed their first run-in with Triatoma sanguisuga - one of 11 species documented in 28 states, according to researchers at Texas A&M University. The bugs have previously carved out territory from California to the Carolinas.
A kissing bug in Delaware bit and sucked the blood from a girl's face in July 2018, a state health official wrote. Subsequent research confirmed the species, but scientists found no traces of Chagas, the disease carried by kissing bugs.
Immediate Chagas infection can cause fever, rash, loss of appetite, diarrhea, and vomiting, researchers have said, but the danger comes from potential chronic infection targeting the heart and gastrointestinal tract.
About 300,000 U.S. residents have Chagas, the CDC said, and they mostly contracted the disease in Latin America.
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About 30 percent of people who contract Chagas are at risk of heart failure and cardiac arrest, which is a growing concern for the American Heart Association. The disease is an "important cause of heart failure, stroke, arrhythmia, and sudden death," according to a 2018 statement commissioned by the group.
The prevalence is growing outside endemic areas throughout Latin America, said the statement, which was commissioned alongside the Inter-American Society of Cardiology.
About 8 million people in Mexico, Central and South America are living with Chagas, the CDC said.
Health officials have cautioned that Chagas is difficult to contract from kissing bugs despite their vectoring ability, and it comes down to their feces.
Kissing bugs can pass along parasites after defecating at the area of their bite, making it a gross but rare combination that must happen before an infection occurs.
Chagas can also be contracted through blood transfusions and organ transplants, researchers have said.