Contact Us    Contact Us     |     Feedback
MOBILE VIEW  | 

TRIATOMA SPECIES

Export To Excel

Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) This management deals specifically with Triatoma species, or kissing bugs. Bites or stings of other insects or arthropods may be similar in appearance. Other related documents include:
    1) ANTS
    2) CENTIPEDES
    3) HYMENOPTERA STINGS
    4) LATRODECTUS ANTIVENIN
    5) LEPIDOPTERISM
    6) PAEDERUS BLISTER BEETLES
    7) SCORPIONS
    8) SPIDERS
    9) SPIDER-BROWN OR VIOLIN
    10) SPIDER-FUNNEL WEB
    11) SPIDER-TEGENARIA AGRESTIS
    12) SPIDER- WIDOW OR HOURGLASS
    13) TICKS
    14) TRIATOMA SPECIES
    B) Triatomes are members of the phylum Arthropoda, class Insecta, and order Hemiptera.

Specific Substances

    A) CONSTITUENTS OF THE GROUP
    1) Tritoma species (Kissing bugs)
    2) Triatoma brasiliensis
    3) Triatoma dimidiata
    4) Triatoma infestans
    5) Triatoma protracta
    6) Triatoma sanguisuga (Mexican bedbug)

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) The extent of reactions to these bites appears to depend on the amount of material injected and the sensitivity of the host. There are several types of dermal reactions possible. Papular lesions, vesicles, urticarial reactions, and nodular to bullous lesions may occur.
    B) These local effects may be accompanied by lymphangitis, lymphadenitis, chills, fever, nausea and vomiting, angioneurotic edema, hypotension, edema of the tongue, and laryngeal edema in sensitive individuals.
    0.2.4) HEENT
    A) CHAGAS' DISEASE - If there is conjunctival entry of the Trypanosoma, periorbital swelling is usually seen.
    0.2.5) CARDIOVASCULAR
    A) Hypotension has been seen after bites, in sensitive individuals. Cardiomyopathies are seen due to Chagas' Disease, transmitted by these insects. Myocarditis, tachycardia, and non- specific EKG changes may also be seen during the acute phase. Congestive heart failure is a rare complication.
    0.2.6) RESPIRATORY
    A) Tongue and laryngeal edema also have occurred.
    0.2.8) GASTROINTESTINAL
    A) Nausea and vomiting may occur after bites of Triatoma species. Chronic manifestations of Chagas' Disease include dysfunction of the esophagus or colon.
    0.2.9) HEPATIC
    A) Generalized lymphadenopathy, and hepatosplenomegaly may occur with Chagas' Disease
    0.2.14) DERMATOLOGIC
    A) There are several types of dermal reactions possible. Papular lesions, vesicles, urticarial reactions, and nodular to bullous lesions may occur.
    B) CHAGAS' DISEASE - There is a local site of induration and redness (chagoma) on the skin at the site of the Trypanosoma entry. This may persist for several weeks.
    0.2.19) IMMUNOLOGIC
    A) Angioneurotic edema, anaphylaxis, or anaphylactoid reactions leading to shock sometime occur. Deaths have been reported.
    0.2.22) OTHER
    A) CHAGAS' DISEASE - Triatoma species are vectors of Chagas' Disease, or American trypanosomiasis. The disease is transmitted through the insect feces, NOT the bite. It is due to the parasitic protozoan, Trypanosoma cruzi.
    1) ACUTE DISEASE - Most often seen in children. The incubation period is about a week. There is a local site of induration and redness on the skin at the site of the Trypanosoma entry.
    a) Fever, generalized lymphadenopathy, and hepatosplenomegaly may also occur. Myocarditis, tachycardia, and non-specific EKG changes may also be seen during the acute phase.
    2) CHRONIC DISEASE appears years after the initial infection and include chronic cardiomyopathy with conduction defects or dysfunction of the esophagus or colon.

Laboratory Monitoring

    A) Usually normal.

Treatment Overview

    0.4.7) BITES/STINGS
    A) ITCHING/INFLAMMATION - A topical corticosteroid, antihistamine, and local anesthetic combination may be of value.
    B) TETANUS - Prophylaxis should be considered.
    C) CHAGAS' DISEASE -
    1) ANTIBIOTICS -
    a) Nifurtimox (a nitrofuran derivative) is the only United States drug available. The dose is 8 to 12 milligrams per kilogram per day.
    b) Benznidazole (a nitroimidazole derivative) has been used outside the United States.

Range Of Toxicity

    A) Bites are usually single, rather than multiple. One insect may be enough to infect a person with Chagas' Disease.

Clinical Effects

Summary Of Exposure

    A) The extent of reactions to these bites appears to depend on the amount of material injected and the sensitivity of the host. There are several types of dermal reactions possible. Papular lesions, vesicles, urticarial reactions, and nodular to bullous lesions may occur.
    B) These local effects may be accompanied by lymphangitis, lymphadenitis, chills, fever, nausea and vomiting, angioneurotic edema, hypotension, edema of the tongue, and laryngeal edema in sensitive individuals.

Vital Signs

    3.3.3) TEMPERATURE
    A) Both chills and fever have occurred after the bites of Triatoma species. Fever is associated with Chagas' Disease (Wyngaarden & Smith, 1988).

Heent

    3.4.1) SUMMARY
    A) CHAGAS' DISEASE - If there is conjunctival entry of the Trypanosoma, periorbital swelling is usually seen.
    3.4.3) EYES
    A) CHAGAS' DISEASE - If there is conjunctival entry of the Trypanosoma, there is periorbital swelling (Wyngaarden & Smith, 1988).

Cardiovascular

    3.5.1) SUMMARY
    A) Hypotension has been seen after bites, in sensitive individuals. Cardiomyopathies are seen due to Chagas' Disease, transmitted by these insects. Myocarditis, tachycardia, and non- specific EKG changes may also be seen during the acute phase. Congestive heart failure is a rare complication.
    3.5.2) CLINICAL EFFECTS
    A) HYPOTENSIVE EPISODE
    1) Hypotension has been seen after bites, in sensitive individuals.
    B) CARDIOVASCULAR FINDING
    1) CHAGAS' DISEASE - Myocarditis, tachycardia, and non-specific EKG changes may also be seen during the acute phase. Congestive heart failure is a rare complication (Wyngaarden & Smith, 1988).
    2) Chronic manifestations appear years after the initial infection and include chronic cardiomyopathy with conduction defects (Wyngaarden & Smith, 1988).

Respiratory

    3.6.1) SUMMARY
    A) Tongue and laryngeal edema also have occurred.
    3.6.2) CLINICAL EFFECTS
    A) EDEMA OF LARYNX
    1) Edema of the tongue and larynx have occurred after bites, in sensitive individuals.

Gastrointestinal

    3.8.1) SUMMARY
    A) Nausea and vomiting may occur after bites of Triatoma species. Chronic manifestations of Chagas' Disease include dysfunction of the esophagus or colon.
    3.8.2) CLINICAL EFFECTS
    A) NAUSEA AND VOMITING
    1) Nausea and vomiting may occur after bites.
    B) DRUG-INDUCED GASTROINTESTINAL DISTURBANCE
    1) CHAGAS' DISEASE - Chronic manifestations appear years after the initial infection and include dysfunction of the esophagus or colon (Wyngaarden & Smith, 1988).

Hepatic

    3.9.1) SUMMARY
    A) Generalized lymphadenopathy, and hepatosplenomegaly may occur with Chagas' Disease
    3.9.2) CLINICAL EFFECTS
    A) HEPATOSPLENOMEGALY
    1) Generalized lymphadenopathy, and hepatosplenomegaly may occur with Chagas' Disease (Wyngaarden & Smith, 1988).

Dermatologic

    3.14.1) SUMMARY
    A) There are several types of dermal reactions possible. Papular lesions, vesicles, urticarial reactions, and nodular to bullous lesions may occur.
    B) CHAGAS' DISEASE - There is a local site of induration and redness (chagoma) on the skin at the site of the Trypanosoma entry. This may persist for several weeks.
    3.14.2) CLINICAL EFFECTS
    A) MACULOPAPULAR ERUPTION
    1) PAPULAR LESION with a central punctum typical, of but often more severe than, most insect bites (Burnett et al, 1987).
    B) BULLOUS ERUPTION
    1) Grouped small vesicles accompanied by moderate swelling, little redness, and no distinct central punctum.
    2) Hemorrhagic nodular to bullous lesions may occur. Lymphangitis and lymphadenitis may be associated with this reaction.
    C) URTICARIA
    1) Giant urticarial-type reaction in which the central punctum may or may NOT be visible. The firm wheals, 5 to 16 cm across, may show edema over a large area. Lymphangitis and lymphadenitis may be associated with this reaction (Wyngaarden & Smith, 1988).
    D) DISORDER OF SKIN
    1) CHAGAS' DISEASE - There is a local site of induration and redness (chagoma) on the skin at the site of the Trypanosoma entry. This may persist for several weeks (Wyngaarden & Smith, 1988).

Immunologic

    3.19.1) SUMMARY
    A) Angioneurotic edema, anaphylaxis, or anaphylactoid reactions leading to shock sometime occur. Deaths have been reported.
    3.19.2) CLINICAL EFFECTS
    A) DISORDER OF IMMUNE FUNCTION
    1) Of those living in areas where Triatoma was endemic, 6.7% had antibodies to them (Hoffman, 1987). In poorer areas, where infestation rates are higher, up to 50% of a population may have positive serologic titers (Wyngaarden & Smith, 1988).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) Usually normal.
    4.1.2) SERUM/BLOOD
    A) OTHER
    1) Routine laboratory values are generally normal after a bite.

Methods

    A) BIOASSAY
    1) Dorn et al (1999) studied the utility of the polymerase chain reaction (PCR) for detection of Trypanosoma cruzi and Trypanosoma rangeli in vectors of Chagas' Disease (Triatoma dimidiata and Rhodnius prolixus). PCR was significantly more sensitive for the detection of Rhodnius prolixus but NOT Triatoma dimidiata compared to microscopy. PCR was significantly more effective for the detection of Trypanosoma cruzi in Triatoma infestans compared to microscopy. The PCR assay was positive in 59% of samples compared to only 13% using microscopy (Shikanai-Yasuda et al, 1996).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) Usually normal.

Range Of Toxicity

Summary

    A) Bites are usually single, rather than multiple. One insect may be enough to infect a person with Chagas' Disease.

Minimum Lethal Exposure

    A) GENERAL/SUMMARY
    1) The minimum lethal human dose to this agent has not been delineated.

Maximum Tolerated Exposure

    A) GENERAL/SUMMARY
    1) Bites are usually single, rather than multiple. One insect may be enough to infect a person with Chagas' Disease. Chagas' Disease is commonly transmitted through insect feces in contact with disrupted skin or conjunctival tissue.

Animal Toxicology

Treatment

    11.2.1) SUMMARY
    A) GENERAL TREATMENT
    1) Remove the patient and other animals from the Triatoma infested area if possible.
    2) Treatment should ALWAYS be done on the advice and with the consultation of a veterinarian.
    3) Additional information regarding treatment of poisoned animals may be obtained from a Board Certified (ABVT) Veterinary Toxicologist (check with nearest veterinary school or veterinary diagnostic laboratory) or the National Animal Poison Control Center.
    4) ANIMAL POISON CONTROL CENTERS
    a) ASPCA Animal Poison Control Center, An Allied Agency of the University of Illinois, 1717 S. Philo Rd, Suite 36, Urbana, IL 61802, website www.aspca.org/apcc
    b) It is an emergency telephone service which provides toxicology information to veterinarians, animal owners, universities, extension personnel and poison center staff for a fee. A veterinary toxicologist is available for consultation.
    c) The following 24-hour phone number is available: (888) 426-4435. A fee may apply. Please inquire with the poison center. The agency will make follow-up calls as needed in critical cases at no extra charge.
    11.2.2) LIFE SUPPORT
    A) GENERAL
    1) MAINTAIN VITAL FUNCTIONS: Secure airway, supply oxygen, and begin supportive fluid therapy if necessary.
    11.2.4) DECONTAMINATION
    A) GASTRIC DECONTAMINATION
    1) GENERAL TREATMENT
    a) Remove the offending kissing bug if it is still on the animal. If none can be found, consider an insecticidal dip, especially with large animals.
    11.2.5) TREATMENT
    A) DOGS/CATS
    1) ANAPHYLAXIS -
    a) AIRWAY - Maintain a patent airway via endotracheal tube or tracheostomy.
    b) EPINEPHRINE - For severe reactions.
    1) DOGS - 0.5 to 1 milliliter of 1:10,000 (DILUTE) solution intravenously or subcutaneously.
    2) CATS - 0.5 milliliter of 1:10,000 (DILUTE) solution intravenously or intramuscularly.
    3) DILUTION - Be sure to dilute epinephrine from the bottle (1:1000) one part to 9 parts saline to obtain the correct concentration (1:10,000).
    4) REPEAT DOSES - If indicated, doses may be repeated in 20 minutes.
    c) FLUID THERAPY - If necessary, begin fluid therapy at maintenance doses (66 milliliters solution/kilogram body weight/day) intravenously or, in hypotensive patients, at high doses (up to shock dose 60 milliliters/kilogram/hour).
    1) Monitor for urine production and pulmonary edema.
    d) ANTIHISTAMINES - Administer doxylamine succinate (1 to 2.2 milligram/kilogram subcutaneously or intramuscularly every 8 to 12 hours).
    e) STEROIDS - Administer dexamethasone sodium phosphate (1 to 5 milligrams/kilogram intravenously every 12 to 24 hours), or prednisone (1 to 5 milligram/kilogram intravenously every 1 to 6 hours).
    B) RUMINANTS/HORSES/SWINE
    1) ANAPHYLAXIS -
    a) AIRWAY - Maintain a patent airway via endotracheal tube or tracheostomy.
    b) FLUIDS -
    1) HORSES - Administer electrolyte and fluid therapy as needed. Maintenance dose of intravenous isotonic fluids: 10 to 20 milliliters/kilogram per day. High dose for shock: 20 to 45 milliliters/kilogram/hour.
    a) Monitor for packed cell volume, adequate urine output and pulmonary edema. Goal is to maintain a urinary flow of 0.1 milliliters/kilogram/minute (2.4 liters/hour) for an 880 pound horse.
    2) CATTLE - Administer electrolyte and fluid therapy, orally or parenterally as needed. Maintenance dose of intravenous isotonic fluids for calves and debilitated adult cattle: 140 milliliters/kilogram/day. Dose for rehydration: 50 to 100 milliliters/kilogram given over 4 to 6 hours.
    c) EPINEPHRINE -
    1) HORSES - 3 to 5 milliliters/450 kilograms of 1:1000 epinephrine intramuscularly or subcutaneously.
    2) CATTLE & SWINE - 0.02 TO 0.03 milligrams/kilogram of 1:1000 epinephrine subcutaneously, intramuscularly, or intravenously.

Continuing Care

    11.4.1) SUMMARY
    11.4.1.2) DECONTAMINATION/TREATMENT
    A) GENERAL TREATMENT
    1) Remove the patient and other animals from the Triatoma infested area if possible.
    2) Treatment should ALWAYS be done on the advice and with the consultation of a veterinarian.
    3) Additional information regarding treatment of poisoned animals may be obtained from a Board Certified (ABVT) Veterinary Toxicologist (check with nearest veterinary school or veterinary diagnostic laboratory) or the National Animal Poison Control Center.
    4) ANIMAL POISON CONTROL CENTERS
    a) ASPCA Animal Poison Control Center, An Allied Agency of the University of Illinois, 1717 S. Philo Rd, Suite 36, Urbana, IL 61802, website www.aspca.org/apcc
    b) It is an emergency telephone service which provides toxicology information to veterinarians, animal owners, universities, extension personnel and poison center staff for a fee. A veterinary toxicologist is available for consultation.
    c) The following 24-hour phone number is available: (888) 426-4435. A fee may apply. Please inquire with the poison center. The agency will make follow-up calls as needed in critical cases at no extra charge.
    11.4.2) DECONTAMINATION
    11.4.2.2) GASTRIC DECONTAMINATION
    A) GASTRIC DECONTAMINATION
    1) GENERAL TREATMENT
    a) Remove the offending kissing bug if it is still on the animal. If none can be found, consider an insecticidal dip, especially with large animals.

References

General Bibliography

    1) Apt W, Aguilera X, & Arribada A: Treatment of chronic Chagas' disease with itraconazole and allopurinol. Am J Trop Med Hyg 1998; 59:133-138.
    2) Burnett JW, Calton GJ, & Morgan RJ: Triatoma: the "kissing bug". Cutis 1987; 39:399.
    3) Gurtler RE, Cecere MC, & Canale DM: Monitoring house reinfestation by vectors of Chagas disease: a comparative trial of detection methods during a four-year follow-up. Acta Tropica 1999; 72:213-234.
    4) Hoffman DR: Allergy to Biting Insects. Clin Rev Allergy 1987; 5:177-190.
    5) Lieberman P, Nicklas R, Randolph C, et al: Anaphylaxis-a practice parameter update 2015. Ann Allergy Asthma Immunol 2015; 115(5):341-384.
    6) Lieberman P, Nicklas RA, Oppenheimer J, et al: The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010; 126(3):477-480.
    7) Lorenzo MG & Lazzari CR: Temperature and relative humidity affect the selection of shelters by Triatoma infestans, vector of Chagas disease. Acta Tropica 1999; 72:241-249.
    8) National Heart,Lung,and Blood Institute: Expert panel report 3: guidelines for the diagnosis and management of asthma. National Heart,Lung,and Blood Institute. Bethesda, MD. 2007. Available from URL: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf.
    9) Nowak RM & Macias CG : Anaphylaxis on the other front line: perspectives from the emergency department. Am J Med 2014; 127(1 Suppl):S34-S44.
    10) Product Information: diphenhydramine HCl intravenous injection solution, intramuscular injection solution, diphenhydramine HCl intravenous injection solution, intramuscular injection solution. Hospira, Inc. (per DailyMed), Lake Forest, IL, 2013.
    11) Russell FE: Venomous Animal Injuries. In: Schachner LA & Hansen RC (Eds): Pediatric Dermatology, Vol 2, Churchill Livingston, London, UK, 1988, pp 1579-1618.
    12) Schmeda-Hirschmann G & Rojas de Arias A: A screening method for natural products on Triatomine bugs. Phytotherapy Res 1992; 6:68-73.
    13) Schofield CJ & Dias JCP: The southern cone initiative against Chagas disease. Adv Parasitol 1999; 42:1-27.
    14) Schofield CJ, Apt W, & Miles MA: The ecology of Chagas's disease in Chile. Ecol Dis 1982; 1:117-129.
    15) Schofield CJ: Control of Chagas' disease vectors. BMJ 1985; 41:187-194.
    16) Shikanai-Yasuda MA, Ochs DE, & Tolezano JE: Use of the polymerase chain reaction for detecting Trypanosoma cruzi in triatomine vectors. Trans Royal Soc Trop Med & Hyg 1996; 90:649-651.
    17) Vanden Hoek,TL; Morrison LJ; Shuster M et al: Part 12: Cardiac Arrest in Special Situations 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. American Heart Association. Dallas, TX. 2010. Available from URL: http://circ.ahajournals.org/cgi/reprint/122/18_suppl_3/S829. As accessed 2010-10-21.
    18) Wyngaarden JB & Smith LH: Cecil's Textbook of Medicine, 17th ed, WB Saunders Co, Philadelphia, PA, 1988.