This author interview is by Dr Steve Klotz, of University of Arizona. Dr Klotz's full paper, Kissing Bugs in the United States: Risk for Vector-Borne Disease in Humans, is available for download in Environmental Health Insights.

First please summarise for readers the content of your article.
This article gives the authors' perspective on the risk of the kissing bug species that are found in the United States causing an epidemic of Trypanosoma cruzi infections in man. This is certainly a "potential threat" but not realized to date. For an epidemic to occur, major changes must occur in the behavior of the insects. We discuss in great detail the kissing bug species found in the US including their behavior, physiology and carriage of T. cruzi. In addition, we also address significant issues such as allergies to kissing bug bites and methods of deterring bites as well as measures one can take to keep kissing bugs out of the home.

How did you come to be involved in your area of study?
We became interested in kissing bugs because numerous patients in the Tucson area came to clinic complaining of anaphylaxis to kissing bug bites as well as fear of Chagas disease in persons bitten numerous times by kissing bugs. Kissing bugs are common in the foothill areas of Tucson where man has moved into their territories and constructed houses. We were initially interested in determining why there were so few autochthonous cases of Chagas in US residents and implemented experiments to test questions such as how often kissing bugs defecated after feeding and did the defecation occur on the host.

What was previously known about the topic of your article?
There are 7 documented cases of autochthonous human Chagas in the US and a recent serological survey of blood donors may have found 16 other presumed autochthonous cases. Given the number of humans living in kissing bug home territories (the entire southern and south western states) this is an extremely small number. Simultaneous with the expansion of humans into the home ranges of kissing bugs is global warming and its role in the expansion of kissing bug home ranges. The question now being asked is, "what is the risk of an epidemic of Chagas occurring?"

How has your work in this area advanced understanding of the topic?
We designed experiments to determine how often wild or sylvan kissing bugs feed on humans and found to our surprise that the sylvan insects feed very often on humans. We have found a community where kissing bugs appear to have colonized homes and if documented, this would represent a significant change in behavior among US kissing bugs. We are currently working on deterrents to feeding of kissing bugs as measures to reduce the risk of significant allergies, such as anaphylaxis, in home owners.

What do you regard as being the most important aspect of the results reported in the article?
The article was a review of many different contributions by ourselves and other researchers that may bear upon the possibility of increasing numbers of US residents becoming infected with T. cruzi.

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