Volume 95, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Chagas disease is a vector-borne and potentially fatal parasitic disease that is transmitted by the triatomine bug, a nocturnal feeding, flying arthropod, often referred to by its colloquial name, the “kissing bug.” Vector-borne transmission is considered the most important means of spreading Chagas disease in endemic and nonendemic areas. Corrugated cardboard boxes may accelerate the spread of these insect vectors to nonendemic areas through their ability to harbor and transport small terrestrial arthropods such as silverfish, termites, and cockroaches. We report the case of a patient living in northern California who presented to a community clinic 6 weeks after being bitten by a positively identified triatomine bug. A local pest control company identified a total of eight adult , nine nymphs, and two eggs; all within the patient's bedding. No bugs were found outside of the patient's bedroom. The Centers for Disease Control and Prevention confirmed one adult female was positive for via polymerase chain reaction. The patient's bedroom doubled as an office and regularly received and stored corrugated cardboard shipping boxes. Corrugated cardboard boxes have been used to trap and study the triatomine bug. This is the first documented case that provides circumstantial evidence that corrugated cardboard boxes may be an inadvertent and unrecognized factor in the spread of Chagas disease.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Shender LA, Lewis MD, Rejmanek D, Mazet JA, , 2016. Molecular diversity of Trypanosoma cruzi detected in the vector Triatoma protracta from California, USA. PLoS Negl Trop Dis 10: e0004291.[Crossref] [Google Scholar]
  2. Bern C, , 2015. Chagas' disease. N Engl J Med 373: 456466.[Crossref] [Google Scholar]
  3. Stevens L, Dorn PL, Schmidt JO, Klotz JH, Lucero D, Klotz SA, , 2011. Kissing bugs. The vectors of Chagas. Adv Parasitol 75: 169192.[Crossref] [Google Scholar]
  4. Dorn PL, Perniciaro L, Yabsley MJ, Roellig DM, Balsamo G, Diaz J, Wesson D, , 2007. Autochthonous transmission of Trypanosoma cruzi, Louisiana. Emerg Infect Dis 13: 605607.[Crossref] [Google Scholar]
  5. Catalá SS, Crocco LB, Muñoz A, Morales G, Paulone I, Giraldez E, Candioti C, Ripol C, , 2004. Entomological aspects of Chagas' disease transmission in the domestic habitat, Argentina. Rev Saude Publica 38: 216222.[Crossref] [Google Scholar]
  6. Wisnivesky-Colli C, Paulone I, Perez A, Chuit R, Gualtieri J, Solarz N, Smith A, Segura EL, , 1987. A new tool for continuous detection of the presence of triatomine bugs, vectors of Chagas disease, in rural households. Medicina (B Aires) 47: 4550. [Google Scholar]
  7. Cecere MC, Leporace M, Fernández MP, Zárate JE, Moreno C, Gürtler RE, Cardinal MV, , 2016. Host-feeding sources and infection with Trypanosoma cruzi of Triatoma infestans and Triatoma eratyrusiformis (Hemiptera: Reduviidae) from the Calchaqui Valleys in northwestern Argentina. J Med Entomol 53: 666673.[Crossref] [Google Scholar]
  8. U.S. Air Force, 2016. Kissing Bugs, Assassin Bugs, and Bed Bugs. Available at: http://www.phsource.us/PH/ME/Insecta/Hemiptera/. Accessed July 11, 2016. [Google Scholar]
  9. Rassi A, Jr Rassi A, Marin-Neto JA, , 2010. Chagas disease. Lancet 375: 13881402.[Crossref] [Google Scholar]
  10. Noireau F, Diosque P, Jansen AM, , 2009. Trypanosoma cruzi: adaptation to its vectors and its hosts. Vet Res 40: 123.[Crossref] [Google Scholar]
  11. Basile L, Jansa JM, Carlier Y, Salamanca DD, Angheben A, Bartoloni A, Seixas J, Van Gool T, Canavate C, Flores-Chavez M, Jackson Y, Chiodini PL, Albajar-Vinas P, Working Group on Chagas Disease; , 2011. Chagas disease in European countries: the challenge of a surveillance system. Euro Surveill 16: pii 19968. [Google Scholar]
  12. CDC, 2013. Parasites—American Trypanosomiasis (Also Known as Chagas Disease). Available at: http://www.cdc.gov/parasites/chagas/gen_info/detailed.html. Accessed May 25, 2016. [Google Scholar]
  13. Navin TR, Roberto RR, Juranek DD, Limpakarnjanarat K, Mortenson EW, Clover JR, Yescott RE, Taclindo C, Steurer F, Allain D, , 1985. Human and sylvatic Trypanosoma cruzi infection in California. Am J Public Health 75: 366369.[Crossref] [Google Scholar]
  14. CDC, 2016. Triatomine Bug FAQs. Available at: http://www.cdc.gov/parasites/chagas/gen_info/vectors/. Accessed May 27, 2016. [Google Scholar]
  15. CDC, 2013. Chagas Disease in the Americas. Available at: http://www.cdc.gov/parasites/chagas/resources/chagasdiseaseintheamericas.pdf. Accessed May 29, 2016. [Google Scholar]
  16. CNBC, 2012. How UPS, Fed Ex Move 25 Million Packages a Day. Available at: http://www.cnbc.com/id/46071532. Accessed May 27, 2016. [Google Scholar]
  17. USA On Canvas, 2016. Corrugated Cardboard. Available at: https://www.usaoncanvas.com/include/guide_corrugated_cardboard_boxes.php. Accessed July 11, 2016. [Google Scholar]
  18. Do-It-Yourself Pest Control, 2015. Eliminate Silverfish. Available at: http://www.silverfishcontrol.com/. Accessed May 25, 2016. [Google Scholar]
  19. Hahn J, Ascerno M, , 2005. Cockroaches. Available at: http://www.extension.umn.edu/garden/insects/find/cockroaches/. Accessed May 24, 2016. [Google Scholar]

Data & Media loading...

  • Received : 07 Jun 2016
  • Accepted : 20 Jul 2016
  • Published online : 02 Nov 2016

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error