The Kiss of Death

by Joseph William Bastien

  Immunoglobin G (IgG) — Antibody involved in the secondary immune response.

  Immunoglobin M (IgM) — Antibody involved in the primary immune response.

  immunopathic medicine — The practice of ways to build up the immune system and to help it deal with organisms within and outside it.

  Inca empire — An early Andean civilization that flourished between 1275 and 1532 and spread across the Andes from Chile to Ecuador, with its capital in Cuzco, Peru. Quechua was the lingua franca. Chagas’ disease likely was present during these times, as indicated by an Inca mummy in which T. cruzi was found.

  infection — The condition resulting when a pathogen (e.g., T. cruzi) becomes established within a host after invasion.

  infestation — The presence of insect vectors in a given location.

  instar — The period between the five nymph stages in the life of triatomines, or vinchucas.

  interdisciplinary approach — A developmental approach that includes the biomedical perspective as well as cultural, economic, environmental, and social factors involved in Chagas’ disease.

  intradomiciliaryWithin the house; in Bolivia this includes bedrooms, kitchen, and storage areas.

  J

  jampiri — An herbal curer in the Andes.

  K

  Kallawayas — An Andean ethnic group of approximately 15,000 people who live in northwestern Bolivia within the Province Bautista Saavedra. They speak both Aymara and Quechua and are noted for their pharmacopeia of medicinal plants and herbs.

  L

  latent Chagas’ — An asymptomatic stage of Chagas’ disease. Latent Chagas’ presents several possibilities: 1) the infection is arrested at this stage; 2) it develops later to late latent Chagas’ with minor clinical findings; and 3) it develops into classic indeterminate Chagas’ disease.

  Leishmania braziliensis — The causative agent of the mucocutaneous form of leishmaniasis, common in Andean regions where Chagas’ disease is also found. It resembles lepromatous leprosy, producing disfigurements of the nose and lips. Andeans refer to it as “lo malde los Andes.” It is common in lower regions of the Andes, and, diagnostically, it may be confused with T. cruzi infection.

  M

  macrolevel processes — Larger units of social analysis, such as the nation, international community, and environment, affecting diseases.

  macrophages — Cells capable of destroying particular substances within early stages of the immune reaction.

  malde corazon (heart problems) — A term commonly used by Bolivians to refer to symptoms of Chagas’ disease, which causes heart diseases.

  matrilateral cross-cousin marriage — A marriage-exchange system in which children marry their mother’s brother’s children.

  matrilineal — A lineage-descent group in which children belong to their mother’s group.

  megasyndromes — Enlarged organs, usually heart (megacardia), esophagus (megaesophagus), and colon (megacolon), caused by T. cruzi infection.

  meningoencephalitis — Inflammation of the brain and its meninges. T. cruzi frequently causes this during the acute phase of Chagas’ disease, especially in children, either killing them or leaving lasting effects.

  mesa — A traditional Andean ritual in which foods symbolic of people, places, and intentions are offered to earth shrines.

  mestizo — Refers to middle- and upper-class Bolivians who have completely adopted Western dress, traditions, and the Spanish language. Mestizo is a broad category that includes many Bolivians who are not campesinos and cholos. Bolivia is a highly class-stratified country with many classes determined by race, ethnicity, language, dress, economics, politics, and appearance; however, campesino and cholo classes predominate and are very well defined.

  metacyclic trypomastigotes — A stage of T. cruzi which develops from the epimastigote stage within the triatomine’s intestine and is infective to animals and humans. Immediately after introduction into the bite site or mucuous membranes, metacyclic trypomastigotes penetrate a variety of cells and become transformed within these cells into amastigotes. After several divisions, the parasite transforms into trypomastigotes that are released into the bloodstream. These trypomastigotes are different from metacyclic trypomastigotes and are taken up by triatomines, where they then transform into epimastigotes and eventually metacyclic trypomastigotes.

  microlevel processes — Smaller units of social analysis, such as the community, family, and individual, that relate to diseases.

  mountain-body metaphor — Kallawaya Andeans understand parts of their body as relating to places on their ayllu mountain; therefore, if they ritually feed earth shrines corresponding to these parts, their bodies will be healthy.

  muerto subito (sudden death) — A term frequently used by Bolivians to describe death caused by heart failure brought about by Chagas’ disease. A person suddenly drops dead and a drop of blood emits from the nose.

  myxoedema — A decreased function of the thyroid gland, accompanied by swelling, anemia, lethargy, slow speech, mental apathy, et cetera. Carlos Chagas considered this to be one of the most characteristic manifestations of the acute form of Chagas’ disease.

  N

  neuron cell — A nerve cell; the structural and functional unit of the nervous system. Neuron cells function in the initiation and conduction of impulses for organic processes. T. cruzi prefers to inhabit neuron cells, consequently impairing the conduction of impulses to the organs related to the neuron cells.

  nifurtimox (synonyms: Bayer 2502, Lampit) — A drug commonly used to treat Chagas’ disease. Nifurtimox is a 5-nitrofuran derivative with antiprotozoal activity; it is also used to treat leishmaniasis and African trypanosomiasis.

  nymphs — Refers to triatomines going through one of five nymph stages before becoming adults, at which time they grow wings. During the nymph stages, triatomines crawl. The nymphal stages can take anywhere from four to forty-eight months depending on the temperature, humidity, and frequency and volume of blood meals. Nymphs can imbibe between six and twelve times their own weight in blood. Nymphs become infected with T. cruzi and spread Chagas’ disease.

  P

  Panstrongylus megistus — Triatomines that belong to the genus Panstrongylus; they are vectors of T. cruzi.

  parasite — A plant or animal that lives upon or within another living organism in order to absorb nutrients from the host. Parasites include multi-celled and single-celled animals, fungi, bacteria, and, possibly, viruses. Parasites can be pathogenic (disease causing) or nonpathogenic.

  Parasitemia — The condition of being actively infected by a parasite. This occurs early in Chagas’ disease but is very difficult to detect, even with microscopic analysis. Also refers to the acute phase of the disease, with intense inflammatory reactions manifested in high fever, chagomas, Romaña’s sign, lymphadenopathy, hepatomegaly, splenomegaly, myocarditis, and meningoencephalitis.

  parasitic cycle — Refers to the parasite, vector, and host relationship.

  parasitic protozoas — Unicellular animals that infect and live off many species of vertebrates and invertebrates and that have adapted to life in nearly all available sites within the body of the host. There are about 10,000 different protozoan parasites. Some of the disease-causing parasitic protozoa include those in the genera Plasmodium (malaria), Trypanosoma (Chagas’ disease, African sleeping sickness), and Entamoeba (amebic dysentery). Parasitic protozoa greatly influence humans, society, and culture.

  partial immunity — A condition in which people infected with T cruzi will usually not suffer another acute attack if they remain infected. One implication is that it may not be wise to rid someone of T. cruzi parasites if that person is likely to be infected again and possibly suffer the deadly effects of another acute phase. The presence of the parasite inhibits strong infections from newly colonizing parasites.

  pathogen — A microorganism or substance capable of producing a disease.

  patrilineal descent — A social grouping held together by descent
through the father.

  peridomicile — Areas outside the house including corrals, animal shelters, sheds, and walls.

  pilot project — A project developed primarily to serve as a model for future projects. For example, houses may be improved in one village by development workers to show peasants how they can replicate these endeavors. The success of a pilot project is indicated by the degree to which it is replicated.

  political economy — The relationship of political-economic factors in bringing into physical proximity parasites, vectors, and hosts. Houses can become “sick” because of overarching economic and political problems that cause impoverishment, migration, and low productivity.

  prevalence — The number of cases or people infected with a disease at a specific time within a well-defined area.

  privatization — Refers to pressure from capitalistic Western nations on Andean nations and communities to divest state-owned enterprises and community-held property and allow for private enterprises and individuals to buy and maintain them.

  promotores — Spanish for community health workers.

  protozoa — A phylum comprising the simplest animal forms-single-celled organisms ranging in size from 1.5um to 50mm. Of the 66,000 known species, 10,000 are parasitic and 56,000 are free-living. They are found in every ecological niche.

  pyrethroid insecticides — Chemical insecticides synthesized to resemble extracts of pyrethrum, a plant-derived compound used for centuries for insect control in the Andes and Asia.

  Q

  qollas — An indigenous word used to refer to highland Aymara and Quechua speakers of Bolivia, as distinguished from cambas, another indigenous word used to refer to Guaranis and others who live in lower regions of Bolivia, especially those in the Department of Santa Cruz.

  Quechuas — A civilization and ethnic group who speak the Quechua language, which was spread at the Inca conquest, and live in the valleys and highlands of the Andean mountains of Chile, Bolivia, Ecuador, and Peru.

  R

  Reduviid — From Reduviidae, a large family of predaceous insects, sometimes referred to as assassin bugs; most members are insectivores. One subfamily, the Triatominae, is found mainly in the Americas; its members are hematophagous and vectors of Chagas’ disease.

  reinfestation — The reappearance of insect vectors from an outside source in a location from which they had previously been eliminated by control measures.

  residentes — A term used by rural peasants to refer to friends and relatives living in urban areas.

  residual effect — The period of time that an insecticide is effective.

  Rhodnius pallescens — The principal vector of T. cruzi in Central America and Panama.

  Rhodnius prolixus — Triatomines that belong to the genus Rhodnius and are vectors of T. cruzi.

  Romaña’s Sign (Signo de Romaña) — A symptom of acute infection by Trypanosoma cruzi, consisting of edema (marked swelling) around the orbit of the eye and in the lymph node on the face in front of the earlobe. It is present only in a minority of infections.

  S

  Sajjra mesa “misfortune table” — A ritual performed by warmi yachaj to remove illness in the Kallawaya region of the Bolivian Andes.

  salivaria — Refers to trypanosomes, such as T. rangeli, that develop in an insect’s saliva or mouth and are injected by biting. The highly pathogenic human salivary trypanosomes belong to the T brucei group, which are transmitted through the saliva of tsetse flies and cause human sleeping sickness. See stercoria.

  sayaña — Aymara concept for house, which includes the house, its surrounding territory, and attendant livestock.

  schizodeme — A classification of T. cruzi strains based on electrophoretic mobility of kinetoplast DNA. See zymodeme.

  Schizotrypanum cruzi — An early classification of Trypanosoma cruzi by Carlos Chagas that was later changed because the parasite fit better into the trypanosome genus.

  Secretaria Nacional de Salud — Bolivia’s ministry of health, which sponsors clinics, hospitals, and medical personnel throughout rural and urban areas of Bolivia. It was previously called Ministerio de Previsión Socialy Salud Pública (MPSSP) until 1993 when the name was changed.

  seropositive — Positive results in a serological test; i.e., shows the presence of specific antibodies to T. cruzi. These tests are indirect in that they do not detect the parasite, nor are they capable of determining the prevalence of the parasite. People who test seropositive for Chagas’ disease usually have a direct examination of xenodiagnosis to determine the population and strain of the parasite.

  shamans — A generalized term used to refer to traditional healers who use rituals and magical paraphernalia to heal.

  sindicatos — Regional political organizations with vested power from the government.

  Signo de Romaña — See Romaña’s Sign.

  Spanish Conquest — In 1532 Spaniards conquered Andean regions and began europeanizing Andean ethnic groups by imposing the Spanish language and Western economic systems (e.g., encomiendas, haciendas, work tribute, taxes) and by missionization. Effects of this colonization continue today. Many in the Andean ethnic groups have strongly resisted these efforts at Westernization and continue to follow deeply rooted Aymara and Quechua traditions.

  stercoria — Refers to trypanosomes, such as T. cruzi, that develop in an insect’s intestines and are deposited in its fecal matter. See salivaria.

  superinfection — A second infection of a host that already is infected by the same species of parasite.

  surveillance — The periodic collection of data in an area to detect changes in infection rates, prevalence, and vector infestation.

  sylvatic cycle — The existence of vectors, parasites, and wild-animal hosts in a cycle not dependent on humans, human habitation, and domestic animals.

  synanthropic animals — Animals that live close to humans, such as cats, dogs, mice, rats, opossums, et cetera.

  T

  transfusional transmission — Infection with T. cruzi from transfused blood or other blood products.

  Triatoma — A genus of insect, along with the genera Panstrongylus and Rhodnius, that are vectors of Chagas’ disease; common names include triatomid and reduviid.

  Triatoma brasiliensis — A triatomine vector of Chagas’ disease in Latin America.

  Triatoma dimidiata — A triatomine vector of Chagas’ disease in Latin America.

  Triatoma infestans (T. infestans) — The most important vector of Chagas’ disease in Bolivia, where it is called vinchuca.

  Triatoma sordida — A triatomine vector of Chagas’ disease in Latin America.

  triatomines — Refers to members of the Triatominae, a subfamily of the family Reduviidae. Triatomines are characterized by their bloodsucking (hematophagous) ability, and certain species carry the parasite T. cruzi. Sixty-eight species are recorded as infected with Trypanosoma cruzi.

  Trypanosoma brucei gambiense — A flagellate protozoan that lives in the blood of cattle and humans, causing African sleeping sickness; tsetse flies are the vectors.

  Trypanosoma cruzi (T. cruzi) — The causative agent of Chagas’ disease in many animals and humans. It is transmitted by bloodsucking insects (triatomines) belonging to the family Reduviidae. It is a flagellate protozoan that transforms within the triatomine’s gut into metacyclic trypomastigotes that are infective to mammals, where it transforms into intracellular amastigotes and trypomastigotes.

  trypanosomes — Protozoa parasites which are classified together because during one stage of their lives they live in the blood and/or tissues of vertebrate hosts, and during other stages they live in the intestines of bloodsucking invertebrate vectors (Schmidt and Roberts 1989). Includes T. cruzi, T. gambiense, and T. rhodesiense, which cause diseases of man, and T. brucei, T. congolense, and T. evansi, which cause diseases of domestic animals.

  trypanosomiasis — Infection caused by trypanosomes, protozoa parasites from the genus Trypanosoma (T.). T. gambiense and T. rhodesiense cau
se African trypanosomiasis, commonly referred to as African sleeping sickness; T. cruzi causes American, or South American, trypanosomiasis, commonly referred to as Chagas’ disease.

  trypomastigote — The form of Trypanosoma cruzi which can exist in the blood of humans; it is typically C-shaped with a large kinetoplast and free flagellum. Also called Tryps.

  tsetse — A bloodsucking fly of the genus Glossina, known as the carrier, or vector, of Trypanosoma gambiense and Trypanosoma rhodesiense, the protozoan parasites that cause African sleeping sickness.

  Tupi-Guarani — A term used to refer to many ethnic groups that live in the departments of Tarija, Santa Cruz, Beni, and Pando in Bolivia. It is a broad term that it is not very culture specific.

  turqasiña — An Andean institution which refers to bartering produce for produce of equivalent value.

  U

  uxorlocal — A situation in which, after marriage, a husband goes to live with his wife.

  V

  vaccine — A suspension of infectious agents or some part of them, given for the purpose of establishing resistance to an infectious disease.

  vector — An agent of transmission; a biological vector is a carrier, especially the animal which transfers an infective agent from one host to another. The vectors in Chagas’ disease are triatomine insects, especially Triatoma infestans, or vinchucas.

  vinchucas — A popular name in Andean countries for triatomine insects carrying the T. cruzi parasite.

  vólvulo (volvulus) — A twisting of the bowel upon itself, causing obstruction. Although a prolapsed mesentery is frequently the cause in high altitudes, this term has also been applied to megacolon symptoms associated with T. cruzi.

  W

  Wankaris — A name given to semisedentary farmers, herders, and gatherers who lived at the Quebrada de Tarapacá (northern Chile, southern Andes) around A.D. 500 and whose mummies have been found with megasyndromes suggesting, although not proving, the existence of Chagas’ disease during those times. Chagas’ disease is still found in these regions; but it has less severe effects, suggesting a long-term adaptation to T. cruzi.