Available in PDF - Table 1. Kissing bug species (Hemiptera: Reduviidae: Triatominae) of southeastern United States.

The kissing bug subfamily, Triatominae, includes more than 100 species, of which 60% are known carriers of T. cruzi. Nearly a dozen species of Triatominae can be found within the United States, predominately in the southwest. Once primarily associated with wild mammal hosts, kissing bugs are now increasingly found in domestic and peridomestic environments. Triatoma sanguisuga and Triatoma protracta are the most common North American species found in buildings. Several insects are often misidentified as kissing bugs (Table 2). Assassin bugs, which are members of the same family, Reduviidae, are beneficial predatory insects and should be conserved due to their value as biocontrol agents. Assassin bugs are commonly encountered outdoors during the day, whereas kissing bugs can be found both outdoors and indoors and are mainly nocturnal.

Available in PDF - Table 2. Insects often mistaken for kissing bugs.

Chagas

Chagas is an infectious disease caused by the parasitic protozoan Trypanosoma cruzi first discovered in 1909 by the physician Carlos Chagas in Brazil. While feeding on a host, the primary kissing bug vectors of Chagas often defecate at or near the feeding site. Kissing bug feces often contain the T. cruzi pathogen. If the infected fecal material is rubbed into the bite wound, mouth, eye, or ingested, then the pathogen may be transmitted to the host. Introduction of T. cruzi into the host can lead to the development and progression of Chagas disease. Kissing bugs are the primary vectors of the disease, though not all species transmit the disease in the same way. The parasite is acquired while feeding on the blood of an infected animal or human. Chagas disease can also be acquired through pregnancy, as well as blood and organ donations; however, blood and organ donations are now screened in most countries. A person infected with Chagas undergoes two phases of infection: acute and chronic. The acute phase may last for several weeks to months, often with no symptoms. If present, symptoms are mild or flu-like: edematous swelling of the eyelids; inflammation of the tear gland and swelling of the lymph glands of the neck. The chronic phase of Chagas appears long after the initial infection, up to 10 or 20 years later. The chronic phase can be asymptomatic as well, but severe symptoms may appear, such as irregular heartbeat, sudden cardiac arrest and heart failure. Chagas in the acute phase may be cured, using medicines such as benznidazole and nifurtimox to kill the parasite. However, once the disease is in the chronic phase, Chagas is medically incurable, and treatment is restricted to managing severe symptoms.

Cases of Chagas disease are limited to the Americas, posing a serious public health concern from southern Mexico to South America. Globally, about 7 million cases of Chagas disease occur every year, resulting in 12,000 deaths. Between 2007, when national blood donation surveillance began in the United States, and 2018, blood screening identified 2,406 cases of Chagas disease. Most of these cases, however, were acquired from outside the United States. There have been only 29 confirmed cases (47 suspected) of locally acquired Chagas in the U.S. from 2000 to 2018. Accurately reporting confirmed cases of Chagas disease in the U.S. is challenging due to its frequently asymptomatic nature and lack of active monitoring. A September 2025 report issued by the Centers for Disease Control and Prevention suggests that Chagas disease is now endemic in the United States. Of the 300,000 cases that the report estimates to exist in the United States actively, fewer than 2% would be aware of their condition. At present, however, there has been limited additional literature or surveillance data published to corroborate these conclusions.

Trypanosoma cruzi in a Giemsa-stained blood smear. Photo by the Centers for Disease Control and Prevention

Kissing bugs in North America behave differently than their counterparts elsewhere, resulting in a lower risk of Chagas disease transmission. Because Chagas disease is spread through their feces, the interval between feeding and defecation strongly influences the likelihood of transmission. Within North American kissing bug species, a much greater time lapse occurs between feeding and defecation compared to species found in South America. This delay in defecation ultimately reduces the possibility of T. cruzi entering the body and developing into Chagas disease. Additionally, infrastructure in North America is generally more developed and better protected from outside environmental exposure, with clear separation between human living spaces and animal or livestock quarters, a common harborage for kissing bugs. From a veterinary perspective, there is concern with kissing bugs regarding dogs. Due to differences in behavior, such as a dog’s likelihood to consume insects it finds, or sleeping outside, dogs have a higher likelihood than humans to be infected with T. cruzi. In a 2020 study, 1,610 workings dogs within the Department of Homeland Security were tested for the presence of T. cruzi, with 120 being positive. Currently, there is no approved vaccine or antiparasitic medicine for dogs in the United States.

Prevention and Management

Reducing risk of being bitten by a kissing bug is the primary way to prevent Chagas disease. Management and protection focus on strategies that make environments less conducive to kissing bug presence. Effective area management plans for kissing bugs should include several components:

1. Inspection of areas to identify kissing bug presence
2. Removal of animal nesting sites near structures
3. Removal of conditions around structures that are conducive to harboring kissing bugs (wood and rock piles, dense vegetation, etc.)
4. Exclusion of kissing bugs from structures (sealing cracks and crevices, installing screens, ensure windows and doors are fitted tightly, etc.)
5. Applications of insecticides to control remaining individuals, if their presence is confirmed

Regularly inspect areas for signs of kissing bugs, including live insects, eggs or fecal spots. Particular attention should be given to cracks, crevices, crawl spaces and areas where pets or wildlife may rest. Because infestations of kissing bugs are relatively uncommon both indoors and outdoors, further control actions may not be needed when no active presence is detected. Preventative measures are still recommended to help limit future kissing bug activity. Limiting burrows, nesting sites and access points (e.g., gaps in fences) can significantly reduce wildlife presence on a property, which in turn may decrease the likelihood of kissing bugs. Common animal hosts for kissing bugs in North America include armadillos, opossums, rodents, squirrels, raccoons, as well as domestic pets such as cats and dogs. If pets spend time outdoors, regularly inspect them and their bedding for signs of kissing bug presence. The removal of potential kissing bug habitat on a property can also be effective, such as by eliminating wood buildups, debris buildup and dense vegetation.

As kissing bugs are primarily nocturnal, they pose the greatest threat to humans during sleeping hours. Kissing bugs are attracted to exterior lighting at night, then may enter structures. If possible, reduce the use of lights near structures at night, especially lighting near doors and windows. Sealing cracks around windows, walls and roofs, as well as installing tight fitting screens on doors and windows, can minimize the likelihood of kissing bugs entering structures and is the most effective method of prevention. Certain entry points, like pet doors, may need custom modifications or specially designed products to create a tight seal and prevent insect entry. After all previous management strategies have been utilized, insecticides (particularly pyrethroids) may be necessary to control remaining individuals.

For international travel, ensure your accommodation is well-constructed and has no or minimal openings to the outdoors. If you suspect you’ve been bitten by a kissing bug and you can locate the suspected insect, try to safely contain the insect using gloves. Seek medical assistance from your primary care physician if any symptoms develop after returning and inform the doctor about travel history.