TOPICS > Health

‘Neglected Infections’ Resurface Among America’s Poor

October 27, 2009 at 12:00 AM EST
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In poor rural areas, inner cities, and among Latin American immigrants, exotic diseases classified by the CDC as "neglected infections" are now affecting millions of people. As Jeffrey Kaye reports, the rarer the illness, the harder it is to find treatment.
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JEFFREY KAYE: Bugs, infections, and disease-causing parasites that most people think are restricted to developing countries are right here in the U.S., in poor rural areas, in inner cities, and among Latin-American immigrants, undetected by millions of victims and their doctors.

Maira Gutierrez, a native of rural El Salvador and now an executive secretary at a Los Angeles movie studio, didn’t know she had Chagas disease until blood she donated tested positive. It then took 10 years for her to find any place that offered treatment.

MAIRA GUTIERREZ: I stopped. I gave up on it. And I just did a lot of research online. I didn’t know anything until I got here.

JEFFREY KAYE: According to the Centers for Disease Control and prevention, 300,000 people in this country have Chagas, which can be fatal. The CDC is studying bugs from Latin America that feed off blood and deposit the parasites they carry in open wounds.

Chagas disease can also be spread by blood transfusions, organ transplants, and during pregnancy.

DR. SHEBA MEYMANDI: You know, your blood pressure is up.

JEFFREY KAYE: Eventually, in 2007, Gutierrez learned that the only clinic in the nation specializing in the treatment and diagnosis of Chagas disease had opened near her. By then, she was experiencing heart palpitations.

MAIRA GUTIERREZ: I think, within a week, I was here and did all the testing for me, my kids. And that’s how I started my treatment.

JEFFREY KAYE: Her doctor, Sheba Meymandi, an L.A. County cardiologist who runs the clinic, says chest pains and palpitations are a sign that the parasite has gotten to the heart.

DR. SHEBA MEYMANDI, cardiologist: So, you develop a massive heart that loses its function. And you develop heart failure.

JEFFREY KAYE: Compared to a normal heart, the pump in a Chagas-infected heart has to work harder.

DR. SHEBA MEYMANDI: The squeezing muscle — the heart is a muscle. It’s a pump. It squeezes.

JEFFREY KAYE: Mm-hmm. Mm-hmm.

DR. SHEBA MEYMANDI: It stops squeezing. It has reduction in ability to squeeze.

JEFFREY KAYE: Why?

DR. SHEBA MEYMANDI: Because the parasites infiltrate the muscle fibers…

JEFFREY KAYE: Right.

DR. SHEBA MEYMANDI: … and destroy muscle fibers.

MAIRA GUTIERREZ: It basically feels like it’s just — you know, your — your breathing gets a little heavier. You feel like your heart is just going to — wants to come out.

Disease is rarely screened

JEFFREY KAYE: Meymandi believes medication has slowed the progress of Gutierrez's infection, but doesn't know whether she will ever be cured.

DR. SHEBA MEYMANDI: So, they get a whole cardiovascular risk assessment.

JEFFREY KAYE: Meymandi says potential victims of Chagas are rarely screened for the disease. So, twice a month, she organizes volunteers to provide free cardiovascular exams in L.A. churches that cater to large immigrant populations. The clinics include blood tests for Chagas.

DR. SHEBA MEYMANDI: You would think, especially in areas where there is a large Latin American immigrant population that people should have access to providers who know about this disease. You know, that's not what we're taught in medical school. Chagas is an exotic disease. That's what you're taught. You're not going to see it much here.

JEFFREY KAYE: So -- so, are physicians, clinicians missing it?

DR. SHEBA MEYMANDI: Oh, absolutely. They're not even looking for it. I mean, they're missing it because they're not looking for it.

JEFFREY KAYE: Chagas is just one of a handful of what the CDC is classifying as the neglected infections of poverty, which affect millions of people.

MARK EBERHARD, division of parasitic diseases, Centers for Disease Control and Prevention: And are perpetuated primarily where, you know, standard of living is lower, people may not go to seek treatment routinely.

Common diseases plague thousands

JEFFREY KAYE: Mark Eberhard runs the Division of Parasitic Diseases at the CDC. He says evidence of these neglected infections has shown up in thousands of blood samples collected annually in national surveys. One of the most common culprits is the Toxocara roundworm.

MARK EBERHARD: We know that for Toxocara, for instance, about 14 percent of the U.S. population across the board have had exposure to that.

JEFFREY KAYE: The eggs of Toxocara roundworms show up in the feces of infected dogs or cats and get into people if they swallow contaminated dirt or through cuts in the skin.

The eggs release larvae, which can migrate to organs, including eyes, and can cause blindness. Often, there are no symptoms, or mild ones, like stomach aches that go away, but it's not an infection most doctors look for. And it can be misdiagnosed for years, or forever.

The same is true of other parasitic infections, including trichomoniasis, a sexually transmitted disease seen in poor urban areas especially in the Southeast.

In downtown Atlanta, at Fulton County's Department of Health and Wellness, Michelle Allen teaches safe sex practices.

WOMAN: I want to talk to you a few minutes about STDs.

JEFFREY KAYE: She says trichomoniasis is common at the clinic for sexually transmitted infections. Although it may cause mild symptoms, it can also lead to complications during pregnancy and make a person more prone to contracting HIV. Infection rates among black women are 10 times higher than among whites or Latinas.

Tisa-Dupree Bright is the clinic's nursing supervisor.

TISA DUPREE-BRIGHT, nursing supervisor, Fulton County Department of Health and Wellness: A lot of times, the females present with no symptoms. They're just coming in for a routine exam, and we find the trichomoniasis when we do the test.

JEFFREY KAYE: While many infections of poverty are under the radar screen, clinicians who work with poor people say there's at least one reason for that, namely, that, often, their most basic medical needs go unattended.

Buchanan County in the Appalachian coal country of Northwest Virginia has high rates of poverty, as well as heart, respiratory and liver diseases. Each year, the Remote Area Medical Volunteer Corps runs free clinics in Grundy, Virginia. Doctors, nurses, dentists, optometrists, and others see hundreds of patients as part of a program that provides weekend clinics around the U.S., mostly in rural areas.

MALE: Other than extractions, I wants fillings, cleanings.

Diseases of poverty often neglected

JEFFREY KAYE: Emergency physician Scott Syverud says he often sees neglected diseases of poverty, but he uses that label more broadly than the CDC.

DR. SCOTT SYVERUD, emergency physician: But, for every person with a toxoplasmosis infection, I will see 100 people with neglected disease of poverty, which is poorly controlled diabetes, high blood pressure, high cholesterol.

When you have a tsunami of people with no health care at all -- I mean, this morning, when I have taken care of -- I have diagnosed two people with new diabetes that have never been told they had it before.

JEFFREY KAYE: Better health care access for the poor would definitely lead to improved detection of neglected infections, according to Mark Eberhard. But, in the meantime, Eberhard says, more attention and resources devoted to the neglected infections of poverty could save lives and prevent disease.

MARK EBERHARD: Maybe having an insult to your liver from Toxocara isn't in the same magnitude as coronary heart disease, but, you know, if we can do something about it, I think that, you know, we should be.

JEFFREY KAYE: In Los Angeles, Dr. Sheba Meymandi contends that the neglect also extends to pharmaceutical research. She and other physicians complain the drugs available for parasitic infections often have side effects and are less than effective.

Why hasn't more work been done to develop better medications?

DR. SHEBA MEYMANDI: I'm not a very politically correct person, so let me say that I think it's because it's a disease of the poor. There's no money in it.

JEFFREY KAYE: In response to such criticisms, some drug companies have stepped up their efforts to find new treatments. Organizers of today's Conference on Neglected Infections of Poverty hoped it would not only raise awareness about the subject, but might help shake loose increased funding for better treatment and prevention programs.