A Case of Cardboard Boxes Likely Facilitating the Biting of a Patient by Trypanosoma cruzi-Infected Triatomine Bugs.

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 Triatoma protracta, 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 Trypanosoma cruzi 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.