It’s like “Sleeping Beauty” with a dose of nightmare fuel: A flat-bodied, six-legged insect moves toward you as you slumber, bound for the blood that surges around your eyes and lips. It crawls on your face. And the poop it leaves behind can be deadly.

The triatomine bug, also known as the notorious kissing bug, has been an obscure threat in the United States, with the highest density in Latin America and some Western states.

But the insect has found new prominence in Delaware, where health officials recently confirmed their first run-in with a kissing bug, making its known distribution across 28 states, according to researchers at Texas A&M University. The bugs have previously carved out territory from California to the Carolinas.

The insects may have been in Delaware already, but they are elusive and more difficult to trap, compared with mosquitoes and ticks, said Sarah Hamer, an associate professor and epidemiologist at Texas A&M. And that means it’s difficult to determine whether there is an expansion.

There is not a lot of evidence that would show a northward invasion, but there is an uptick in awareness, she told The Washington Post.

A kissing bug in Delaware bit and sucked the blood from a girl’s face in July 2018, a state health official wrote. Subsequent research confirmed the species, but scientists found no traces of Chagas disease, which is carried by kissing bugs.

Immediate Chagas disease infection can cause fever, rash, loss of appetite, diarrhea and vomiting, researchers have said, but the danger comes from potential chronic infection targeting the heart and gastrointestinal tract.

About 300,000 U.S. residents have Chagas disease, the CDC said, and they mostly contracted the disease in Latin America.

Approximately 30 percent of people who contract Chagas disease are at risk of heart failure and cardiac arrest, which is a growing concern for the American Heart Association. The disease is an “important cause of heart failure, stroke, arrhythmia, and sudden death,” according to a 2018 statement commissioned by the group.

The prevalence is growing outside endemic areas throughout Latin America, said the statement, which was commissioned alongside the Inter-American Society of Cardiology.

About 8 million people in Mexico and Central and South America are living with Chagas disease, the CDC said.

Health officials have cautioned that Chagas disease is difficult to contract from kissing bugs despite their vectoring ability, and it comes down to their feces.

Kissing bugs can pass along parasites after defecating at the area of their bite, making it a gross but rare combination that must happen before an infection occurs.

“A lot has to happen. It’s really inefficient for the parasite for that fecal transmission to occur,” Hamer said. People should be on the lookout for kissing bugs but not exactly fearful that any insect could be a Chagas disease vector, she said.

Kissing bugs are typically an inch long, and many in the United States have orange or reddish markings on their bodies. Their skinny, elongated heads are also unique characteristics, Hamer said.

But humans are not the only victims. Dogs, especially in Texas, have been hit hard with Chagas disease, she said. They are known to be curious and eat kissing bugs, which is an effective way for the disease to spread.

“Dogs are a sentinel, or an indication, that kissing bugs are there,” Hamer said.

Read more: