Hawaii visitor got parasite eating slug on a dare. What is rat lungworm disease?

Hawaii health officials have confirmed three new cases of rat lungworm disease, including one in a visitor who contracted the parasite after eating a slug on a dare.

All of the newly identified cases of the disease, sometimes called angiostrongyliasis, were in adult visitors from the mainland United States who contracted the parasitic worm while traveling on the Big Island, the state’s Health Department said in a news release Thursday.

Hawaii’s Health Department warned that the roundworm-caused disease “can have debilitating effects on an infected person’s brain and spinal cord,” with most Hawaii cases of the illness resulting from people “accidentally ingesting a snail or slug infected with the parasite Angiostrongylus cantonensis.”

Symptoms of the parasite “vary widely,” from neck stiffness and severe headaches to serious neurological problems and long-term disability, the Health Department said. Tingling, fever, nausea and vomiting are also possible, but some people infected with the worm don’t have any symptoms at all, according to the Centers for Disease Control and Prevention.

The CDC said that “even if infected, most people recover fully without treatment.” Cases are rarely reported in the continental U.S., according to the health agency.

“The parasite dies over time, even without treatment,” the CDC says. “Sometimes the symptoms of the infection last for several weeks or months, while the body’s immune system responds to the dying parasites. The most common types of treatment are for the symptoms of the infection, such as pain medication for headache or medications to reduce the body’s reaction to the parasite, rather than for the infection itself.”

But for some patients the symptoms are awful and ongoing, as the Washington Post reported in 2017, chronicling the story of a woman named Tricia Mynar who compared the pain to childbirth.

“That was like eating ice cream compared to this,” Mynar told KHON TV. “It was like someone stuck an ice pick in my collarbone, in my chest and in the back of my neck. The majority is in your head and the pain is just excruciating.”

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The slug-eating visitor traveled to east Hawaii in December 2018 and grew sick from “purposely eating” the slug late in the month, health officials said. That case brings the total number of angiostrongyliasis infections on the Big Island to eight in 2018, and brings the infection number across the whole state last year to 10, according to the Health Department.

The other two cases health officials confirmed Thursday occurred this year, bringing the total number of infections in 2019 to five, according to the Health Department. Each of those 2019 cases was on the Big Island.

The newly reported 2019 cases were in individuals traveling on the west side of the Big Island. One grew ill in early January but was not hospitalized, health officials said. It’s not clear how the person came down with the infection, but “they do remember eating many homemade salads while on vacation,” the Health Department said.

The second new case this year was in a person who became ill in February and was briefly hospitalized, officials said. That person “was not able to identify an exact source of infection, but the individual likely became infected while ‘grazing,’ or eating unwashed raw fruits, vegetables and other plants straight from the land,” officials said.

“It’s important that we ensure our visitors know the precautions to take to prevent rat lungworm disease, which can have severe long-term effects,” Health Director Bruce Anderson said in a statement. “Getting information to visitors about the disease is just as critical as raising awareness amongst our residents.”

To reduce the risk of infection, the state Health Department recommends washing produce carefully under running water to “remove any tiny slugs or snails” with “close attention to leafy greens.”

People are also advised to limit rat, snail and slug populations near their homes, to wear gloves when working outside, and to “inspect, wash and store produce in sealed containers, regardless of whether it came from a local retailer, farmer’s market, or backyard garden.”

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