Angiostrongyliasis, more commonly known as rat lungworm disease, is endemic in Hawaii with cases tracing as far back as the 1950s and 1960s, but that doesn’t soften the blow felt every time a person is infected with this debilitating disease.

For this reason, the Governor’s Joint Task Force on Rat Lungworm Disease and the Hawaii Department of Health are collaborating closely to make strides in the prevention, diagnosis and treatment of the disease.

From left, Vernon Ansdell, William L. Gosnell and Kenton Kramer represented Hawaii at the American Society of Tropical Medicine and Hygiene annual meeting this week in Baltimore to discuss issues concerning the diagnosis and treatment of rat lungworm disease.

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The crux of the issue with rat lungworm disease is that there is limited information out there about how to best go about diagnosing and safely treating the disease.

Early symptoms may be non-specific and we recognize the frustration those infected with the parasite and their families feel when repeat medical visits are needed to diagnose their symptoms.

The task force’s Subcommittee on Clinical Management of Angiostrongyliasis is made up of physicians and experts in tropical medicine from across the state. We are working diligently to develop clinical practice guidelines for diagnosis and treatment of this very serious disease.

We’ve met three times since convening earlier this year and have focused our discussion on treatment. So far, we have reviewed in detail all the relevant studies on treatment in humans and animals, and focused on the role of anti-parasitic drugs, such as albendazole.

Most of the symptoms of rat lungworm disease are caused by inflammation resulting from the death of the parasite’s larvae in the human brain and spinal cord.

The use of anti-parasitic drugs, like albendazole, is controversial because, in theory, it may actually worsen a patient’s illness as it results in the mass death of larvae in the body. It remains controversial despite more than twenty years of debate in the medical community.

Several members of our subcommittee attended the Annual Meeting of the American Society of Tropical Medicine and Hygiene in Baltimore this November.

We met with experts on rat lungworm disease from around the world to discuss the development of clinical practice guidelines, which we hope will be a critical resource to be utilized by practicing physicians statewide.

Addressing Misinformation

We are concerned about significant misinformation circulating regarding rat lungworm disease.

For example, lumbar punctures, commonly known as spinal taps, have been misrepresented as an invasive, painful procedure. Information obtained from a lumbar puncture provides priceless information that helps physicians make very important decisions regarding diagnosis and treatment of patients.

In fact, it is a common, very safe procedure that is typically a critical part of the work up for rat lungworm disease. Local anesthetic makes it relatively painless and, as an added benefit, a spinal tap will usually dramatically relieve the headaches, which typically accompany an infection.

What we do know is that there are steps we can take each day to prevent infection.

While many gaps in knowledge still exist around diagnosis and treatment of the disease, what we do know is that there are steps we can take each day to prevent infection. Most people get sick with the disease by eating an infected slug or snail. Much of the time, consumption is accidental and the mollusks are lodged on unwashed produce.

By thoroughly washing fresh fruits and vegetables under clean, running water, no matter where they were grown or purchased, unwanted pests can be removed. The running water will not kill pests, but it will remove them and greatly reduce the risk of infection.

As the battle of the experts continues on the clinical front, I think we can all agree that if the public is better armed with the knowledge to prevent infection and encouraged to take those recommended steps, we will all be better protected from rat lungworm disease in the meantime.

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