Task force offers guidelines to treat rat lungworm disease

HONOLULU — A task force of Hawaii Governor David Ige’s announced new preliminary guidelines to help physicians diagnose, treat and manage rat lungworm disease.

The task force’s clinical subcommittee spent the last year crafting the guidelines, which were announced Thursday and will be presented in November during the annual meeting of the American Society of Tropical Medicine and Hygiene, according to the Hawaii State Department of Health.

Before the group’s work, there were no clear or reliable diagnosis or treatment protocols available for Hawaii physicians, subcommittee chairman Vernon Ansdell said. “These preliminary guidelines provide critical guidance to physicians to help them make timely and accurate diagnoses and give their patients the best possible treatment available,” he said.

Rat lungworm disease, also known as angiostrongyliasis, is caused by a parasitic roundworm and can affect a person’s brain and spinal cord, according to the Health Department.

The worm larvae are passed to humans who ingest raw or undercooked freshwater shrimp, land crabs and snails or raw produce that contains infected slugs or snails and their slime.

The adult parasite is found only in rodents, but its larvae can be passed through feces. In turn, creatures like snails and slugs can become infected by ingesting the larvae. Humans get rat lungworm by accidentally eating infected snails or slugs.

The parasite causes a rare type of meningitis. Its symptoms include severe headaches and neck stiffness, tingling or painful feelings in the skin or extremities, low-grade fever, nausea and vomiting. Some effects can be permanent and create lifestyles changes, such as the inability to walk or drive.

For treatment, “the most important drug is a steroid that suppresses inflammation,” Ansdell said.

The preliminary guidelines also call for a complete neurologic examination, a carefully sought exposure history, and stress the importance of a lumbar puncture, or spinal tap, in diagnosing the disease.

It “sounds very dramatic, a spinal tap,” Ansdell said, but it’s a “standard procedure” and is “invaluable when it comes to making the diagnosis.”

It also helps with treatment by relieving pressure in the brain, he said.

The development of the new guidelines is a “crucial and imperative step forward,” said Anna Koethe, public health information coordinator for the Department of Health.


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