Like the pain of childbirth ‘every day’: Excruciating rat lungworm disease spreading in Hawaii

But the incidence of angiostrongyliasis, nicknamed "rat lungworm" illness because of its origins (it comes from a parasite in the lungs of rats via rat feces to snails and slugs and then through contaminated food or drink to humans) is on the rise in Hawaii.

Humans cannot spread the disease to each other. And the parasites "cannot mature or reproduce in humans," said the health department.

"I would never want anyone to experience this."

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Apart from sharing the pain of sufferers like Mynar, officials worry about the impact on tourism, a mainstay of the state’s economy, and on restaurants.

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Doctors refine the diagnosis by looking at what they’ve eaten and where they’ve been. The patients start out thinking they have flu, as Mynar did.

Angiostrongylus cantonensis. (CDC)

Fortunately, relatively few people do.

Some of those infected show no symptoms or have mild symptoms. Others get battered with "severe headaches, stiffness of the neck, tingling or painful feelings in the skin or extremities, low-grade fever, nausea, vomiting" and sometimes a temporary paralysis of the face and light sensitivity.

"All our rules we have in place now, if followed, are more than adequate," sanitation official Peter Oshiro told Hawaii News Now, "and we’re very confident that it can prevent the occurrence of any more rat lungworm diseases from any of our regulated establishments."

Nor are officials anticipating anything they are willing to call an epidemic.

"It was like my nerve endings snapping in my feet. I was feeling like there was fire ants, hundreds of them, crawling on my feet… like a luau of fire-ants." And then there were her feet.

They had left the kava out in uncovered buckets after preparing the drink at home, according to the health department. The latest group to become infected with the parasite, according to the Department of Health, picked it up at a home in Keaau on the Big Island a few weeks after drinking homemade kava, made from Piper methysticum, a plant native to the western Pacific islands.
The majority is in your head and the pain is just excruciating." "It was like someone stuck an ice pick in my collarbone, in my chest and in the back of my neck. "That was like eating ice cream compared to this," she told KHON TV.

The cases in Hawaii have been found on the island of Hawaii, known as the Big Island, and on Maui, just to the north and west of the Big Island.

Mynar said she couldn’t stand to be in the light for a while, and lived out some of her days in dark rooms.
It’s like the pain of childbirth "every day," said the mother of three.
That’s already more than the average of 9 for an entire year in the state, reported the Honolulu Star-Advertiser.

The clinical description of the symptoms of rat lungworm illness – "severe headaches, nausea, vomiting, neck stiffness, seizures, and neurologic abnormalities" – lets this particular affliction off the hook.
There are also four related cases considered "highly probable based on clinical indications," the department said. The Hawaii State Department of Health confirmed two new cases Wednesday, bringing the total of confirmed cases to 11 this year in the state.
The patients start out thinking they have Diagnosis is challenging as there is no readily available blood test, according to the state health department.

To really fathom its hideousness, you have to listen to the words of someone suffering through it, like Tricia Mynar, who’s been describing her experience on TV in Hawaii to raise awareness.

"It was a feeling like somebody was taking a hot knife and just stabbing me in different parts of my body," she said. Eliza Lape, of San Francisco, told KPIX, she and her husband were infected while in Hawaii for their marriage.

So far no sense of crisis appears to have overtaken Hawaii, a state accustomed because of its climate and location to diseases like dengue fever that rarely appear in the continental U.S., and to the respiratory distress caused by "vog" (volcanic smog) from the sulfur emitted by active volcanoes.

And the headaches: Worse, she said, than the "worst migraine you could feel."
The disease attacks the brain and the spinal cord. It can also cause a rare type of meningitis called eosinophilic meningitis.

"The assumption," state epidemiologist Sarah Park told a news conference, "is because it was in an area… we know was infested with these mollusks, that there were probably more in there that were inadvertently ingested."

Maui restaurants have already "taken a hit as customers steer clear of local produce," reported Hawaii News Now.
People have to wait it out, sometimes with rehabilitation, taking pain medications and steroids to reduce the symptoms, which can last anywhere between 2 to 8 weeks or longer. But the treatments do not cure the illness.

Hawaii State Sen. It’s in their lung," Green explained on KHON. They bust out of the rat, then they poop, and then slimy mollusks go over them. It can affect your lettuce. ""What happens is, it’s in the rat. It can affect your vegetables. That’s why you’ve got to either cook the heck out of these slugs or probably snails, because I don’t think people are eating slugs, or really wash your lettuce." Josh Green, who is a physician, described it more colloquially in a TV interview. "The worms… ultimately have larvae.

It was then "poured into a large and after consuming most of the contents, the individuals noticed a slug at the bottom of the bowl." An investigation by the health department "determined the source of the infections was likely the homemade kava tainted by slugs."

"Cases like this recent cluster are especially concerning," Health Director Dr. These healthy habits can protect against food contamination and prevent serious illnesses" Virginia Pressler said in a news release, "because they can be prevented with basic precautions such as storing food in covered containers and properly inspecting and washing food before eating.
"Angiostrongyliasis is of increasing public health importance as globalization contributes to the geographical spread and more international travelers encounter the disease," said a 2014 study. It has spread from its traditional endemic areas of Asia and the Pacific Basin to the American continent including the USA, Brazil and Caribbean islands. Most reports of the disease are from Thailand and Taiwan with increasing reports from mainland China." Recently, the incidence of human infections has increased rapidly. "The parasite is on the move.
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"We’re probably seeing more cases because you all are helping to get the word out," state epidemiologist Park said.
Angiostrongyliasis, which affects the brain and the spinal cord, is caused by a parasitic nematode or worm called Angiosrongylus cantonensis (A. cantonensis, which is found in rodents, travels like this: cantonensis.) According to the Hawaii health department fact sheet, which has become a bit of a must-read in the state in recent weeks, A.

They had left the kava out in uncovered buckets after preparing the drink at home, according to the health department.
When she first contracted it, "it was like people pushing needles "in my back, pushing forward from my shoulder blades all the way to my lungs" and out "the front of my chest," she told Maui News Now.

Ben Manilla, her husband, wound up in intensive care in San Francisco.

Tricia Mynar who lives on Maui, thinks she got it while visiting the Big Island from eating her favorite salad, but that’s not been confirmed by health officials.
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The produce, not to mention any ingestion of the mollusks, can spread it to humans. It is then consumed by snails, slugs, freshwater shrimp, land crabs and frogs. The rodents poop, releasing the larvae of the worm into the ecosystem. They, in turn, can spread it to produce.

I had to stand at my kitchen counter and put my hands on the counter to hold my body up. I literally slept two nights standing. I couldn’t have any type of wind touch my skin because my nerves were hypersensitive." "I couldn’t sleep.