Parasites cause intense pain for Big Isle victims


POSTED: Monday, January 05, 2009

WAILUKU » The pain was so bad he screamed for hours.

“;It just got so intense, nothing took the pain away,”; said Big Island resident Zsolt Halda, 36. “;It felt like they were doing surgery on me and ripping out my organs.”;





        Here is some information about rat lungworm disease, caused by the parasite Angiostrongylus cantonensis, provided in a fact sheet by the Centers for Disease Control and Prevention:

Symptoms: Some people do not have any symptoms or have mild symptoms, while others have headache, stiff neck, tingling or painful feelings in the skin, low-grade fever, nausea and vomiting.


Contamination: The rat lungworm is usually spread through larvae in rat feces being consumed by snails or slugs, then eaten by human beings. It is not passed from one person to another person.


Treatment: People usually do not require treatment. The parasite dies over time even without treatment. Even people who develop meningitis usually do not need antibiotics. 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) rather than for the infection itself.


To avoid infection: Do not eat raw or undercooked snails or slugs, and thoroughly wash produce that might have them, especially home-grown produce such as lettuce. If you handle snails or slugs, wear gloves and wash your hands.


Other ways of getting infected can include eating raw or undercooked freshwater prawns, crabs or frogs. Fish do not spread this parasite.



Halda was a victim of what is commonly called rat lungworm disease, a rare ailment that has inexplicably hit three Big Island residents hard in the last few weeks.

Dr. Jon Martell, the attending physician at Hilo Medical Center, said the three patients are the worst he has seen in his 14 years of treating such cases.

“;Something's different,”; Martell said.

The disease arises from parasitic worms, Angiostrongylus cantonensis, sometimes ingested inadvertently by eating raw produce that contains a small snail or slug. The worms migrate through the human body and usually die after several weeks.

Most people recover fully without treatment, according to the federal Centers for Disease Control and Prevention.

But sometimes the larvae migrate into cerebral fluid, causing inflammation in the brain and spinal cord membrane and a form of meningitis, according to a study by the state and CDC published in 2007. In some cases, rat lungworm disease can cause significant pain and trauma, including paralysis, blindness and death, as occurred in a fatal case in Taiwan in 1944, according to the study.

The study identified 24 rat lungworm cases in Hawaii from January 2001 to February 2005, including 11 on Oahu, nine on the Big Island, three on Maui and one on Lanai.

Patients usually became sick in three days, but one took as long as 48 days, according to the study.

Halda said he and a friend, Silka Strauch, who live in Black Sands between Pahoa and Kalapana, have been eating raw vegetables and taking precautions by cleaning the produce with a peroxide rinse.

He suspects they may have accidentally consumed tiny larvae of slugs lodged in the deep folds of peppers.

Halda said Strauch came down with agonizing pain, but no one at Hilo Medical Center could find anything wrong with her initially and she was not admitted to the hospital.

“;I had to take her home ... three separate times,”; he said. “;No one should have to be turned away.”;

Halda said Strauch was unable to walk and had pain so intense that even the slightest touch hurt her.

“;You couldn't even put a sheet on her,”; he said.

He said Strauch was admitted to the hospital on Dec. 8, and he was admitted on Dec. 15.

Strauch has been in a coma for several days, he said.

Dr. Sarah Park, state epidemiologist, said there is no diagnostic test that confirms the presence of rat lungworm disease, short of finding the parasite, and physicians have to rely partially on the likelihood of possible exposure through a patient's food history.

She said in certain instances, an analysis of spinal fluid can indicate the likelihood of rat lungworm disease.

Park said there is no medical treatment for the disease, and physicians treat the symptoms with pain relievers for aches and steroids for inflammation.

Beatrix Pfleiderer, another friend of Strauch's, said she fears the disease poses a “;rising danger.”;

A 24-year-old Puna man was admitted to Hilo Medical Center with a case last week.

She said others have contracted the disease but have not gone to the hospital because they do not have medical insurance.

Park said the movement to consume home-grown produce is great and that people simply dunk produce in water and assume it is clean.

“;You've got to clean each leaf,”; she said. “;Our biggest challenge is constantly reminding people about the risks.”;

Park said a species of slug on the Big Island has tiny larvae, about 1 to 2 millimeters long.

The presence of the Southeast Asian slug, Parmarion martens, was noticed about 10 years ago and has spread rapidly, said Robert Hollingsworth, an entomologist with the U.S. Pacific Basin Agricultural Research Center.

“;The concern is when it's very small and hard to see,”; he said.