Vacation in paradise capped off by severe case of rat lungworm disease

What should have been happy vacation memories turned into a horrific nightmare of foodborne illness from salad after 55-year-old Julie Packard returned home from Hawaii.

Packard, now 58, and her family vacationed in paradise in December 2021. It was their second trip to the island state, and they thought they would have a great time. Four days into the trip, Julie began experiencing tightness in her chest and odd sensations in her arms and legs. 

Upon returning to their home in Washington, Julie’s symptoms developed further. She had red bumps on her skin and felt like she had a cold. She went to the doctor but was sent home.

Days later, Julie went to the doctor again and was diagnosed with shingles. When she became more ill and developed other symptoms, she went to two more doctors.

“No one asked if I had traveled before becoming sick,” she said.

Julie reached out to two doctors on the Big Island of Hawaii four weeks into her illness. They were of little help. She developed aphasia, which causes people to speak gibberish when they attempt to talk. A doctor in Washington did a brain scan.

“We thought maybe it was brain cancer,” she said, “but the MIR came back negative.”

Finally, one of the doctors on the Big Island sent information on rat lungworm disease. By then, Julie’s symptoms were just as scary as the name of the disease. The foodborne illness is caused by tiny snails and slugs that often live on lettuce leaves. Their trails can contaminate the leafy greens and other fresh produce and quickly be eaten without being noticed.

At five weeks and counting, Julie saw an infectious disease specialist. He put her on steroids and other medications. The medicine did not resolve her symptoms, and at six weeks, she started having mobility problems and blurry vision.

“The worm had gone up my spine and damaged my optic nerve,” she said.

Julie developed eosinophilic meningitis, a rare form of meningitis. Meningitis is inflammation of the brain and spinal cord’s fluid and membranes, also called meninges. One doctor told her to wait a year to see if her symptoms would subside. She continued to have nerve pain and was forced to wear an eye patch to combat double vision.

“I did a lot of physical and speech therapy,” she said. “I am still healing at this point.”

Julie, a social worker, was off work for seven months. She started working part-time and has finally begun working full-time again. She continues to have gastro problems and now reacts to gluten and dairy products.

“As a social worker, I helped families navigate the health care system. I thought I knew how, but this showed me how hard it can be,” she said.

“I just want to raise awareness about this disease. I advise you not to eat raw vegetables or produce if you travel to Hawaii. I thought I knew how to be safe, but I didn’t. I wouldn’t have had salad if I had read an article about this before I went. Many people in the medical community just don’t know about this.”

Julie said she would go to Hawaii again if the opportunity came up, but she would go with her new-found knowledge about what to eat.

About rat lungworm disease

Rat lungworm disease is well known in the South Pacific and Asia. In recent years, it has spread to the Hawaiian Islands and has been detected in Florida and Georgia.

People are exposed to the parasite by eating or drinking contaminated foods and beverages, including raw or uncooked snails, slugs, frogs, some seafood, fresh produce, certain homemade beverages, and water from catchment systems.

Rats become infected when larvae hatch eggs in their lungs. They excrete the larvae, and snails, slugs, frogs, and crustaceans eat the rat droppings. 

In recent years, the disease has infected few residents of Hawaii, though there was an uptick in cases, according to the Hawaii State Department of Health. The department does not keep statistics on tourists who become infected.

According to Susan Jarvi, a researcher at the Department of Pharmaceutical Sciences at the Daniel K. Inouye College of Pharmacy at the University of Hawaii at Hilo, rat lungworm disease is challenging to diagnose. It is generally diagnosed based on symptoms and possible exposure to the parasite. She said a definitive diagnosis in humans can be determined by detecting the parasite through identification of the parasite DNA in cerebral spinal fluid, which requires a spinal tap. Jarvi is working to develop a blood test for diagnosis.    

Jarvi said that the treatment of rat lungworm disease generally involves the use of anthelmintics along with corticosteroids to help control inflammation. Albendazole is the anthelmintic drug of choice because of its ability to cross the blood-brain barrier. Still, it is provided by prescription only and is expensive in the United States. Recently, Jarvi’s lab has demonstrated that the commonly used pinworm medicine pyrantel pamoate is highly effective as a post-exposure prophylactic. It is available over-the-counter and has been adopted by the Hilo Medical Center in their general guidelines. 

In addition to research work by universities in Hawaii, the state has set up a governor’s joint task force on rat lungworm disease.

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Source: https://www.foodsafetynews.com/2024/12/vacation-in-paradise-capped-off-by-severe-case-of-rat-lungworm-disease/