By: Candess Zona-Mendola

Six more adults are severely ill with an incurable infection after ingesting contaminated kava drinks in Maui, according to the Hawaii Department of Health. All six victims were hospitalized. The local hospital currently treating them reported the cases to the Hawaii Department of Health over this last weekend. There are now 11 confirmed cases of Rat Lungworm infection, without counting the four pending confirmation. The victims of the infection have been found on Maui and the Big Island. Three victims were Big Island residents, four were Maui residents, two of which were exposed on the Big Island, and two were tourists.

This morning, the health agency reported that two more cases of the parasitic infection were confirmed, and another four cases are pending identification. The agency believes the link between the cases is highly probably, as the exposure to the parasite was a similar method.

The tourists infected were a pair of newlyweds from San Francisco were both infected on their wedding trip. The husband of the couple informed new media that he had to undergo surgery, contracted pneumonia twice, and is currently having kidney issues relating to the parasite. The couple does not know how they became infected. It is hopeful that the Hawaiian Department of Health may potentially find a source.

What is Kava?

The most recently identified group of people infected with Rat Lungworm became infected with the parasite after drinking a homemade kava drink. Kava, a popular social drink in the South Pacific, is made from a plant that grows in the Western Pacific islands called Piper methysticum.

What is Rat Lungworm? What are the Signs and Symptoms?

Rat Lungworm is a parasite that is typically found in host animals such as: rats, slugs, snails, frogs, shrimp, monitor lizards, and prawns. Snails, both land and freshwater, are the primary host of this organism. As many of these animals live in trees and gardens, it is very common that they come into contact with many of the produce items we eat. Hawaiians are especially at risk, as the parasite thrives in tropical climates. The parasite is a roundworm, also called a parasitic nematode.

Although the disease caused by Rat Lungworm, angiostrongyliasis and its complication human eosinophilic meningitis, is relatively rare, it is not unusual for Hawaiian residents to know someone who has become afflicted with it. In fact, illnesses and complications related to Rat Lungworm infections are on the rise.  According to a recent article in Honolulu Magazine, the prevalence of the infections are “between one to nine cases reported every year and two deaths since 2007.” Professor of Pharmaceutical Sciences at the University of Hawaii Hilo Susan Jarvi told the Honolulu Magazine that “[o]n the Big Island, practically everybody knows somebody with rat lungworm disease…It’s been going on so long … It’s a fairly preventable disease, if you know about it.” She informed the magazine that she gets a few calls each week about the infection.

On the islands, residents typically become infected with the parasite by ingesting raw produce (like leafy greens, herbs, sweet potatoes, or fruits), raw shrimp, freshwater crabs, or snails, or water contaminated by animal vectors. Symptoms of the infection can show within about one to three weeks after ingestion of the parasite. Usually, the victim will suffer a severe headache and neck stiffness. Some victims may show no symptoms at all. In some cases, symptoms can also be much worse to include: fever, nausea, vomiting, seizures, neurologic abnormalities, tingling and/or painful feelings in the skin or extremities. One victim, Tricia Mynar, was interviewed by the local news outlet KHON TV and described her suffering with the illness as feeling like the pain of childbirth on a daily basis. Mynar commented, “It was like someone stuck an ice pick in my collarbone, in my chest and in the back of my neck. The majority is in your head and the pain is just excruciating.”

The Centers for Disease Control and Prevention (CDC) has provided a handy resource for anyone who believes that they may have become ill with Rat Lungworm. Again, the infection is currently incurable. According to the CDC’s website, treatment options are limited for those infected with the parasite,

“Treatment is usually supportive with the use of analgesics for pain and corticosteroids to limit the inflammatory reaction. Careful removal of CSF at frequent intervals can help to relieve headache in patients with elevated intracranial pressure. No anti-helminthic drugs have been proven to be effective in treatment, and there is concern that anti-helminthics could exacerbate neurological symptoms due to a systemic response to dying worms. The effectiveness of any regimen may vary by endemic region.”

The victim is therefore treated for comfort and has to wait it out.

The Bright Side

The only good news, if you can call it that, is that humans are considered a bad host for this parasite. Rat Lungworms are unable to develop into maturity and reproduce in a human host. This means, within about a year, all parasites will die and the victim will be essentially cured.

Rat Lungworm infections are preventable. In the most recent cases, the Hawaiian health agency reported that those who became ill did so after drinking kava and finding a slug at the bottom of the container. Hawaiian Health Director Virginia Pressler commented this week in a news release,

“Cases like this recent cluster are especially concerning because they can be prevented with basic precautions such as storing food in covered containers and properly inspecting and washing food before eating. These healthy habits can protect against food contamination and prevent serious illnesses.”

Meanwhile, the health agency also is pressing concerns on local growers and restaurants to be mindful of food safety when serving patrons. Proper washing of product and heating food to an optimum cooking temperature of at least 165 degrees Fahrenheit will help reduce the risk of infection. The health agencies also recommend that all residents do their part in controlling slugs, snails, and rats around homes and food service areas.

Sources:

http://mauinow.com/2017/04/19/new-cluster-of-rat-lungworm-linked-to-consumption-of-tainted-kava-drink/

http://health.hawaii.gov/docd/files/2015/07/angio-fact-sheet-20150716.pdf

http://www.webmd.com/vitamins-supplements/ingredientmono-872-kava.aspx?activeingredientid=872&activeingredientname=kava

http://www.honolulumagazine.com/Honolulu-Magazine/April-2017/6-Things-You-Need-to-Know-About-Rat-Lungworm-Disease-Before-You-Eat-a-Salad/

http://www.staradvertiser.com/2017/04/19/breaking-news/rat-lungworm-cases-climb-in-hawaii-2-conf