Chaunda Rodrigues, 31, of Hilo, Hawaii, buys an avocado lettuce sandwich from a local market on December 31, 2019.But when Rodriguez started eating, something stuck to her teeth.Terrifyingly, it was part of a slimy 2.5-inch slug.Then came the aftershocks.A few days later, a lab at the University of Hawaii confirmed that the creature Rodriguez bit into contained Angiostrongylus cantoni, a food-borne parasite that can invade the human brain.
Since Guangzhou A. cantonensis, also known as “mouse lungworm”, was first discovered in southern China in the mid-1930s, the spread of neurotrophic nematodes has been slow but unstoppable.Today, it inhabits tropical islands and warm, humid regions on five continents.While mice are the ultimate host for the parasite, humans most often get sick after ingesting infectious larvae from snails and slugs, many of which are invasive species.A classic example is the Asian half-slug Parmarion martensi.Since it was first discovered on Oahu in 1996, on the Big Island in 2004, and on Maui in 2017, P. martensi has regularly carried large numbers of larvae into human habitats.Once inside humans, these larvae travel to the central nervous system where they normally grow and die, sometimes leaving behind deadly inflammation and nerve damage.
Rodriguez is not a passive person.Once her predicament became clear, she was quickly given an antihelminthic drug called Albenza.She also posted on Facebook, publicly sharing her saga and a vivid photo of her slimy, severed gastropod.Finally, two weeks after biting the slug, Rodriguez and her husband filed a lawsuit against Island Naturals Market for negligent failure to clean the ingredients in the sandwiches it manufactures and sells to prevent exposure to the potentially deadly parasite.
Although many diseases caused by Aspergillus candidensis go undiagnosed or never reported, in 2019 there were nine official cases among local residents and tourists on the Big Island of Hawaii.Could a few albendazole tablets protect Rodriguez from the same fate?No one knows for sure, but thankfully she’s been fine.The bad news, on the other hand, is that millions of people visit Hawaii every year and know nothing about rat lungworm, including answers to the basic question: What the hell is this?How can I avoid it?How is it diagnosed?Are there early warning signs that allow me to receive timely and effective treatment before complications arise?The same ignorance applies to most doctors in their country.
A patient who learned this the hard way, a 56-year-old woman from Seattle, like many others now, can’t wait to enjoy some sultry sunshine and warm letters under stricter COVID lockdowns and protocols. wind.Julie Packard happily ate a few salads and a veggie roll during her eight-day stay on the island of Hawaii in December 2021, never thinking that dangerous parasites could contaminate local produce .Her early symptoms – strange tightness and sporadic tingling in her chest – started before she left.A few days later, Packard also suffered myalgias, burning pain and a rash on his trunk, followed by changes in vision and balance.Bottom line?It wasn’t until five weeks after her symptoms worsened that Packard finally had a spinal tap, and a small sample of her cerebrospinal fluid was shipped to the NIH’s Parasitic Diseases Laboratory.There, an ultrasensitive test for A. cantonensis DNA turned out to be strongly positive, but her brain had been injured.Even 3 months later—despite 2 weeks of albendazole and continued Decadron therapy—the former athletic social worker still had diplopia and unsteady gait.
Other telltale signs and dire consequences of angiostrongyliasis include severe, persistent headaches, paresthesias, bowel and bladder dysfunction—even death—from radiculomyelitis, hydrocephalus, and coma.
As any medical student can attest, you can’t talk about “parasites” without mentioning “life cycle”.The earth cycle of rat lungworm first became clear in the 1950s and 1960s.Briefly: Adult worms live and mate in rat pulmonary arteries, fertilized eggs hatch in rat lungs, and larvae are excreted in rat feces.After snails and slugs eat the feces and their larvae mature, the cycle starts all over again when a new group of mice eats the mollusks.
How do people get into the picture?In the first few decades after the discovery of rat lungworm, most human cases (often manifesting as eosinophilic meningitis) were associated with the consumption of raw or undercooked freshwater snails or shrimp.However, in the 1960s, studies in Hawaii and Polynesia suggested that fresh leafy greens harboring snails or flatworms could also spread the infection.In a famous outbreak in 2000, 12 medical students from Chicago developed rat lungworm meningitis after sharing a large Caesar salad in Jamaica, raising further suspicions that produce could also transmit the nerve-invasive nematode.
From the modern saga of rat lungworm, many lessons can be learned from its continued global spread (today, the parasite is also found in Southeast Asia, the Pacific Islands, Japan, Australia, South America, the Caribbean, and the southeastern United States). Very active. As part of Africa and the Canary Islands and Balearic Islands), there is a need to balance healthy eating with real foodborne hazards in these and other endemic areas.Fortunately, thoroughly washing produce can remove infected A. cantonensis-infected mollusks, cooking and freezing kills larvae thoroughly, and early treatment can mitigate disease.Meanwhile, if residents and tourists in affected areas are not warned, how can they take steps to protect themselves?
Although many challenges remain in controlling A. cantonensis, one thing is clear.As it continues to relocate and build new homes, widespread education of those at risk and their doctors will be key to reducing harm—or even better, preventing infection in the first place.
Claire Panosian Dunavan, MD, is a professor of infectious diseases at the David Geffen School of Medicine at UCLA and past president of the American Society for Tropical Medicine and Hygiene.She recently made a documentary on rat lungworm called “The Unexpected Host – The Story of Mouse Pneumocystis,” which will air in the fall.
The material on this website is for informational purposes only and is not a substitute for medical advice, diagnosis or treatment by a qualified healthcare provider.
Post time: Jun-14-2022