Collaborate to battle rat lungworm disease

On this, everyone can agree: Rat lungworm disease, caused by an infestation of parasitic larvae affecting the brain, is every bit as ugly as its name. And that should fuel the drive to develop better surveillance, coordination and treatment.

Judging by reports from the front lines of this battle, it’s an evolving strategy, as doctors dealing with some intensive cases here are learning what works.

Their voices need to be in the forefront of the discussion, to reduce the public risk from this potentially deadly infestation.

The experience in recent weeks underscores how critical communication and collaboration will be to success. At the very least, public education will help patients avoid exposure to the disease and learn what symptoms should trigger a trip to the doctor.

Honolulu Star-Advertiser writer Sophie Cocke chronicled the difficulty some have had with diagnosis and treatment. She related the story of Tatum Larson, 24, and her series of medical appointments on Maui, where health professionals were unable to pinpoint the source of her burning nerve pain in bones and skin.

Ultimately when she went home to Washington, a Seattle doctor took another look. By then Larson had learned of rat lungworm disease and mentioned it; the doctor diagnosed it. A Hawaii Department of Health test of her spinal fluid confirmed its presence — as well as the value of public health education.

This should be among the beneficiaries of an allocation in the state budget that was passed by the state Legislature last week. The appropriation, $500,000 for each of the next two years, went to the state Department of Health, which has not yet determined how the money will be spent.

Certainly there are myriad goals that the funding — unanticipated and unrequested by DOH — could fulfill. These include the research going on at the University of Hawaii at Hilo. Hawaii island is seeing many of the more severe cases.

A separate appropriation aimed at this team’s work did not emerge from conference committee deliberations in the final days of the session. But a collaborative approach to this grant could direct needed resources to various purposes.

Collaboration is also what’s needed in the clinical treatment of this disease. Experts know that the parasite is carried by various organisms. It infects humans most easily when they consume produce in which tiny slugs can be hidden.

But they disagree over how it’s to be treated, which is disconcerting. The illness, while given a higher profile in the most recent cases, is not new to Hawaii. Even so, some health-care providers still seem unaware of what to look for.

Hilo researchers told lawmakers at a briefing early in the session that administering anti-parasite medication was effective in killing the worm larvae.

DOH officials asserted, by contrast, that the medication could worsen symptoms and favors protocols from the Centers for Disease Control and Prevention, backed by research from a Hawaii physician with experience in the disease.

However, Jon Martell, medical director at Hilo Medical Center, where 12 severe cases have been treated in the past six months, rightly noted that there are more studies from Asia, which has extensive experience in the disease. These also support the potential for administering the anti-parasite medication in conjunction with steroids.

There is a mechanism to bridge the differences among health care professionals: a task force convened by Gov. David Ige a year ago, on which both sides are represented. But the group has met only twice in that time.

Surely members can hear an urgent call for more regular exchanges, enabling progress toward better care. The public deserves to know that this is the aim of the experts’ concerted effort.