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Hawaii rat lungworm task force creates new guidelines for faster diagnosis

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Slugs or snails infected with rat lungworm parasites can pass them along to humans who happen to eat all or part of the tiny animals, often on raw, unwashed produce.

A group commissioned by Gov. David Ige to prevent the spread of rat lungworm disease has created guidelines for earlier diagnosis of the potentially crippling illness.

The Joint Task Force on Rat Lungworm Disease announced today a plan to train doctors statewide on detecting angiostrongyliasis, or rat lungworm disease, following the fifth confirmed case this year in a toddler from East Hawaii.

Many physicians in Hawaii are unaware of the symptoms associated with the disease and some patients have had delayed treatment as a result.

Doctors are now being advised to follow specific guidelines that include the use of a controversial antiparasitic drug, albendazole, for better patient outcomes and encouraging patients with symptoms to get a spinal tap, or lumbar puncture, for timely diagnosis.

“There were no clear, reliable diagnosis and treatment protocols available to Hawaii physicians for this potentially serious and debilitating disease,” task force member Dr. Vernon Ansdell, an associate professor at the University of Hawaii John A. Burns School of Medicine, said in a news release. “Diagnosing angiostrongyliasis can be problematic because patients infected with the parasite do not always present the same symptoms. These preliminary guidelines provide critical guidance to physicians to help them make timely and accurate diagnoses and give their patients the best possible treatment available.”

Last year, there were 18 confirmed cases of rat lungworm, most of them on the Big Island. The most common symptoms include severe headaches and stiffness in the neck, while the most serious cases can lead to neurological problems, severe pain and long-term disability.

The next step is training doctors in all counties on symptoms of the disease, he said. Doctors will be offered continuing medical education courses through JABSOM starting in Hilo on Hawaii Island on Oct. 10. Courses will also be offered on Maui, Kauai and in Honolulu in early 2019.

Rat lungworm, first detected in Hawaii in 1960, is poised to expand throughout the tropics and mainland as temperatures warm, according to UH researchers. The disease has been found on five of the six largest islands, where it occurred mostly in warm and rainy areas.

Rats are the primary hosts, while snails and slugs are considered intermediate hosts that can hide in produce, water catchment systems and garden hoses unbeknownst to the victims who accidentally ingest them.

The Legislature last year granted the Health Department $1 million over two years to help control the spread of rat lungworm. Health officials are working with experts to develop guidelines for schools, farms, food establishments and physicians on how best to prevent the disease.

The DOH recommends controlling the population of snails, slugs and rats around homes, gardens and farms, as well as carefully inspecting and washing produce as precautionary measures.

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