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Brain-invading parasites on the rise in Hawaii

Hawaiian health officials are alarmed at the steep rise in brain infections caused by a parasitic worm.

In Maui, Hawaii, at least six cases of brain invasions by Angiostrongylus cantonensis, a parasitic lungworm that is responsible for angiostrongyliasis, or rat lungworm disease, have been confirmed. This is specifically worrying, as only two cases of the disease have been documented in the island in the decade prior to the current outbreak.

Only rats play host to the adult form of the Angiostrongylus cantonensis parasite. However, rats can spread this infection through their faeces, which can carry larvae of the roundworm. The worm can then be picked up by frogs, crabs, slugs, snails, freshwater shrimp, and other animals.

Here’s what’s scary: a person consuming or handling any creature infected by the worm becomes susceptible to the infection. Even coming into contact with raw vegetables, fruits, and other food sources contaminated by the worm can lead to an infection.

In most cases, infected people show no symptoms, and are even able to recover without medical assistance. In some people, however, the parasite travels to the nervous system and brain. This leads to the development of a parasitic meningitis, in turn resulting in troublesome symptoms such as extreme headaches, numbness, tremors, and fever. The disease can even prove fatal.

Worse than labor

“The parasites are in the lining of my brain, moving around,” said Tricia Mynar, a preschool teacher and resident of Maui who believes she was infected during her one-month stay on Hawaii Island.

Every week, 47-year-old Mynar stayed in Waimea during the workdays, then on the weekends flew back home to Maui.

She experienced her first symptoms in the latter part of February. At first Mynar thought she had the flu.

“The following Tuesday after I got the flu symptoms I called in sick and went to the doctor,” she told Honolulu Civil Beat. ( “My flu was better but I had this weird sensation in my right foot, like someone had dropped a suitcase on it.”

The pain didn’t go away. In fact, it worsened, until she could feel it traveling from her scalp and all the way down her spine.

“I became so sensitive to any kind of wind that blew through my house I had to stand up and rest my head on the kitchen counter to get any kind of sleep,” Mynar explained. “I couldn’t lay down on anything because of the pain.”

Additional medication prescribed by her doctor didn’t help.

“I had pain all over my body, but especially on both sides of my spine. It was like I was getting a shiatsu massage but the person forgot to remove his fingers and was trying to knead his way into my lungs, pushing, pushing, trying to push my back into my chest.”

As her condition grew more severe, she lost feeling in her right foot’s three toes. After returning to Maui, intense pain seized her upper left arm, so much so that the slightest touch – even from fabric or the wind – caused her a world of hurt.

A blood test revealed her parasitic level had reached 19. In comparison, level 6 or lower is considered normal.

It was then the doctor suspected she had contracted angiostrongyliasis.

“It was like someone suddenly took a lei needle and pushed it through the soft spot on top of my head, then pushed it down below my left ear, then up to my left temple, then moved from back to front behind my right eye. As the lei needle pain shot out through my right eye there were flashing white lights.”

She added that the sensation of that “needle” is far worse than the pain of labor.

Her lumbar was punctured to gather spinal fluid, which was then tested for the parasite. After the infection was confirmed, she was confined to the hospital for a week.

She further described her misery as akin to someone opening the top of her skull, setting “a hot iron inside my brain, then (pushing) the steam button.”

Though now being cared for by her parents at home, Mynar is still suffering. “I have a half dozen medicine bottles, several for pain because any movement of my head spikes my pain level to 12. I don’t see any improvement, just that every day is a different day, different pain. Tremors are the hardest part. They affect me so bad that sometimes I can’t hear my own speech.”

As you can expect, the disease has brought about drastic changes in Mynar’s life. At the moment, she has to use a walker to move around. As it is too painful to go out, her doctor, an occupational therapist, and physical therapist visit her at the house.

“Yesterday I tried for the first time to open a book and learned I have blurred vision,” she said. “Somebody came to clean the yard and the noise was so horrible I had to smash the sides of my head with pillows.”

Precautionary measures

Health officials have confirmed the discovery of the roundworm in snails and slugs in Maui, Kauai, Oahu, and Hawaii Island.

“I hope people really understand it’s in their hands to prevent infection by properly washing all of the produce… regardless where they buy it from,” said Cheryl Vasconcellos, Hana Heath’s executive director.

As some slugs are tiny and translucent, they may go unseen, and therefore unwittingly ingested upon the consumption of unwashed vegetables. The infected slug’s slime may even be enough to transmit the parasite into the human body.

Of course, health representatives are also advising against touching snails or slugs.

“Everyone needs to be vigilant about it and take precautionary measures,” said Vasconcellos.

What is causing the spread?

It has yet to be determined what caused this recent rise in infections in Maui. It is, however, possibly related to the region’s burgeoning populations of a species of invasive semi-slug – 80 percent of which is host to the roundworm.

Another potential contributor to the spread of the parasite is increasing globalization and, specifically, shipping.

Previously endemic in the Caribbean and Asia (the first case of human infection was documented in 1944 in Taiwan), the parasite is now prevalent in the United States thanks to global shipping. “Some suggest that it’s due to snails or slugs in the ship ballasts – ships coming from Asia and going through the Panama Canal,” said virologist Peter Hotez from Houston’s Baylor College of Medicine.

One other factor possibly leading to the increased distribution of the parasite is human activity, such as actions that contribute to climate change.

In 2015, scientists determined the presence of the parasite in Oklahoma, a region previously “predicted to lack suitable habitat for the parasite.” It’s possible global travel, our gradual intrusion into natural habitats, and human activities that lead to climate change could all play a part in the expansion of the rat lungworm into ecosystems it could previously not survive in.

Scientists have yet to develop an angiostrongyliasis treatment; those suffering from the infection have to make do with antibiotics and painkillers such as oxycontin and morphine. — TJD, GMA News