Hawaiian officials fear infections of rare parasitic worm will increase

PHOTO: A parasitic nematode (roundworm parasite), called Angiostrongylus cantonensis.PlayState of Hawaii, Department of Health
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A spike in infections from a rare parasitic worm in the Hawaiian island of Maui has local health officials concerned about the parasite's potential to spread.

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A worm called Angiostrongylus cantonensis causes the infection; there is no treatment, and in rare cases, it can be fatal. People who catch the infection by eating raw or undercooked snails, or contaminated fruits and vegetables, can develop meningitis.

Earlier this week, health officials in Maui reported that six cases of the parasitic infection have been reported in the last three months compared to the previous decade when only two cases were found, according to the Associated Press and ABC News affiliate KITV.

Dr. Lorrin Pang, the Maui district health officer, explained to worried residents why the disease is so damaging. In a live-streamed presentation on Facebook, Pang said that the parasite can live in the body for months. As a result, inflammation from the body's immune response can result in scarring or other damage to the nervous system, which can cause pain during the infection.

"Our body realizes this is so foreign we attack it...by that time the worm is one inch big and by then it's a major battle," Pang said, describing the immune system fight to kill the parasite. "There is a whole lot of collateral damage...attacking the worm attacks ourselves and that is the issue."

A bad headache, neck stiffness, light sensitivity and vomiting and can start more than six weeks after ingesting the worm, according to the Centers for Disease Control and Prevention.

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Dr. Constantine Tsigrelis, an infectious disease specialist with University Hospitals Cleveland Medical Center, said that treatment is complicated because doctors don't want to exacerbate an immune response that kills the parasite but then injures the brain or nervous system in the process.

"An anti-parasitic drug could kill the worm but the problem is that the dying organisms can create a very severe inflammatory response and the patient can get worse," Tsigrelis told ABC News.

The worm can’t live very long inside humans, usually only a few months according to Pang. However, it can cause permanent damage as it invades the brain's membrane. The worm has been found in Louisiana, Hawaii and the Caribbean, but lives primarily in the Pacific Basin and Southeast Asia, according to the CDC.

The parasite lives in the blood vessels of rats' lungs – giving the parasite its name – but the larvae can be expelled in rat droppings and eaten by snails, slugs and other animals, who can pass these baby parasitic worms on to humans.

Tsigrelis said potential visitors should not be deterred from a Hawaiian getaway. But they should take steps to protect themselves.

“If you’re going to Hawaii, enjoy the local food but take those precautions regarding washing fresh produce, making sure salads have been washed and avoiding undercooked slugs, snails, crabs,” Tsigrelis said.

Washing hands and utensils after eating or preparing raw slugs, snails, or freshwater shrimp can prevent infection, as can thoroughly cleaning raw vegetables, according to the Hawaiian Department of Health. Boiling food for three to five minutes, or freezing it at 5 degrees Fahrenheit for 24 hours or more, kills the larvae. Clearing snails, slugs and rats from gardens and other outdoor spaces can also prevent the spread of the worm.

Allison Bond, MD, is a resident in internal medicine at Massachusetts General Hospital in Boston. Follow her on Twitter @AllisonRBond.