The Washington PostDemocracy Dies in Darkness

‘Like someone stuck an ice pick in my collarbone’: Painful rat lungworm disease on upswing in Hawaii

The clinical description of the symptoms of rat lungworm illness — “severe headaches, nausea, vomiting, neck stiffness, seizures, and neurologic abnormalities” — lets this particular affliction off the hook.

To really fathom its hideousness, you have to listen to the words of someone suffering through it, like Tricia Mynar, who’s been describing her experience on TV in Hawaii to raise awareness.

It’s like the pain of childbirth “every day,” said the mother of three.

“That was like eating ice cream compared to this,” she told KHON TV. “It was like someone stuck an ice pick in my collarbone, in my chest and in the back of my neck. The majority is in your head and the pain is just excruciating.”

When she first contracted it, “it was like people pushing needles in my back, pushing forward from my shoulder blades all the way to my lungs” and out “the front of my chest,” she told Maui News Now.

“I couldn’t sleep. I had to stand at my kitchen counter and put my hands on the counter to hold my body up. I literally slept two nights standing. I couldn’t have any type of wind touch my skin because my nerves were hypersensitive.”

And then there were her feet. “It was like my nerve endings snapping in my feet. I was feeling like there was fire ants, hundreds of them, crawling on my feet … like a luau of fire-ants.”

And the headaches: Worse, she said, than the “worst migraine you could feel.”

“I would never want anyone to experience this.”

Fortunately, relatively few people are.

But the incidence of angiostrongyliasis, nicknamed “rat lungworm” illness because of its origins (it comes from a parasite in the lungs of rats via rat feces to snails and slugs and then through contaminated food or drink to humans) is on the rise in Hawaii.

The Hawaii State Department of Health confirmed two new cases Wednesday, bringing the total of confirmed cases to 11 this year in the state. There are also four related cases considered “highly probable based on clinical indications,” the department said.

That’s already more than the average of nine for an entire year in the state, reported the Honolulu Star-Advertiser.

Angiostrongyliasis, which affects the brain and the spinal cord, is caused by a parasitic nematode or worm called Angiostrongylus cantonensis. According to the Hawaii health department fact sheet, which has become a bit of a must-read in the state in recent weeks, A. cantonensis, which is found in rodents, travels like this:

The rodents poop, releasing the larvae of the worm into the ecosystem. It is then consumed by snails, slugs, freshwater shrimp, land crabs and frogs. They, in turn, can spread it to produce. The produce, not to mention any ingestion of the mollusks, can spread it to humans.

Hawaii state Sen. Josh Green, who is a physician, described it more colloquially in a TV interview.  “What happens is, it’s in the rat. It’s in their lung,” Green explained on KHON. “The worms … ultimately have larvae. They bust out of the rat, then they poop, and then slimy mollusks go over them. It can affect your lettuce. It can affect your vegetables. That’s why you’ve got to either cook the heck out of these slugs or probably snails, because I don’t think people are eating slugs, or really wash your lettuce.”

The cases in Hawaii have been found on the island of Hawaii, known as the Big Island, and on Maui, just to the north and west of the Big Island.

The latest group to become infected with the parasite, according to the Department of Health, picked it up at a home in Keaau on the Big Island a few weeks after drinking homemade kava, made from Piper methysticum, a plant native to the western Pacific islands.

They had left the kava out in uncovered buckets after preparing the drink at home, according to the health department.

“After consuming most of the contents, the individuals noticed a slug at the bottom of the bowl.” An investigation by the health department “determined the source of the infections was likely the homemade kava tainted by slugs.”

“The assumption,” state epidemiologist Sarah Park told a news conference, “is because it was in an area … we know was infested with these mollusks, that there were probably more in there that were inadvertently ingested.”

“Cases like this recent cluster are especially concerning,” Health Director Virginia Pressler said in a news release, “because they can be prevented with basic precautions such as storing food in covered containers and properly inspecting and washing food before eating. These healthy habits can protect against food contamination and prevent serious illnesses.”

The disease attacks the brain and the spinal cord. It can also cause a rare type of meningitis called eosinophilic meningitis.

Some of those infected show no symptoms or have mild symptoms. Others get battered with “severe headaches, stiffness of the neck, tingling or painful feelings in the skin or extremities, low-grade fever, nausea, vomiting” and sometimes a temporary paralysis of the face and light sensitivity.

Mynar said she couldn’t stand to be in the light for a while, and lived out some of her days in dark rooms.

Eliza Lape, of San Francisco, told KPIX, she and her husband were infected while in Hawaii for their wedding. “It was a feeling like somebody was taking a hot knife and just stabbing me in different parts of my body,” she said.

Ben Manilla, her husband, wound up in intensive care in San Francisco.

Tricia Mynar, who lives on Maui, thinks she got it while visiting the Big Island from eating her favorite salad, but that’s not been confirmed by health officials.

Diagnosis is challenging as there is no readily available blood test, according to the state health department. The patients start out thinking they have flu, as Mynar did. Doctors refine the diagnosis by looking at what they’ve eaten and where they’ve been.

“Angiostrongyliasis is of increasing public health importance as globalization contributes to the geographical spread and more international travelers encounter the disease,” said a 2014 study. “The parasite is on the move. It has spread from its traditional endemic areas of Asia and the Pacific Basin to the American continent including the USA, Brazil and Caribbean islands. Recently, the incidence of human infections has increased rapidly. Most reports of the disease are from Thailand and Taiwan with increasing reports from mainland China.”

Humans cannot spread the disease to each other. And the parasites “cannot mature or reproduce in humans,” said the health department.

But the treatments do not cure the illness. People have to wait it out, sometimes with rehabilitation, taking pain medications and steroids to reduce the symptoms, which can last anywhere between two to eight weeks or longer.

So far no sense of crisis appears to have overtaken Hawaii, a state accustomed because of its climate and location to diseases like dengue fever that rarely appear in the continental United States, and to the respiratory distress caused by “vog” (volcanic smog) from the sulfur emitted by active volcanoes.

Apart from sympathizing with the pain of sufferers like Mynar, officials worry about the impact on tourism, a mainstay of the state’s economy, and on restaurants.

Maui restaurants have already “taken a hit as customers steer clear of local produce,” reported Hawaii News Now.

Nor are officials anticipating anything they are willing to call an epidemic.

“We’re probably seeing more cases because you all are helping to get the word out,” state epidemiologist Park said.

“All our rules we have in place now, if followed, are more than adequate,” sanitation official Peter Oshiro told Hawaii News Now, “and we’re very confident that it can prevent the occurrence of any more rat lungworm diseases from any of our regulated establishments.”

More from Morning Mix:

The country’s first drive-through marijuana shop is opening in Colorado

He hugged his family and said, ‘I’ll see you next time,’ before being gunned down on Facebook video

5-year-old dies after getting crushed in Atlanta rotating restaurant