Doctors are raising alarms over a rare parasitic infection in Hawaii after a New England woman developed parasitic worms in her brain. The 30-year-old, who had just returned from Thailand, Japan, and Hawaii, experienced headaches and a burning sensation in her feet and legs. Over several days the burning progressed to her arms, prompting multiple emergency room visits. Initially, physicians sent her home with headache and anxiety medications, unaware of the underlying infection.
Her condition worsened until confusion set in. Doctors then admitted her for more testing. A lumbar puncture revealed eosinophilic meningitis — inflammation of the membranes surrounding the brain and spinal cord — caused by Angiostrongylus cantonensis, better known as rat lungworm.
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A Rare Infection Common in Hawaii
Health officials note that while cases remain rare, rat lungworm is a known public health issue in Hawaii. The parasite’s life cycle involves rats, snails, and slugs. Rats excrete larvae in their feces, which are eaten by snails or slugs where the larvae develop. Humans accidentally ingest larvae by eating undercooked snails or slugs, or vegetables contaminated with their slime.
In Hawaii, small outbreaks have occurred, including 19 confirmed cases in 2017. Most years since then have seen fewer than 10. Doctors warn that eating raw fish, salads, or other uncooked foods can increase the risk, especially when produce comes into contact with infected snails or slugs.
Misdiagnosis and Rapid Decline
Initially, doctors suspected Guillain–Barré syndrome, an autoimmune disorder that attacks the nerves. They also considered ibuprofen side effects and eosinophilic granulomatosis. As her symptoms intensified — headaches, fever, and nerve pain — they performed the spinal fluid test that confirmed the infection. Without timely diagnosis, rat lungworm can be fatal or cause lasting neurological damage.
Treatment and Recovery
The patient received a 14-day course of high-dose prednisone to reduce inflammation and relieve nerve pain. Doctors also prescribed albendazole, an antiparasitic drug that penetrates the brain and spinal fluid, alongside gabapentin and amitriptyline for pain management. Her symptoms improved significantly, and she was discharged on the sixth day of hospitalization.
Health Experts Issue Warning
Specialists emphasize that rare parasitic infection in Hawaii may present with unusual symptoms like burning feet, shooting limb pain, or severe headaches. Left untreated, the inflammation can cause seizures, stroke, or coma.
Public health officials urge visitors and residents to wash produce thoroughly, avoid eating raw snails or slugs, and take precautions when consuming raw fish or salads in areas where the parasite is known to circulate. Doctors recommend immediate evaluation if burning sensations, headaches, or confusion appear after travel to tropical regions.
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