Toddler is the first rat lungworm case on Oahu this year

The state Department of Health on Friday confirmed that Oahu’s first case of rat lungworm disease this year is a toddler from Central Oahu.

The department would not say how the child contracted the disease, caused by a parasite that can move throughout the body and cause major damage to the nerves. The toddler was hospitalized earlier this month, and laboratory results confirmed the parasite in the child’s spinal fluid.

This is the fourth case statewide in 2018. The state said there was another probable case in an infant on Oahu this year.

“What we know about most toddler cases is kids explore the world by touch, smell and taste. They’ll pick things up and put them in their mouth. That’s how most toddlers get sick: by accidentally picking up a snail or slug and putting it in their mouth,” said DOH spokeswoman Anna Koethe. “We as parents and caregivers of small children need to recognize that the risk of rat lungworm disease is statewide. We need to just be vigilant and aware of where our children are playing and what they might be playing with.”

In 2017 the DOH confirmed 18 cases of rat lungworm and three probable cases. Most of the cases have been on Hawaii island. To confirm the disease, patients typically get a spinal tap to draw fluid that is tested for the presence of the parasite or its DNA. Cases are considered probable when patients exhibit symptoms of the illness but haven’t had a lab test.

Shortly after July 4, Waimanalo farmer Nick Booth had excruciating knots in his stomach accompanied by intense headaches as the roundworm parasites he’d ingested made their way from his intestines through his spinal cord to his brain. At first doctors did not know what was wrong with him. But three weeks later health officials confirmed Oahu’s first case of rat lungworm disease in seven years.

Nearly a year later Booth is still feeling the disease’s effects.

“I still have quite a bit of nerve pain in my back and a lot of muscle spasms at night,” he said, adding that he still takes four prescription drugs, down from about 10 a year ago, to manage the pain. “The nerve pain is debilitating. I feel paranoid to drink water. I honestly am scared to eat lettuce and things. I have found snails in sealed lettuce packages.”

When finding out about the most recent case, he said, “It’s horrible. I can’t imagine what that would be like.”

Booth said he “never felt pain like that” after contracting the disease.

“That’s pretty scary. For the toddler, I feel so bad for the parents,” said Booth, who had contracted a rare type of meningitis caused by the infection. “Children and old people would probably have it the worst just because of their lower immune systems.”

The Health Department is warning consumers to inspect, wash and store produce in sealed containers and to wash all fruits and vegetables thoroughly to remove any tiny slugs or snails, particularly on leafy greens. The DOH also recommends using traps and baits to control snails, slugs and rats around homes, gardens and farms, and to wear gloves for safety.

State officials have been grappling with how to control rats, snails, slugs and the relatively new semi-slug — 75 percent of which are estimated to carry the disease.

In the islands, most people have become ill by accidentally ingesting an infected snail or slug. The most common symptoms include severe headaches and neck stiffness, with neurological problems, severe pain and long-term disability in serious cases.

There is no specific treatment for rat lungworm. Health officials said they do not promote antiparasitic drugs because they have not been proved effective and might make symptoms worse.

“The only changes I’ve really seen has been signs at the farmers market telling people to wash their food,” Booth said. “You would not believe how many doctors I’ve talked to in various fields that had no idea what this is. They never heard of it or have no idea they should be scared for their children or themselves.”

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