Hilo Family Updates Condition After Exposure to Rat Lungworm

Rodrigues family

A Hilo woman seems to be OK after nearly ingesting a two-and-half-inch slug found in a made-to-order sandwich from a local health food store.

Chaunda Rodrigues, her husband and their infant child, were exposed to the parasite known as Rat Lungworm Disease on New Year’s Eve after eating avocado sandwiches from Hilo’s Island Naturals Market and Deli. Rodrigues discovered the slug when she pulled half of it from the inside of her jaw.

With no treatment protocol in place, the family preemptively decided to take a deworming medication to avoid future side effects of the disease, which can result in transient meningitis or a more serious disease involving the brain, spinal cord and nerve roots. It’s been three weeks since the incident and up to now, Rodrigues says they seem to be OK.

“We can’t tell if anything is amiss at this point, so that’s a good sign,” Rodrigues said.

Initially, Rodrigues was told by doctors at Hilo Medical Center there was no preventative measures they could take until they became symptomatic. After some persistence, Rodrigues ultimately was prescribed a deworming medication called albendazole.

They were on the medication for a week.

“The ER doctor seemed very confident that albendazole would take care of any parasite,” Rodrigues said.

Since they were prescribed the dewormer, the Rodrigues family hasn’t gone back to the doctor and no one has reached out.

After a few days of stiff neck and pressure in her head, Rodrigues’ symptoms went away and she hasn’t felt anything else since then.

“I don’t know why they don’t just prescribe it immediately or that it’s not published as the recommended treatment for rat lungworm exposure,” she said.

Rodrigues and her husband have retained a lawyer and filed a complaint with 3rd Circuit Court against Island Naturals, which asserts the health food store was negligent in the care of its preparation of two avocado sandwiches the Hilo woman purchased. The couple is demanding a jury trial.

Rodrigues was not able to comment on the lawsuit.

Russell Ruderman, owner of Island Naturals also chose not to comment on the lawsuit.

New Treatment

The rat lungworm parasite under a microscope. PC: Dr. Susan Jarvi

On Jan. 15, 2020, Hilo Medical Center released a treatment protocol for future cases. Dr. Jon Martell, Chief Medical Officer at HMC and rat lungworm expert, said they get calls of people coming in contact with slugs all the time, and that it’s a major source of distress.

“We have been completely frustrated that we haven’t had anything to offer these people,” Martell said. “There was nothing out there that was common practice.”

That changed when Hilo doctors announced the updated early treatment protocol in which they now recommend taking pyrantel pamoate, commonly known as pinworm medication, which can be purchased over-the-counter. The treatment is only islandwide.

This update in protocol comes following the release of an unpublished study at the international rat lungworm conference in Hilo after the first of the year. The study, “In vitro efficacy of anthelmintic drugs on Angiostrongylus cantonensis L3 larvae,” was authored by researchers John Jacob, Ingo Lange, Ghee Tan and Susan Jarvi at the University of Hawai‘i at Hilo’s Daniel K. Inouye College of Pharmacy.

Their research revealed that pinworm medication has the ability to immobilize the worms and safely pass through the human body. Martell advises those who believe they’ve come in contact with rat lung worm should also make an appointment with their primary care doctor and have the slug tested for the parasite.

Clinical trials have not been conducted for treatment after exposure via eating a snail or slug, so this is not a proven treatment. However, the potential benefits appear to outweigh the minimal risk of treatment, Martell said.

While slugs are found all around the island, East Hawai‘i has been a hot spot for rat lungworm. Sixty percent of slugs and snails carry the parasite in East Hawai‘i alone, Martell said. Even if someone ingests one of these slugs, they may not develop symptoms as it depends on how much the slug is carrying.

Ruderman is also a senator representing Puna, Pahala and Ka‘ū. In the past, he has championed legislation to put more research toward the disease. He said he was thankful for HMC’s announcement on early treatment saying it was bold and courageous for them to put out the study.

“It will help in the future when someone feels they’ve been exposed,” he said.