Urgent warning for Hawaiian tourists as brain parasite cases continue: ‘Don’t eat raw food’
Hawaiian tourists are being warned against eating raw food while visiting the tropical state, deemed the “epicenter” of a nasty brain parasitic disease.
Neuroangiostrongyliasis, or rat lungworm disease, is a serious illness humans can become infected with after consuming raw snails, slugs or other specimens that carry the parasite. It can also be transmitted in vegetables such as Kale or potatoes.
Its symptoms can mimic the flu, but also be serious. They range from headaches, nausea, coughing and fevers to long-term neurological problems and disabilities, with experts warning the illness can have a severe, lasting impact on those who become sick.
“Don’t eat raw food in Hawaii,” Kay Howe told SFGate. In 2008, Howe’s son contracted the disease while living in the Puna District of Hawaii Island when he was 23 years old and he went into a coma for months, prompting Howe to become an advocate of the illness.
“This is a tropical place. There’s a parasite, and we advise to cook everything,” said Howe, who has since gained her master’s in tropical conservation biology and works in a lab specializing in rat lungworm.
Howe and other specialists recommend tourists avoid popular roadside smoothie stops, as produce needs to be washed – and dried – with care.
“I know it’s very popular. It’s very healthy. But if you haven’t been able to inspect the kale yourself, I wouldn’t recommend that you include that,” Franny Brewer, the program manager for the Big Island Invasive Species Committee, added.
While locals know of the disease, many visitors don’t – and there aren’t any initiatives to educate those visiting.
The experts warned that many people are unaware if they’ve been infected, especially since its symptoms closely mimic the flu. Treatment for the illness includes antiparasitic medicine such as Albendazole, but there is no easy test to diagnose rat lungworm disease. To diagnose, patients require a spinal tap, according to the report. Getting a diagnosis quickly can be difficult, the experts said.
“We often have to fight a doctor to get them to deliver [the Albendazole],” Howe said. “You know, they’ll be, ‘Oh, wait until symptoms develop.’ And it’s like, you don’t want to wait for symptoms to develop. That’s how bad this is. You know, once it’s in your brain, it’s in your brain.” In her experience talking with people — and in the case of her son — doctors often refuse to test for rat lungworm, not believing it to be the culprit.”
“The people who are in the ER with symptoms, they have to somehow convince the doctor to give them a spinal tap,” Howe added.
The disease, which has seen 80 laboratory-confirmed cases between 2014 and 2023, is largely underdiagnosed. While the number of cases remains relatively low, experts warn the disease is severe and can have lifelong repercussions.
“We find that a lot of visitors have never heard of it or might not realize that it’s endemic in our state, and we want people to know what they can do to protect themselves,” Dr. Sarah Kemble with the Hawaii State Department of Health told SFGate. “Don’t eat raw snails, slugs, freshwater shrimp. And visitors should be aware that when they buy locally fresh fruits and vegetables, they should wash them very carefully before consuming them.”
While the disease occurs on all of the islands, most of the cases have been found on Hawaii Island.
Howe now lives several blocks away from her infected son. While he is independent, he was left permanently disabled, with his vision and short-term memory affected, she told the outlet.
“When you have seven serious cases a year or 15 serious cases a year amongst a relatively small population on Hawaii Island, that’s not really rare anymore,” she said.
“The severity of the disease and the fact that you may never, very well ever, recover the quality of life that you had. You shouldn’t be looking at case numbers. You should be looking at severity.”
