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Rat Lungworm Disease Foundation

Volume 17
Issue 1
April, 2023

Rat Lungworm Disease Foundation


Rat lungworm is here to stay, and public must be educated

By Claire Panosian Dunavan, Vernon Ansdell and Robert Cowie Rat lungworm is here to stay. This undeniable truth has important repercussions for the state. It also raises questions. What can be done to better protect Hawaii’s residents and visitors from a parasite that sometimes wreaks terrible harm? And, for those possibly exposed, what can be done to speed their diagnosis and treatment?

Claire Panosian Dunavan is an infectious diseases specialist at UCLA and producer of “Accidental Host — The Story of Rat Lungworm Disease,” Vernon Ansdell, center, is a tropical medicine specialist at the University of Hawaii John A. Burns School of Medicine, and Robert Cowie is a biologist at UH-Manoa; Ansdell and Cowie are on the Hawaii Governor’s Joint Task Force on Rat Lungworm Disease.

The next RLW Community Group Meeting will be held on Wednesday, April 12, 2023 @ 4-5 pm (HST). Please adjust to your time zone. Zoom link below. If you are interested in sharing your experience or research with the group, please email the ratlungwormdiseasefoundation@gmail.com

April Community Meeting Agenda - Introductions and meeting guidelines:

Welcome all participants
News and Updates:

Where is the best place to be seen for RLWD on Hawaii island? Addressing Facebook posts from the public and where to get RLWD treatment? Monthly Topic: Q & A and community input with the Hawaii island Department of Health’s Kelly O’Leary. Inspiration: Darlene Closing remarks:

March Community Meeting Replay on YouTube - I have started to record the monthly meetings on YouTube. The link is public so please share with those interested.


Recent News - Big Island Invasive Species Committee (BIISC) Slug and Snail Sighting Reporting Survey

BIISC RLW Overview - www.biisc.org/pest/rlw/

BIISC Slug and Snail Reporting -

This newly release survey is available to everyone to aid in Hawaii’s slug and snail reporting. This app will help researchers and educators understand were the prevalence pockets of slugs and snails are located. This information can coincide with potential RLWD cases in human, pets, and livestock cases. Follow the link for instructions and submissions.

Hawai’i Island Epidemiology Specialist Reporting - Did you or anyone you know encounter RLW? Angelica is the epidemiology specialist and case investigator for RLW cases on Hawai’i Island. Please reach out to her or share her contact information with those in need. The Big Island reporting line number is Angelica@ 808-933-0912. Hawaii Department of Health’s Disease Outbreak Control Division - https://health.hawaii.gov/docd/disease_listing/rat-lungworm

The RLWDF’s monthly support group meetings are held on the second Wednesday of every month from 4-5pm (HST). The focus of this group is to offer support, education and hope for the recently infected and recovering, caregivers, researchers, educators, health care practiconers and anyone else interested in learning more about this disease and the long-term impacts on humans and animals. We welcome all new members and focus on how we as a group can spread more awareness regarding this disease in all areas of research and treatment. If you are interested in sharing your experience or research with the group, please email - ratlungwormdiseasefoundation@gmail.com (These meetings are protected under HIPAA laws, and we ask you practice discretion while sharing participant’s personal information outside of the meeting.)

3/20/23 Rat Lungworm Disease Foundation’s Mission Statement www.ratlungwormdiseasefoundation.org is a 501(c)(3) organization. We represent hundreds of diagnosed and undiagnosed patients infected by Rat Lungworm Disease/Neuro Angiostrongyliasis.

This is an emerging global Infectious Disease. We provide education and prevention tips focused on science-based research for current patients, survivors, caregivers, medical practitioners, and all health-based organizations.

With available research and support essential for proper diagnosis, early treatment, traumatic brain injury, empowerment skills, pain management, and long-term recovery skills. We work to make the patient voice stronger and educate the public.

By supporting patient-centered research, and mainstream healthcare protocols for Rat Lungworm Disease/ Neuro Angiostrongyliasis survivors. We continue to spread prevention tips and awareness as this is the best and only way to avoid contracting this disease.

RLWDF's March Community Group Meeting Zoom Link - Rat Lungworm Disease Foundation is inviting you to a scheduled Zoom meeting.

Aloha and Happy Spring,

The April 12, 2023 (4pm HST) Rat Lungworm Disease Community Support Meeting is happening!

Please join us with a rep from the Hawaii island Department of Health to provide input in the new efforts to spread RLW information around the island. We will also discuss where the best place to go for RLWD testing and treatment in Hawai’i. You should not have to leave the Hawaiian Islands for a proper diagnosis, treatment, and long-term after care for ongoing symptoms and pain relief. Join us and bring your thoughts and solutions to stop this from happening to infected victims of this disease. Hawai'i needs to STOP harming residents and visitors with RLWD and START providing "Public Health Care" for victims in 2023. Below are recent Facebook posts that we will also dive into.

See ya there!

3/23 Facebook Comments

Katie Jade Getchell
March 19 at 9:33 AM
I have a concern and would like to know what you all feel is the most constructive path forward. I learned that a distant acquaintance of mine got RLW (very recently). They suffered symptoms for a month, all the while having several visits to Queen’s North Hawaii hospital in Waimea during which their repeated requests for RLW testing were refused. Eventually they went to the mainland, and were finally diagnosed at a hospital there, but only after weeks of unnecessary and aggravated pain. Of course, the treatment and after-effects are more severe due to the wasted time. It’s not my case and in some ways none of my business but North Hawaii is “my hospital” too and the place I’d count on for care.

I have no idea if my acquaintance has time or energy for a formal or legal complaint, but besides that what can we do to convince this hospital to get with the program? I was shocked and worried when I learned that they kept saying no to RLW testing.

Brittany Anderson
I wonder if it's the same person I know. These medical groups bring in doctors from the mainland that in many cases have absolutely no experience with tropical or rural medicine. Bodhi and I had terrible experiences at North Hawaii.

Open Document for April newsletter

RLWDF’s April Community Group Meeting Zoom Link

Time: Apr 12, 2023 04:00 PM Hawaii

Join Zoom Meeting - https://us02web.zoom.us/j/84939675902?pwd=TUMzenBXc2RwOHZyYlBTVFYzUTFiQT09


Meeting ID: 849 3967 5902
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Rat Lungworm Disease Foundation




“The Zen of Dancing in the Rain: Becoming One with the Storm” - By Aurita Maldonado

Please buy an eBook copy for $0.99 or a hard copy for $19.99 on Amazon ( link below )

Society has become a place where combat veterans would rather commit suicide than live. Many who “have it all” are discovering that they still feel miserable but can’t figure out why. They feel powerless under the boredom of what society deems necessary.

Aurita Maldonado is a Puerto Rican female warrior and Afro-Latin dance instructor who chose a different path before and after her two combat tours in Afghanistan and Iraq. She received a Purple Heart for wounds received in Afghanistan before leaving the Army to align her thoughts, words, and actions.

She adopted a new mission: to cultivate peace, happiness, and learn to become her own best friend. All while learning to live as one with Mother Earth. In 2010 Aurita rejected lucrative government jobs, sold her possessions, and moved to Haines, Alaska to begin her journey with Post Traumatic Stress Disorder and self-acceptance. An extreme athlete, she used movement to help her navigate the storms with a grin until she was suddenly paralyzed from the waist down in a fight against a deadly rat lungworm infection.

The Zen of Dancing in the Rain: Becoming One with the Storm
The Zen of Dancing in the Rain: Becoming One with the Storm

Support Group GoalsThe RLWDF’s monthly support group meetings are held on the second Wednesday of every month from 4-5pm (HST). The focus of this group is to offer support, education and hope for the recently infected and recovering, caregivers,researchers, educators, health care practiconers and anyone else interested in learning more about this disease and the long-term impacts on humans and animals. We welcome all new members and focus on how we as a group can spread more awareness regarding this disease in all areas of research and treatment. If you are interested in sharing your experience or research with the group, please email the ratlungwormdiseasefoundation@gmail.com

(These meetings are protected under HIPAA laws, and we ask you practice discretion while sharing participant’s personal information outside of the meeting.)

There has been a lot of recent news coming from Florida regarding the African snail and Rat lungworm/Angiostrongyliasis warnings to the public. It amazes me that Florida has been able to eradicate the African snail from the state starting in 1975. This makes me wonder why Hawai’i is not able follow their lead by using the same successful methods especially, because it is an agriculture producing state with plans to promote the exportation of local foods to other states. Hawai’i is literally exporting RLWD/Angio inside animals such as slugs & snails, coqui frogs, and centipedes. Any thoughts on this? Bellow the most recent article about Florida.

3,000 Giant African Land Snails found in Pasco County, some with rat lungworm - YouTube https://www.wtsp.com/article/news/local/pascocounty/snails-found-in-pasco-county/67-6525f57a-a50a-4a93-a199-efdd2873ad10

"The giant African land snail has already been eradicated twice in Florida: once in 1975 and another in 2021” And, again in 2022.

Report any sightings of Giant African Land Snails to the Florida Department of Agriculture (FDA) by calling 1-888-397-1517.

Mahalo for your participation and support.


July Meeting Agenda

Introductions and meeting guidelines: Welcome all participants!

News and Updates: Florida and the African Slug Quarantine. When will Hawai’i and other states follow their lead?

Inspiration by: Darlene

Survivor Spotlight: Open to anyone attending (5-10 min update)

Monthly Topic: Open discussion with Q & A. Bring your stories, concerns, ideas and solutions for a roundtable talk.

Mahalo and closing remarks: Shawzy

Dr. Susan Jarvi’s Lecture on Immunology

The Immunology lecture was very insightful and loaded with new information and terminology to ponder. The Jarvi lab has taken an exciting new direction focusing on immunology, the brain, the lymphatic system and how all of these systems are impacted by RLWD.

We were introduced to T cells, T helpers, T regulators, B cells, and Memory cells. We discussed the brain’s lymphatic system and the convergence of lymph nodes in the lymph vessels of the body. The lymph drainage system is called the glymphatic system and aids in the brains housekeeping department.

The brain has it’s own lymphatic system to protect it and is isolated from the rest of the body. The formation of bone marrow in the skull is what protects the brain against pathological neuroinflammation. This is a new Neurological discovery! Makes sense right? If you missed this past meeting, know that the Jarvi lab will continue research in this area so we will learn more about it in the future and keep having discussions on this topic. All input is welcome.

Dr Susan Jarvi told us about the parasite, rat lungworm disease video:


UH Hilo DKICOP Jarvi Lab, RLW Overview Link:


Hawai’i Department of Health Participation

Jason De La Cruz has left the department and Hawai’i Island for new adventures in Public Health in Atlanta, GA. We now have Kelly O’Leary joining our monthly meetings and is a liaison for the HDOH. The goal is to get the 2018 RLW Medical Protocols into the hospitals, nursing schools and local care providers to help implement immediate treatment and assistance for the recently infected. This would also aid in the state counting cases more accurately. Hopefully, this will happen during the remainder of this year. Is the HDOH even counting cases anymore? Anyone know?

Survivor Spotlight

A recent victim of this disease reached out for help to understand more about what she contracted and the symptoms she was dealing with. She attended a support group meeting a few months back and wanted to share with the group that she is feeling so much better and how grateful she was for early treatment and the support group. This is a success story and is the best case scenario anyone can ask for. Education and early treatment are the best protocols for prevention of long-term symptoms and chronic pain outcomes! This story is proof!

Topic: RLWDF's August Monthly Support Group

Time: August 10, 2022 04:00 PM Hawaii

Join Zoom Meeting


Meeting ID: 830 0392 6045

Passcode: 033973

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The Rat Lungworm Disease Foundation Inc.



Rebekah Uccellini posted the following on the Hawaii Ratlungworm Awareness forum on Facebook this important message:

Aloha everyone, I have had the great honor to work with one of the best Chinese Medicine Doctors in the world, (he studied under the last Emperors Physician in China, and began the Oriental College Medicine in Portland Oregon). His name is Dr Fruehauf. He saved my life literally from a severe case of Ratlungworm (I previously had an autoimmune disease and the worm ate a maze through my brain. When I came to Dr Fruehauf, I had severe brain swelling, and loss of all functions, and my body was shutting down). Doctors told my family that I would be brain damaged for a lifetime and be on permanent disability.

Dr Fruehauf saved my life, and helped my brain to heal beyond what any Western Medical Doctor thought was possible. This past week he told me that he developed a formula into a pill form for others going through RLWD- as I know many on the Hawaiian islands can't travel to Portland Oregon to see him. I wanted to be sure to let you all know that it will be available in a few weeks and I will post the link for it here. You can call Hai Shan Clinic (+1 (503) 695-2977 ) and ask to be put on a waiting list for when the formula for Ratlungworm is available. I️ know one of the formulas is called the “Release Pearls”.

Wishing you all a speedy recovery, and if there are any supplements, herbs, medicines or doctors that have most supported your healing- please do share them here.
Mahalo - Rebekah

The paper Kay Howe authored on the results of a rat Lungworm disease prevention education course with teachers and workshops for the general public was just published yesterday in the journal, Parasitology. Kay wants to thank all who were involved. There is always timely information available on the FaceBook Hawaii Rat Lungworm Awareness Group HERE

Shawzy Cann on the air at KTUH in Hawaii For a Rat Lungworm Disease Update.
Watch the in-studio interview below:

Biological Tissues Sample and Veterinary Sample Submission Forms
can be downloaded here and sent to Jarvi Lab for testing.

The full program of the Rat Lungworm Disease International Workshop, with abstracts/summaries of the research presented, is still available online from the following link: Full Program PDF if anyone is interested. There are extra printed copies at the Jarvi Lab as well, anyone is welcome to have them by calling 932-7148 in Hilo.

The University of Hawai‘i at Hilo was proud to participate in the 6th International Scientific Workshop on Angiostrongylus Cantonensis and Angiostrongyliasis. It was held on January 5th through 8th, 2020 at the Hilo Hawaiian Hotel in Hilo, Hawaiʻi

The event has concluded. Information about the event, presenters, and presentations can be found in the Program. Questions can be directed to: rlwlab@hawaii.edu

Rat Lungworm Disease survivors video that was made by first year UH Medical students. They were inspired to make it after they came to one of our Rat Lungworm Disease support group meetings. Rat Lung Worm survivors share their stories and continued struggles with the disease.

Facebook post
By Kristen Consillio July 15, 2019


This is a slug in a jar, the black string like things are it’s poop. Normally, the poop should be a green like color, but if its a dark color, it has the rat lungworm parasites in it.

Shawzy Cann describes the agony of burrowing worms on the left side of her brain as the “worst pain” she’s ever felt.

The 43-year-old former Hawaii island resident is one of the 82 people with confirmed cases of rat lungworm disease from 2007 to 2017. A review of the cases was published last week in the American Journal of Tropical Medicine and Hygiene. Of the 82 cases, there were two deaths and 65 hospitalizations.

Hawaii island had the most cases at 68, followed by Maui at 10 and two cases each on Kauai and Oahu, the review found. In 2018, state health officials said, 10 people contracted the disease, and so far this year there have been six, though there are likely many more unconfirmed or unreported cases, according to the state Department of Health.

Cann, who now lives in Colorado, said she became violently ill on Halloween weekend in 2014 after eating organic mixed greens purchased from the Hilo farmers market. A spinal tap at Hilo Medical Center confirmed rat lungworm, and she was hospitalized for 11 days. Her then-husband also contracted the disease. She said she knows of at least three or four other people who got sick that year, including a neighbor in Puna who died.

“I literally went to the hospital saying, ‘Something is eating my brain. Please help me,’” said Cann, who became paralyzed on the right side of her body, lost her ability to walk and still goes to physical therapy twice a week. She is also on medication to control seizures resulting from the illness. “We’re in such pain. That’s why we have chronic pain the rest of our lives, because our nerves have been destroyed. I have nerve damage on three-quarters of my body.”

Most people become ill by accidentally ingesting a snail or slug infected with the roundworm parasite found on produce such as leafy greens. The disease, known as angiostrongyliasis, can be debilitating, often affecting the brain and spinal cord. The most common symptoms include severe headaches and neck stiffness. In the worst cases, the disease results in neurological problems, severe pain, long-term disability and death.

State officials have been grappling with how to control rats, snails, slugs and the relatively new semi-slug — 75% of which are estimated to carry the disease. The worms can cause significant damage as they travel through the body and attack nerve endings. The only way to confirm rat lungworm is through a spinal tap. There are no current blood tests to detect it.

“The problem with spinal taps is they don’t always come up positive. Say the worms are in your heart or in your lungs, they’re not in your spine at the moment. The worm parasites in the antibodies, they need to be floating in your spinal column at the moment when they stick that tiny little needle in,” said Cann.

The Health Department said it is not keeping track of those who were infected and doesn’t know the prevalence of the infection or parasite, “as mild and even some moderate infections are likely not recognized or reported.” The DOH said its focus is to identify when infections occur and try to prevent them.

Most infected individuals have relatively mild to moderate symptoms and generally recover within a few weeks, the department said, though in less common cases symptoms can be more severe and long- lasting.

“The risk of rat lungworm disease exists statewide, and the public should continue to take preventive measures to protect themselves,” said David Johnston, a state epidemiologist who worked on the study, adding that consumers should thoroughly wash produce and cook food to prevent the spread of rat lungworm.

Cann contends the state needs to do more to track the true number of cases.

“The state’s not doing anything right now. Nobody’s counting right. There’s nobody responsible for counting undocumented cases,” she said. “I would double or triple that number because a lot of people have gone to the hospital for help and have been refused. Those people aren’t counted.”

The Legislature in 2017 appropriated $1 million to help the Health Department’s overall response and outreach in 2018 and 2019. In 2018, the department said, it spent about $250,000 on public education, including working with retailers, distributors and farmers to build awareness of the disease.

Grocery stores and restaurants are working with the DOH to report any shipments of produce that may have been infested with slugs or snails. The department said it is tracking down the source of any affected produce and working with growers on inspections and controlling snail, slug and rat populations.

“I have permanent damage,” said Cann, who has chronic pain from her head all the way down the right side of her body. She’s also been on antibiotics four times in the last nine months to treat kidney infections. “It is lifelong symptoms. I have heavy anxiety that leads to panic attacks that can lead to seizures if I don’t manage my pain for the rest of my life. This is the worst thing that anybody could ever do to me. It’s like being electrocuted, like somebody’s holding a stun gun to the back of your neck. This is torture.”

Rat Lungworm Support Group

The Rat Lungworm Support Group was created at the urging of a survivor who voiced the need for support network at a public input meeting in Pahoa in 2017. Since December 2017 the Rat Lungworm Support Group has been meeting every second Wednesday of the month at the Keaau Community Center at 16-186 Pili Mua Street from 4:00-6:00 pm. The group is primarily focused on supporting the survivors and their caregivers who are living through long term effects of rat lungworm. Also welcomed to the meetings are healthcare providers, representatives from government and academia, and advocates for supporting research and prevention efforts.

The group is supported by Hilo Medical Center, the state’s leading hospital in the diagnosis and treatment of the disease, the Daniel K. Inouye College of Pharmacy and the Department of Health. For more information, contact Elena Cabatu, Director of Public Affairs at Hilo Medical Center, at ecabatu@hhsc.org or 932-3160.


Survivors and their caregivers interested in joining the group through the Zoom online meeting platform from the comfort of their home may join by clicking on the link https://ehihalawai.zoom.us/j/153765346. The session will be opened from 3:30-6:15 pm HST.

The screen capture below is a post on a Facebook support group for victims of Rat Lungworm Disease on the Hawaiian Islands.

It shows that the Hawaiian authorities are severly mishandling the treatment and prevention of this disease which is far more prevalent on the Hawaiian Islands that anywhere else. They continue to downplay the severity of Rat Lungworm Disease and misinform victims of it's treatment so as to not risk a highly profitable tourism industry there. The Hawaiian legislature also allotted one million dollars in public money for a Rat Lungworm campaign that completely bypassed the hard work of Dr. Susan Jarvi and Kaye Howe the top researchers on the disease in Hawaii and have taken a route of a watered-down campaign of public announcements and printed literature. Anyone who suspects being infected by a slug or any other Rat Lungworm parasite carrier can have the slug or snail tested at the Sue Jarvi lab for a small $25/sample charge, which is honestly far below their costs of reagents or personnel time for processing the sample. Call 932-7148 for more information if you're interested.

Facebook post

Anyone who has gone through this disease knows that it's so difficult to find information out there that is consistent, clear, and informative as to exactly what to do if you or a loved one gets sick.

You also know how much you have to become your own doctor, your own healer, and when it feels as though you are fighting for your life the last thing you have energy for is searching for answers.

When I got sick it was Kay Howe and Aurita Maldonado's stories and guidance that helped me navigate through it. They helped me know I️ was not alone and that I'd get to the other side of it.

Kay Howe and I️ have been compiling information, links, stories from the victims, and links to supportive doctors, specialists and nutritional support that has been effective for those who are healing. Kay has shared her knowledge with thousands of people across the state and I can't possibly try to count the lives she must have saved through her dedication in action. And hearing the journey of those who have lived it is LIFE-AFFIRMING. I️n the moments I️ nearly gave up fighting, it was hearing others experiences that reminded me I️ was not alone.

It's also so important that our experiences are documented because it's still considered the "norm" that people get better in weeks or months, when we know dozens and dozens of people have been dealing with symptoms for years after first infection. Doctors are just beginning to scratch the surface of understanding this disease and the way it impacts people differently, and the severity of cases coming out of Hawaii have been on the rise and it's important that they are not swept under the rug.

I know it is not easy to share your journey - I have been struggling the last 3.5 years to find the words myself and all of my energy has gone into just putting my life back together, to climb out of medical debt and live a full life with chronic pain.

My life will never be the same, I️ know this - and I️ know that no one deserves to go through this hell, and if sharing our journeys can save others lives - or help them regain their life back faster, then it is worth it.

If you'd like to share your journey or any part of it, please send it to
Ken Curtis who will be sure to make your voice heard.

Feel free to share anything you feel called to share - from one single line to a full blogpost.

Some topics I️ have heard the community and medical profession most interested in documenting:

- Describe the illness for you specifically, and what residual impacts has this had on your life and your health

- what has been most effective in helping you to get better (from Western medicines, to natural medicines, alternative modalities, specific doctors etc...

- do you still experience pain now? Difficulty sleeping?

- do you have Difficulty with critical thinking, clarity mentally, brain-fog or with communication?

- has it been difficult for you to go back to work? If so for how long? This may also be helpful for you to document for those needing to apply for disability.

- any links you have to following your story/path/blog.

Thank you in advance. I know the resolve and resilience it takes to get through this and I am so inspired by each one of you. Massive gratitude to Kay Howe who has been a warrior and champion for so many - likely saving hundreds of people from having the same fate as her son.

- Update -

Aloha everyone - I have had the great honor to work with one of the best Chinese Medicine Doctors in the world whom studied under the last Emperors Physician in China. He later came to the United States and founded the Oriental College of Medicine in Portland Oregon. His name is Dr. Fruehauf. He literally saved my life from a severe case of Ratlungworm Disease.

I previously had contracted an autoimmune disease and the worm ate a maze through my brain. When I came to Dr Fruehauf, I had severe brain swelling, and loss of all functions, and my body was shutting down. Doctors told my family that I would be brain damaged for a lifetime and be on permanent disability.

Dr Fruehauf saved my life, and helped my brain to heal beyond what any Western Medical Doctor thought was possible. This past week he told me that he developed a formula into a pill form for others going through RLWD. As I know many on the Hawaiian islands can't travel to Portland Oregon to see him, I wanted to be sure to let you all know that it will be available in a few weeks and I will post the link for it here.

Wishing you all a speedy recovery, and if there are any supplements, herbs, medicines or doctors that have most supported your healing- please do share them here with others. Mahalo - Rebekah

Hawaii Farm to School Rat Lungworm Disease Prevention Workshops Videos - Click Here

Governor of Hawaii Task Force on Rat Lungworm Disease Treatment Guidelines released on August 30th 2018 click here

Rat Lungworm Disease
The purpose of this website is to be of service to anyone who has been stricken with Rat Lungworm Disease (Angiostrongylus cantonensis). It was developed by Rebekah Uccellini with the assistance of Kaye Howe - both former residents of Hawaii. Rebekah was infected with Rat Lungworm disease and Kaye's son was also a victim when infected over 9 years ago. Kaye Howe went back to school and entered the Tropical Conservation Biology and Environmental Science Masters Program to become a full time researcher on the disease and has been working with Dr. Susan Jarvi at the University of Hawaii in Hilo since 2011. Between these women is a wealth of knowledge about the disease and it is their desire to be of assistance to others by drawing on their vast first-hand experience. The last thing anyone who is confronted with this illness wants to contend with is trying to surf through dozens and dozens of websites looking for answers for their questions. It is Rebekah and Kaye's desire to steer you towards people that can provide the answers you are seeking.

Southern Califonia Urban Wildlife Management
Will be hosting Kathleen Howe from the University of Hawaii at Hilo for an information session on Angiostrongylus cantonensis - Rat Lungworm Disease. California is now one of eight states on the mainland with verified cases of this disease and as little prepared as Hawaii was to deal with it, the mainland is at an even more critical juncture. Healthcare professionals on the mainland need to be prepared to make diagnosis and initiate speedy treatment.

Why the Sudden Increase in Rat-Lungworm Infection?
Understanding why the reported cases of rat-lungworm infections has increased begins with understanding the life-cycle of the parasite. The rat-lungworm resides in the lungs of rats or pulmonary arteries. This is where they lay their eggs. The eggs hatch into larvae and then are excreted in the rat feces. Snails, slugs, or flatworms eat the feces infecting themselves with the larvae. The rat eats another host (snail, slug, or flatworm), and the cycle starts all over again.

Sometimes humans enter the equation by eating a raw snail or slug, but most of the time when they make their way to produce. While most cases have occurred in parts of Asia, the Pacific Island, the Caribbean, and Africa, it has been seen in other parts of the world, such as Hawai'i. Infections in other parts of the contiguous United States have been rare and under specific circumstances. For example, in 1993 a New Orleans boy became infected with rat-lungworm by swallowing a raw snail “on a dare.” Within a few weeks he became ill from the infection. His symptoms resolved in 2 weeks.

Why the sudden proliferation in Hawaii?
Parmarion martensi is a new kid on the block in Hawaii. It is a South east Asian semi slug. It gets the name of semi slug because the mollusk is too large to fit inside its tiny shell. Due to its size, it can carry at least twice as many parasites than other mollusks. They may leave behind rat-lungworm larvae in their mucus trail or even go un-noticed on vegetables not washed properly as young semi slugs may be smaller than an uncooked grain of rice. Rise in this new semi slug may be responsible for increase in rat-lungworm infections.

Eastern Hawai'i Island appears to have an extremely high prevalence of Angiostrongyliasis cantonensis infection in Rattus spp. It is also the epicenter for angiostrongyliasis in the United States. It is known that the parasite exists on all main Hawaiian Islands in a variety of intermediate gastropod host species. It is also noted that the increase in the number of human angiostrongyliasis cases has paralleled the introduction of the semi-slug P. martensi to east Hawai'i, and that the semi-slug is also heavily infected.

Now on the mainland in the U.S. and 30 other nations
On the mainland in the United States, the spread of the disease has been verified in California, Texas, Alabama, Louisiana, Florida, and elsewhere along the Gulf Coast, even northwards to Tennessee according to a 2015 study in the Journal of Parasitology. The geographical distribution of this disease has changed dramatically in just a few decades according to experts. The parasite seems to thrive best in tropical and sub-tropical climates that have large annual rainfall, but seem to possibly be adapting to cooler drier climates.

Years ago, Oklahoma seemed an unlikely place to find the parasite, but recent studies have concluded their presence in the state. Thirty other nations around the world have also been added to the list of Rat Lungworm parasite locations. Most experts concur that global warming is likely playing a role in the spread of the parasite and that other region specific viruses and diseases will also be affected. There were 18 cases reported in 2017 on the islands by the state health director of Hawaii.

Slug Outbreak at Kentucky Soybean Farms
Knowing that slugs and snails are potentially carriers of disease, health organizations are watching the current slug and snail outbreak in Kentucky. "I haven't seen a slug outbreak like this in 40 years of growing soybeans," commented a farmer in Logan County, Kentucky. Recent slug damage to soybean seedlings ranged from 5% to 95% with different degrees of feeding and defoliation. This well-known agricultural pest is known for sporadic outbreaks causing a lot of damage. The environmental conditions and the mild winter of 2016-2017 may have contributed to a large number of adult survivors and increased egg laying in 2017 along with rain, wet soil, and cloudy days.

Slugs enjoy moist, cool environments and are often found under pots, logs, and rocks. They burrow into the ground during the day and emerge at sunset to ravage crops until sunrise. More damage is observed in untilled fields, while reduced damage has been found in regularly tilled farmland. These slugs are known to attack other crops as well, including corn and lettuce. While no rat-lungworm slug related infections have been reported, consumers in that area need to take additional steps to ensure their family is protected from this harmful parasite.

Protect Your Family from Rat Lungworm Infection
Safety begins by selecting healthy foods. Choose unbruised and undamaged produce. Bacteria can get inside the damaged area and infect the bruised portions. When buying pre-cut or bagged produce, only purchase those that are refrigerated or surrounded by ice. Always bag meat and vegetables in separate bags to take home. This prevents cross-contamination and makes unpacking groceries easier when you arrive home.

Once you get the produce home, store it properly. Refrigerate all pre-cut or packaged produce as well as any perishable fruits or vegetables such as strawberries, lettuce, herbs, and mushrooms. Be sure your refrigerator is clean and reaches a temperature 40º F or below. Use a refrigerator thermometer to ensure its proper temperature. Always take all headed vegetables apart and carefully check each leaf and wash individually under potable, running water, throwing out any that have any evidence of slug feces or damage. Cooking for 3-5 minutes, freezing for 24 hours, or drying are good ways to kill the parasite. The parasite does well in wet by not in dry environments. For those green kale smoothies we recommend checking and washing the leaves and then freezing for 24 hours.

Avoid Cross-Contamination
Keep fruits and vegetables intended to be eaten raw away from raw meat, poultry, and seafood. Use different cutting boards and utensils for fruits and vegetables intended to be eaten raw. If separate cutting boards are not available, wash thoroughly with soap and hot water before using.

Wash hands prior to food preparation for a minimum of 20 seconds with soap and warm water. Inspect the produce and remove any bruised or damaged spots and throw away any produce that looks rotten. Whether the produce was grown in your own garden, from a Farmers Market, or the grocery store it should be washed prior to serving. Even if you do not plan to eat the skin, the produce will need to be washed to prevent external bacteria and dirt from transferring to the surface onto the inside of the fruit or vegetable.

Use No Soap - Just Clean Water
The Food and Drug Administration does not advise using soap, detergent, or commercial produced washing materials on produce. Scrub firm produce with a clean produce brush and dry with a clean cloth towel or paper towel. Other fruits and vegetables should be washed under running water just before eating, cutting, or cooking.

If pre-cut or bagged produce is labeled as being "pre-washed" it is safe to consume and use out of the packaging. If you decide to wash labeled "pre-washed" produce do so in a manner that does not introduce cross-contamination with raw meats, poultry, or seafood. When washing garden produce it is wise to wear rubber/latex kitchen gloves.

Whether you are worried about rat-lungworm infection, E. coli, or any other foodborne bacteria or parasite, safe practices will protect yourself and your family from becoming ill.

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clinical guidelines
Download the PDF clinical guidelines from the University of Hawaii for Rat Lungworm Disease by clicking on the graphic above and saving the document to your hard-drive

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Updated early treatment protocol for Rat Lungworm Disease treatment. Please Read

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Coqui Frogs
Lungworm is spreading throughout the environment. Itʻs not only in rats, and of course in humans but now in coqui frogs, but the scientists found it is also in centipedes, greenhouse frogs and even bufos. They have published a paper, "Occurrence of Rat Lungworm (Angiostrongylus cantonensis) in Invasive Coqui Frogs (Eleutherodactylus coqui) and Other Hosts in Hawaii, USA," was published in the Journal of Wildlife Diseases.

rat lungworm disease A snail seems harmless enough unless it enters into the food chain of a rat when it consumes the rat's feces containing a round worm larvae which is infected with Angiostrongylus cantonensis. Then all hell breaks loose...

rat lungworm disease
Dr. Susan Jarvi's lab, located at the Daniel K. Inouye College of Pharmacy at UH Hilo, currently has two main areas of investigation: avian pathogens and rat lungworm disease.

rat lungworm disease
Kaye Howe was living in Indonesia when her son contracted Rat Lungworm Disease in Oahu. Her son Graham, was hospitalized at the Hilo Medical Center on December 26, 2008 with Rat Lungworm Disease.

rat lungworm disease
Graham McCumber is the son of Kaye Howe and has struggled with Rat Lungworm Disease for almost a decade. He has written a book about his journey and more recently Graham has written his second book.

rat lungworm disease
Rebekah Uccellini Kuby worked in Hawaii doing community development and poverty alleviation projects for years. She has helped to create more than 23 organic gardens — many in areas once deemed to be food deserts.

Truth by Graham McCumber

Truth: A Prayer to a Full Moon for Truth
by Graham Gabriel McCumber

Creator Book: Reaching Your Potential as a Human Being by Graham McCumber

Creator Book: Reaching Your Potential as a Human Being
by Graham Gabriel McCumber

This information is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the parasites described above or think that you may have a parasitic infection, consult a health care provider.

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