Abstract
.Angiostrongyliasis, caused by the Angiostrongylus cantonensis roundworm, became reportable in the state of Hawaii in 2007. We confirmed 82 reported cases between 2007 and 2017. There was a median of seven cases per year, and the majority (57%) of cases occurred between January and April. Most (83%) cases were found on the island of Hawaii, with geographic information system (GIS) analysis identifying hot spots on the east side of the island. However, cases were identified on the other major islands as well, suggesting the risk of exposure is present statewide. Comparisons of cases from 2007 to 2017 with cases from previous assessments found no statistical differences in cerebrospinal fluid results, peripheral blood results, or ages of cases. However, differences in geographic distribution of the cases were statistically significant. Improved testing and increasing awareness of the disease have contributed to our efforts to better understand the general risk factors and modes of transmission present in Hawaii and also helped improve our prevention efforts, although we still do not fully understand the specific causes of cases being concentrated in certain parts of the state over others. Continued outreach efforts, including public forums and publication of preliminary clinical guidelines, aim to inform and improve our public health response and efforts to prevent angiostrongyliasis.
Highlights
Angiostrongyliasis, known as rat lungworm disease, is caused by the parasitic nematode Angiostrongylus cantonensis
Eosinophilic meningitis was defined as having a cerebrospinal fluid (CSF) specimen with 3 6 leukocytes per mm,[3] and eosinophil percentage of 3 10% or absolute eosinophil count 3 10
A case was considered confirmed if they met the criteria for a probable case and either A. cantonensis larvae or young adult worms were identified in their CSF, had a positive real-time polymerase chain reaction (RTi-PCR) test for A. cantonensis DNA from a CSF specimen, or were epidemiologically linked to a confirmed case
Summary
Angiostrongyliasis, known as rat lungworm disease, is caused by the parasitic nematode Angiostrongylus cantonensis. Its primary host includes several species of rats, primarily those in the Rattus genus,[1,2,3,4,5] in which mature A. cantonensis lay eggs. These eggs hatch into first-stage larvae, which are expelled in the rat’s feces. Intermediate hosts, including snails and slugs, ingest the contaminated feces, and the first-stage larvae enter these hosts and develop into third-stage larvae. If a rat eats an infected intermediate host, the third-stage larvae infect the rat, in which they can continue to develop into mature adults, reproduce, and continue the cycle. The immune system’s reaction to the dead parasites is responsible for most symptoms associated with angiostrongyliasis.[6]
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