Angiostrongyliasis, also known as rat lungworm, is a disease that affects the brain and spinal cord. POL is relying on resources provided by our member, the Hawaii State Department of Health for the following information:


Rat lungworm is caused by a parasitic nematode (roundworm parasite) called Angiostrongylus cantonensis. The adult form of A. cantonensis is only found in rodents. However, infected rodents can pass larvae of the worm in their feces. Snails, slugs, and certain other animals (including freshwater shrimp, land crabs, and frogs) can become infected by ingesting this larvae; these are considered intermediate hosts. Humans can become infected with A. cantonensis if they eat (intentionally or otherwise) a raw or undercooked infected intermediate host, thereby ingesting the parasite. For more information on the life-cycle of A. cantonensis, visit the CDC website.

SIGNS & SYMPTOMS.  This infection can cause a rare type of meningitis (eosinophilic meningitis). Some infected people don’t have any symptoms or only have mild symptoms; in some other infected people the symptoms can be much more severe. When symptoms are present, they can include severe headache and stiffness of the neck, tingling or painful feelings in the skin or extremities, low-grade fever, nausea, and vomiting. Sometimes, a temporary paralysis of the face may also be present, as well as light sensitivity. The symptoms usually start 1 to 3 weeks after exposure to the parasite, but have been known to range anywhere from 1 day to as long as 6 weeks after exposure. Although it varies from case to case, the symptoms usually last between 2–8 weeks; symptoms have been reported to last for longer periods of time.

TRANSMISSION.  You can get angiostrongyliasis by eating food contaminated by the larval stage of A. cantonensis worms. In Hawaii, these larval worms can be found in raw or undercooked snails or slugs. Sometimes people can become infected by eating raw produce that contains a small infected snail or slug, or part of one. It is not known for certain whether the slime left by infected snails and slugs are able to cause infection. Angiostrongyliasis is not spread person-to-person.

DIAGNOSIS. Diagnosing angiostrongyliasis can be difficult, as there are no readily available blood tests. In Hawaii, cases can be diagnosed with a polymerase chain reaction (PCR) test, performed by the State Laboratories Division, that detects A. cantonensis DNA in patients’ cerebrospinal fluid (CSF) or other tissue. However, more frequently diagnosis is based on a patient’s exposure history (such as if they have history of travel to areas where the parasite is known to be found or history of ingestion of raw or undercooked snails, slugs, or other animals known to carry the parasite) and their clinical signs and symptoms consistent with angiostrongyliasis as well as laboratory finding of eosinophils (a special type of white blood cell) in their CSF.

TREATMENT.  There is no specific treatment for the disease. The parasites cannot mature or reproduce in humans and will die eventually. Supportive treatment and pain medications can be given to relieve the symptoms, and some patients are treated with steroids. No anti-parasitic drugs have been shown to be effective in treating angiostrongyliasis, and there is concern that they could actually make the symptoms worse because of the body’s response to potentially more rapidly dying worms. Persons with symptoms should consult their health care provider for more information.

PREVENTION.  To prevent angiostrongyliasis, don’t eat raw or undercooked snails or slugs, and if you handle snails or slugs, be sure to wear gloves and wash your hands. Eating raw or undercooked freshwater shrimp, land crabs and frogs may also result in infection, although, there has not been any documented cases in Hawaii. You should also thoroughly inspect and wash fresh produce and vegetables, especially if eaten raw. Eliminating snails, slugs, and rats founds near houses and gardens might also help reduce risk exposure to A. cantonensis.

When preparing food for cooking, any suspect food products should be boiled for at least 3 to 5 minutes, or frozen at 5°F (15°C) for at least 24 hours; this will kill the larval stage of the worm.

REPORTING.  HDOH requires that clinicians report patients with eosinophilic meningitis, i.e., signs and/or symptoms consistent with meningitis plus eosinophils in the cerebrospinal fluid (CSF) without possible alternative causes, including CNS infection with other microbes, reaction to foreign material in the CNS (e.g., intracranial hardware or myelography dye), medications (e.g., intrathecal vancomycin or gentamicin), neoplasms, multiple sclerosis, and neurosarcoidosis by calling (808) 586-4586.


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Papa Ola Lōkahi presents "Your Neighborhoods by the Numbers," a free interactive workshop on May 3, 2017 taught by Mr. Eric Coyle of the U.S. Census Bureau.

Census Workshop Neighborhoods by Numbers POL 2017 0503

Papa Ola Lōkahi is a Census Information Center, designated by the U.S. Census Bureau, specializing in Native Hawaiian and Pacific Islander communities..

Register now!

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Masthead Niu Maka 2016 Makalii

The Makahiki 2016 issue of Niu Maka, our newsletter, recaps the highlights of 2016.


  • Message from the Executive Director, Sheri Daniels
  • Meet Gayle
  • Native Hawaiian Health Scholarship Program
  • Hookele i ke Ola - Patient Navigator Training Program
  • Imi Hale wraps us
  • E Ola Mau a Mau - Native Hawaiian Health Study update
  • Pulse of the Community
  • Ke Ala Ola - Native Hawaiian Health Resource Map
  • Health Award to Aunty Betty
  • Halia Aloha
  • Ai Pono
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Pule Hoola

This Pule Ho‘ōla, Healing Prayer, poetically compares the restoration of a house to the healing of a sick patient.  Slowly, under the care of a kahuna, the patient regains strength.  She is healed!

As February is Hawaiian Language Month, Papa Ola Lōkahi will be featuring excerpts and essays throughout the month.  This Pule Ho‘ōla comes from Fornander via Gutmanis (p. 90).

E ola mau!


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Friday, December 9, 2016, 9:00 AM

Department of Land and Natural Resources

1151 Punchbowl St, Room 132

Dr. Sheri-Ann Daniels, Executive Director

Papa Ola Lōkahi, the Native Hawaiian Board of Health, opposes the holdover of revocable permits to Alexander & Baldwin and East Maui Irrigation Company.

Recommendations from the E Ola Mau Native Hawaiian Health Needs Assessment in 1985 include increasing access to and engagement among Native Hawaiians to traditional and/or subsistence fishing and farming practices to improve community health. More recently, the 2013 publication Assessment & Priorities for Health & Well-Being in Native Hawaiians and other Pacific Peoples asserts improved health behaviors and outcomes among Hawaiians involved in activities of land, food and health.

From Governor David Ige’s goal to reduce the State’s dependence on imported foods, to the World Health Organization’s look at policies and measures for increasing access to healthy diets, to Article 20 of the United Nations Declaration on the Rights of Indigenous Peoples, which states: Indigenous peoples have the right to maintain and develop their political, economic and social systems or institutions, to be secure in the enjoyment of their own means of subsistence and development, and to engage freely in all their traditional and other economic activities, it is well documented that access to land, food and cultural practice will improve health and economic outcomes.

POL promotes policy and practices in Hawai‘i tying together land, food and health, activities that would be critically impacted if healthy stream waters are diverted away from lo‘i, family and community farms, and downstream fishing grounds.

Further, we urge the State of Hawai‘i Board of Land &Natural Resources to compel the applicants to bear the burden of proving why, having harvested the last of the sugar cane on Maui for which these waters were diverted, they deserve to continue diverting the life-giving waters of Nā Wai Eha.

Mahalo nui for the opportunity to offer testimony in opposition to extended water permits to Alexander & Baldwin and East Maui Irrigation Co.

Ka Wai I ke Ola! Water is Life! Water is Well-Being!

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