Deadly worm
Illness rare, with no cases among Maui County residents this year
Vet tells owners to be aware
When 4-year-old Kili first developed a cough of sorts, the owners of the mixed breed pitbull thought he was choking on something.
But then things got worse — he suffered an infection of his central nervous system, lost weight, hid from light and had muscle tremors, among all sorts of other issues.
Veterinarians at Kahului Animal Hospital couldn’t figure out what was wrong and ran numerous tests while treating Kili over the course of several weeks from the end of January. Eventually, they diagnosed rat lungworm disease, an illness that’s rare on Maui aside from a spike in cases in 2017.
After hearing the doctor’s diagnosis and seeing Kili suffer, his owners decided to put him to sleep.
“Not a question it was the right thing to do,” veterinarian Terry Smith said Monday.
Animals can’t transmit the disease to humans and the number cases has been low, but Smith wants to raise awareness for pet owners not to let their guard down.
The disease is caused by small parasitic roundworms or nematodes that live in rats, snails and slugs. Rats host the worm and pass larvae through their feces, which are eaten by slugs and snails that are later eaten by rats, repeating the cycle. The worms become dangerous when they enter other animals or humans. According to the state Department of Health, the disease affects the brain and spinal cord.
Kili’s owners and veterinarians noticed a stark difference in the dog after he contracted the disease. He went from “vivacious” and “charging around” and “doing mischief,” to being “up all night” shaking and developing two large lumps on
each side of his jaw, said Smith, who runs the animal hospital with fellow veterinarian Debbie Dorsey.
Through much testing and care, including a stay at Smith and Dorsey’s home, Smith finally determined it was rat lungworm disease at the end of
February, with laboratory tests confirming it last week.
“It was a diagnostic challenge first of all,” Smith said. “There is not an easy test.”
He also noted how much Kili’s family loved him by allowing Smith to conduct multiple tests to try to find a remedy.
Smith performed a necropsy after Kili died, collecting blood and tissue samples to send to the Daniel K. Inouye College of Pharmacy’s laboratory at the University of Hawaii at Hilo. Blood tests showed nothing, but the tissue samples were key.
Since test results confirmed the diagnosis on March 24, Smith has called government officials, including the Department of Health, to notify them of his findings. He also wants to get informational posters in veterinarians’ offices across the state.
Kili’s home is in the Twin Falls area of East Maui, where there are other pets, livestock and agriculture, all potentially susceptible to rat lungworm disease, said Smith, who suspects Kili may have eaten a slug.
State Department of Health spokeswoman Janice Okubo said in an email Monday that the department does not track pets infected with the disease because pets do not transmit the disease to humans. However, Okubo advised people to wash produce before eating it to prevent ingestion of organisms that could carry rat lungworm disease, which is endemic in Hawaii rodents, slugs and snails.
There have been no confirmed incidents of rat lungworm disease in a human so far this year in Maui County, according to the DOH, though there have been two cases confirmed in Hawaii County. Last year, there was one case in Maui County and two cases each in Hawaii and Honolulu counties. The majority of rat lungworm cases in the state are on Hawaii island.
Maui County saw a high rate of rat lungworm infections in humans in 2017, with seven cases reported, including four residents and three visitors.
Some people who contract the disease have mild symptoms or none at all. Symptoms can include severe headache and stiffness of the neck, tingling or painful feelings in the skin or extremities, low-grade fever, nausea and vomiting, according to the DOH.
Temporary facial paralysis is also a potential symptom, as well as light sensitivity. Symptoms usually start one to three weeks after exposure but can range from one day to as long as six weeks after exposure.
Okubo said rainy seasons often means that slugs and snails increase around gardens and yards, which can be an elevated risk for rat lungworm disease for both people and pets.
For more information, visit health.hawaii.gov/docd/dis ease_listing/rat-lungwormangiostrongyliasis/.
The University of Hawaii College of Tropical Agriculture and Human Resources has information on controlling slugs and snails at manoa.hawaii. edu/ctahr/farmfoodsafety/ratlungworm/.
■ Melissa reached mtanji@mauinews.com.
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