Doctors are warning about the unusual symptoms of a rare parasitic infection that is common in Hawaii.
A New England woman who complained of a burning sensation in her feet and legs was revealed to have parasitic worms in her brain.
The 30-year-old woman was admitted to the hospital suffered headaches and burning in her feet that progressed up her body and through her arms.
She had just returned from a trip to Thailand, Japan, and Hawaii, where she ate raw fish that doctors believe may have transmitted the parasites to her.
The woman, who researchers said came from a coastal community in New England, visited two hospital emergency rooms with symptoms, but doctors didn’t deem her condition serious enough to admit her, and sent her home with headache and anxiety medicine.
The woman wasn’t taken to the hospital for more testing until her confusion got worse. Once there, doctors performed a lumbar puncture to look more closely at her symptoms.
This test provided important clues that led to doctors discovering angiostrongyliasis, a parasitic infection caused by the roundworm Angiostrongylus cantonensis, commonly known as rat lungworm.
The infections caused inflammation of the membranes surrounding the brain and spinal cord, leading to burning or shooting pain in the limbs.
Doctors are warning about the link between burning sensations in the legs and a rare parasitic infection that is common in Hawaii (stock image)
Twelve days before presenting to the hospital, the patient had just returned from a three-week trip.
The first week was spent in Bangkok, Thailand, where she explored the city and enjoyed various street foods, avoiding raw dishes.
She then spent five days in Tokyo, Japan, mostly staying in her hotel and having sushi for several meals.
For the final 10 days, she vacationed in Hawaii, swimming in the ocean multiple times and regularly eating salad and sushi.
Doctors first thought she might have Guillain–Barré syndrome, a rare autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nerves, causing inflammation and damage. But her normal exam made that unlikely.
Other causes like ibuprofen use or a rare condition called eosinophilic granulomatosis were also ruled out.
As her symptoms got worse, including a headache and fever, doctors did a lumbar puncture (spinal fluid test), which showed eosinophilic meningitis – inflammation of the membranes surrounding the brain and spinal cord.
The most likely cause was a parasite called Angiostrongylus cantonensis, which is found in tropical regions.
The roundworm is a known issue in Hawaii, gaining attention in recent years due to small outbreaks in the state.
In 2017, there were 19 confirmed cases, but the number of cases has remained below 10 in the years that followed.
The parasite’s life cycle involves slugs, snails, and rats. Rats release first-stage larvae in their feces, which are eaten by snails or slugs, where they develop into third-stage larvae (L3).
Rats ingest infected slugs or snails, and the larvae migrate to their brain, becoming adults and moving to the lungs to lay eggs. The cycle repeats when the rat excretes first-stage larvae.
Humans become infected by ingesting L3 larvae, typically from undercooked snails, slugs, or contaminated vegetables, especially leafy greens touched by infected slugs.
Once ingested, the larvae migrate from the digestive tract to muscles and the brain, causing symptoms like burning feet. In the brain, the larvae typically die before reaching adulthood.
The woman was likely infected when snail or slug slime came in contact with the food that was prepared for her.
The patient was treated with a combination of medications to address her symptoms and infection. A 14-day course of high-dose prednisone, a steroid, was started to reduce inflammation and relieve symptoms like headache and nerve pain.
In a separate case, Dr Sam Ghali, an urgent care doctor from the University of Florida , took to social media to share an image of a patient with telltale signs of a different parasitic infection called cysticercosis
Albendazole, a medication that targets the parasite causing the infection, was also added because it can reach the brain and spinal fluid. This was given alongside prednisone to treat the infection.
To help with nerve pain, gabapentin and amitriptyline were used. As a result of these treatments, her symptoms improved, and she didn’t need additional tests or procedures.
By the sixth day in the hospital, she was feeling better and was discharged.
The patient’s timely diagnosis and the combination of targeted treatments played a crucial role in her recovery.
It can be fatal if left untreated.
The inflammation of the membranes surrounding the brain and spinal cord can lead to increased intracranial pressure, neurological damage, and complications like seizures, stroke, or coma. In some cases, the infection or inflammation can spread to other parts of the body.
