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Hawai‘i Journal of Medicine & Public Health A Journal of Asia Pacific Medicine & Public Health June 2013, Volume 72, No. 6, Supplement 2, ISSN 2165-8218 Guest Editor’s Message: Eosinophilic Meningitis Caused by Angiostrongylus cantonensis, the Rat Lungworm: Biology, Distribution, Epidemiology, Detection, Diagnosis, Treatment, and Management 3 Robert H. Cowie PhD The Discovery of Humans in Hawai‘i Infected with Angiostrongylus cantonensis, and Early Epidemiological Findings 5 Gordon D. Wallace DVM, MPH Biology, Systematics, Life Cycle, and Distribution of Angiostrongylus cantonensis, the Cause of Rat Lungworm Disease 6 Robert H. Cowie PhD Definitive, Intermediate, Paratenic, and Accidental Hosts of Angiostrongylus cantonensis and its Molluscan Intermediate Hosts in Hawai‘i 10 Jaynee R. Kim BS; Kenneth A. Hayes PhD; Norine W. Yeung PhD; and Robert H. Cowie PhD The Occurrence of the Rat Lungworm, Angiostrongylus cantonensis, in Nonindigenous Snails in the Gulf of Mexico Region of the United States 11 John L. Teem PhD; Yvonne Qvarnstrom PhD; Henry S. Bishop BS; Alexandre J. da Silva PhD; Jacoby Carter PhD; Jodi White-Mclean PhD; and Trevor Smith PhD Genetic Diversity of the Rat Lungworm, Angiostrongylus cantonensis, the Major Cause of Eosinophilic Meningitis 15 Praphathip Eamsobhana PhD; Phaik Eem Lim PhD; and Hoi Sen Yong PhD Angiostrongylus cantonensis and Rat Lungworm Disease in Brazil 18 Silvana Carvalho Thiengo PhD; Raquel de Oliveira Simões MsC; Monica Ammon Fernandez PhD; and Arnaldo Maldonado Júnior PhD The Apple Snail Pomacea canaliculata, a Novel Vector of the Rat Lungworm, Angiostrongylus cantonensis: its Introduction, Spread, and Control in China 23 Ting-Bao Yang PhD; Zhong-Dao Wu MD, PhD; and Zhao-Rong Lun PhD Human Parasitic Meningitis Caused by Angiostrongylus cantonensis Infection in Taiwan 26 Hung-Chin Tsai MD, PhD; Yao-Shen Chen MD; and Chuan-Min Yen PhD Angiostrongyliasis in Thailand: Epidemiology and Laboratory Investigations 28 Praphathip Eamsobhana PhD Rat Lungworm: An Emerging Zoonosis in Jamaica 33 Ralph D. Robinson PhD; Cecelia A. Waugh PhD; Cheridah D. Todd MPhil; Jacob Lorenzo-Morales PhD; and John F. Lindo PhD Angiostrongylus cantonensis: Epidemiology in the Continental United States and Hawai‘i 34 Sarah Y. Park MD and LeAnne M. Fox MD, MPH Clinical Aspects of Eosinophilic Meningitis and Meningoencephalitis caused by Angiostrongylus cantonensis, the Rat Lungworm 35 Gerald S. Murphy MD and Stuart Johnson MD A Severe Case of Angiostrongylus Eosinophilic Meningitis with Encephalitis and Neurologic Sequelae in Hawai‘i 41 Edward Kwon MD; Tomas M. Ferguson MD; Sarah Y. Park MD; Augustina Manuzak MPH, PhD; Yvonne Qvarnstrom PhD; Stephen Morgan MSA; Paul Ciminera MD, MPH; and Gerald S. Murphy MD continues on next page Table of Contents continued from previous page Hawai‘i Journal of Medicine & Public Health A Severe Case of Rat Lungworm Disease in Hawai‘i 46 A Journal of Asia Pacific Medicine & Public Health Kathleen Howe BA ISSN 2165-8218 (Print), ISSN 2165-8242 (Online) The Role of Eosinophils in Angiostrongyliasis: Multiple Roles The Journal’s aim is to provide new scientific information in a scholarly manner, for a Versatile Cell? 49 with a focus on the unique, multicultural, and environmental aspects William L. Gosnell PhD and Kenton J. Kramer PhD of the Hawaiian Islands and Pacific Rim region. Published by University Clinical, Differential Diagnosis of CNS Angiostrongyliasis: A Short Review 52 Education & Research Associates (UCERA) Vichai Senthong MD; Jarin Chindaprasirt MD; and Kittisak Sawanyawisuth MD, MAS, PhD Hawai‘i Journal of Medicine & Public Health 677 Ala Moana Blvd., Suite 1016B The Current Status of Laboratory Diagnosis of Angiostrongylus Honolulu, Hawai‘i 96813 cantonensis Infections in Humans Using Serologic http://www.hjmph.org and Molecular Methods 55 Email: [email protected] Patricia P. Wilkins PhD; Yvonne Qvarnstrom PhD; A. Christian Whelen The Hawai‘i Journal of Medicine & Public Health was formerly two separate PhD; Caitlin Saucier BS; Alexandre J. da Silva PhD; and Praphathip journals: The Hawai‘i Medical Journal and the Hawai‘i Journal of Public Health. Eamsobhana MD The Hawai‘i Medical Journal was founded in 1941 by the Hawai‘i Medical Association (HMA), which was incorporated in 1856 under the Hawaiian Expression of Recombinant Antigenic Proteins from Angiostrongylus monarchy. In 2009 the journal was transferred by HMA to University Clinical, cantonensis: A Brief Report 58 Education & Research Associates (UCERA). The Hawai‘i Journal of Public Alessandra L. Morassutti PhD; Andrey Perelygin PhD; Keith Levert PhD; Health was a collaborative effort between the Hawai‘i State Department of Health Seh-Ching Lin PhD; Yeuk-Mui Lee PhD; Alexandre J. da Silva PhD; and the Office of Public Health Studies at the John A. Burns School of Medicine Patricia P. Wilkins PhD; and Carlos Graeff-Teixeira PhD established in 2008. Editors: Detection of Rat Lungworm in Intermediate, Definitive, and Paratenic S. Kalani Brady MD Hosts Obtained from Environmental Sources 63 Michael J. Meagher MD Yvonne Qvarnstrom PhD; Henry S. Bishop BS; Editor Emeritus: and Alexandre J da Silva PhD Norman Goldstein MD Associate Editors: Pathways for Transmission of Angiostrongyliasis and the Risk of Donald Hayes MD, MPH Disease Associated with Them 70 Kawika Liu MD Robert H. Cowie PhD Jay Maddock PhD Alan D. Tice MD Copy Editor: Control Measures for Slug and Snail Hosts of Angiostrongylus Alfred D. Morris MD cantonensis, with Special Reference to the Semi-slug Public Health Manuscript Editors: Parmarion martensi 75 Tonya Lowery St. John MPH Robert G. Hollingsworth PhD; Kathleen Howe BA; Ranjani Rajan MPH and Susan I. Jarvi PhD Contributing Editors: Satoru Izutsu PhD Rat Lungworm Disease in Hawai‘i: Community Outreach Russell T. Stodd MD and Education on the Island of Hawai‘i (the ‘Big Island’) 81 Carl-Wilhelm Vogel MD, PhD Marlena Castro Dixon MS Statistical Editor: John J. Chen PhD Layout Editor & Production Manager: Telling Consumers, Gardeners, and Farmers about the Possible Risk Drake Chinen of Rat Lungworm in the Local Food Supply in Hawai‘i 82 Subscription Manager: James R. Hollyer MS Meagan Calogeras Effects of Washing Produce Contaminated with the Snail and Slug Editorial Board Hosts of Angiostrongylus cantonensis with Three Common Benjamin W. Berg MD, Patricia Lanoie Blanchette MD, Household Solutions 83 S. Kalani Brady MD, John Breinich MLS, Norine W. Yeung PhD; Kenneth A. Hayes PhD; John J. Chen PhD, Donald Hayes MD, MPH, Satoru Izutsu PhD, Kawika Liu MD, and Robert H. Cowie PhD Tonya Lowery St. John MPH, Jay Maddock PhD, Douglas Massey MD, Michael J. Meagher MD, Alfred D. Morris MD, Ranjani Rajan MPH Myron E. Shirasu MD, Russell T. Stodd MD, Frank L. Tabrah MD, Carl-Wilhelm Vogel MD Advertising Representative Roth Communications 2040 Alewa Drive, Honolulu, HI 96817 Phone (808) 595-4124 Full text articles available on PubMed Central The Hawai‘i Journal of Medicine & Public Health (ISSN 2165-8218) is a monthly peer-reviewed journal published by University Clinical, Education & Research Associates (UCERA). The Journal cannot be held responsible for opinions expressed in papers, discussion, communications, or advertisements. The right is reserved to reject material submitted for editorial or advertising columns. Print subscriptions are available for an annual fee of $165; single copy $15 includes postage; contact the Hawai‘i Journal of Medicine & Public Health for foreign subscriptions. ©Copyright 2013 by University Clinical, Education & Research Associates (UCERA). Guest Editor’s Message: Eosinophilic Meningitis Caused by Angiostrongylus cantonensis, the Rat Lungworm: Biology, Distribution, Epidemiology, Detection, Diagnosis, Treatment, and Management Robert H. Cowie PhD One of the major causes of eosinophilic meningitis is infection entists and clinicians from places as far apart as Brazil, China, by the nematode Angiostrongylus cantonensis, the rat lung- Jamaica, Taiwan, Thailand, the mainland United States, and worm. Angiostrongylus cantonensis was first described from Hawai‘i, with expertise in a much broader range of fields than southern China, but has now spread to many parts of the world was represented at the Bangkok workshop, spanning ecology, as a result of the human-associated spread of both its definitive parasitology, epidemiology, detection, diagnosis, treatment, and and intermediate hosts (rats and snails/slugs, respectively). The food safety. The workshop’s goal was to develop a rigorous and first cases in Hawai‘i were reported in 1961 but the disease has concerted research agenda to address rat lungworm disease at attracted increasing attention in Hawai‘i following outbreaks a global scale through advancing an integrated understanding over the last decade. of all aspects of the disease. A prioritized list of objectives was The disease is contracted when people ingest the immature developed1 and the top needs in eight areas, as identified in this worms that are carried by snails and slugs. Ingestion is most list, are presented in Table 1. often inadvertent - a small baby slug among lettuce leaves for There is a need to raise awareness and understanding of instance. However, in some parts of the world raw snails are a angiostrongyliasis within the medical community as well as delicacy and their ingestion can lead to disease, and there are the general public. This special issue of the Hawai‘i Journal cases, including one in Hawai‘i, in which people have delib- of Medicine and Public Health is part