The mother of a young Hawaiian girl who nearly died from rat lungworm disease is working to raise awareness of the rare parasitic infection.
Emily Faith Kubowski's daughter Elowen first began showing symptoms last December, and the disease progressed to the point where her doctors feared she might not survive.
“They were pretty sure she would never use her legs or smile again. “And now she's like a miracle,” Kubowski said in a recent interview with KHNL-TV.
Hawaii is the U.S. epicenter for rat lungworm infections, a rare disease that occurs primarily in tropical Asian countries such as Thailand and the Pacific Islands.
Kubowski believes her daughter may have been infected with the parasite, which spreads by ingesting tiny snails crawling on the ground in Puna on the Big Island, where his family lives.
“She most likely crawled over something and had the parasite on her hand and then released it into her mouth, the way toddlers always bring things from the floor into their mouth,” the mother said.
Emily Faith Kubowski's daughter Elowen almost died from rat lungworm disease. The mother, seen center above with her partner, speaks out to raise awareness
The parasite caused the toddler to go from smiling and healthy to seriously ill and lethargic
Elowen's initial symptoms included restlessness before she stopped using her legs, had difficulty swallowing, and fell asleep unexpectedly and repeatedly.
The doctors were confused, but the mother believed she knew the cause of the illness.
“I told everyone it was rat lungworm because I know adults who have it,” she said.
“The first lumbar puncture showed no signs of this, even the white blood cell count, which would indicate a parasitic infection,” Kubowski said. “But her second lumbar puncture showed naked-eye parasites floating in her spinal fluid.”
Elowen was in the hospital for months but was able to turn things around last spring after intensive treatment.
Now her mother is calling on the Centers for Disease Control and Prevention to raise awareness of the parasite's risks and hopes health care providers in Hawaii keep an eye out for possible cases.
“I feel like if our health care providers, particularly in East Hawaii on the Big Island, were better trained and had more resources available, cases like this wouldn't go through,” she said.
Known in the scientific community as angiostrongyliasis, rat lungworm can wreak havoc on the human digestive and nervous systems, even causing paralysis.
Emily Faith Kubowski's daughter Elowen first started showing symptoms last December
Lungworm disease in rats is caused by a rat-borne parasite (above) that excretes larvae that ingest slugs or snails
Lungworm disease in rats is caused by a rat-borne parasite that excretes larvae that are ingested by slugs.
People then knowingly or unknowingly eat the slugs, which often hide in unwashed food.
Researchers believe most cases are caused by an invasive creature that is half snail and half slug – called a semi-slug – that climbs quickly and can easily get into sinks and water tanks.
According to the Centers for Disease Control and Prevention (CDC), most cases of rat lungworm disease occur in tropical Asian countries such as Thailand and the Pacific Islands.
This is very rarely reported in the continental United States.
“Cases of rat lungworm were identified in Hawaii as early as 1959, so it is not new to the islands,” says the study published in the American Journal of Tropical Medicine and Hygiene.
However, it wasn't until 2007 that Hawaii began reporting cases to the state Department of Health.
Of the 82 cases reported, 51 were confirmed while the other 31 were “probable.”
Ten cases were reported in 2018 and five cases in 2019, but were not included in the study.
Between 2007 and 2017, 82 cases of the rare rat lungworm disease were reported in Hawaii. Pictured: A “half snail” believed to be responsible for the number of cases in Hawaii
What is lungworm disease in rats?
Lungworm disease in rats is caused by a rat-borne parasite that excretes larvae that are ingested by slugs.
People then knowingly or unknowingly eat the slugs, which often hide in unwashed food.
Researchers believe most cases are caused by an invasive creature that is half snail and half slug – called a semi-slug – that climbs quickly and can easily get into sinks and water tanks.
According to the Centers for Disease Control and Prevention (CDC), most cases of rat lungworm disease occur in tropical Asian countries such as Thailand and the Pacific Islands.
Researchers found that the majority of infected people reported sometimes eating unwashed food, and at least half reported storing food in unsealed containers.
Children under 10 were more likely to experience symptoms such as fever and vomiting, while adults experienced headaches, joint pain, muscle pain and neck stiffness.
According to the CDC, in most cases the infection goes away without treatment after the parasite dies.
However, researchers reported that 65 of the cases resulted in hospitalizations and two people died.
The study listed a number of potential sources, including the Cuban slug, the African giant snail and the marsh snail.
However, the team believes that the invasive semi-snail could be the cause of most cases, as they climb quickly and can easily get into water tanks or hide in fruits and vegetables.
Lead study author David Johnston, an epidemiologist with the Hawaii State Department of Health, says the overall risk to humans is low and it is important to raise awareness of the disease.
“As we continue to improve our understanding of rat lungworm disease in Hawaii and the risk factors associated with infection, we are applying what we have learned to improve our prevention efforts in the state,” he told Infectious Disease News.
“These efforts are focused on educating the public about the disease, its transmission and the best prevention strategies.”
The Hawaii Department of Health strongly recommends against eating raw or undercooked snails.
Officials also recommend cooking snails, shrimp and crabs before consumption and washing all products before consumption.