This year, nine confirmed cases of rat lungworm disease have surfaced in Hawaii (Maui and the Big Island), and a couple in California who recently traveled to the Aloha State came down with symptoms after they returned home from their honeymoon. Four additional cases have been suspected since the start of the year and fortunately no deaths have been reported. The Hawaii Department of Health confirmed 11 cases in 2016, and between 2007 and 2015, 42 cases were reported. Here are your questions answered.
Rat lungworm is in the family of roundworms (nematodes), named Angiostrongylus. Angiostrongylus cantonensis is a parasite that can cause neurological infections such as meningitis, and its sister species, Angiostrongylus costaricensis, can cause severe gastrointestinal illness. The specific meningitis, or inflammation of the brain, caused by A. cantonensis is an eosinophilic meningitis, where the main blood cell involved is an eosinophil, prevalent in parasitic infections as opposed to a bacterial or viral meningitis.
It's found primarily in Southeast Asia and the Pacific Basin but up until recently it's been extremely rare in the United States. In 2015 a study published in the Journal of Parasitology cited cases had been reported in Florida, Alabama, California, Louisiana, and Hawaii.
It primarily lives in rodents but the larvae can be passed to other species through rat feces. Adult nematodes live in the pulmonary arteries of rats. The females lay eggs and these, once they hatch and become first stage larvae, may migrate to the rat’s throat and then enter the GI system, eventually exiting through feces.
Symptoms include severe headache, fever, neck stiffness, visual disturbances, difficulty looking at light (photophobia), nausea, vomiting, numbness, temporary paralysis of the face and possibly coma and death.
The incubation period, on average, can be anywhere from a week to three weeks and symptoms could start within that time and possibly last for months. Neurological sequelae of the survivors can last for extended periods of time.
An individual could become exposed to A. cantonensis when one eats undercooked slugs, snails, frogs, shrimp, mollusks and contaminated fruits and vegetables. Slime from slugs may also be a source of contamination of the deadly parasite.
If a person presents with symptoms of meningitis, the cerebrospinal fluid, or fluid surrounding the brain and spinal cord is able to be sampled during a lumbar puncture. The needle entering through the back could aspirate enough of a sample for laboratory technicians to determine if the meningitis is caused by bacteria, virus or parasites, the latter of which causing a higher concentration of eosinophils to be demonstrated in the CSF fluid as well as the blood.
Currently there is no official treatment of the parasite. The parasite will die on its own but can do so in a relatively short amount of time such as days, or become latent for months. Dead worms could also cause severe neurological symptoms. Symptomatic measures of the patient are instituted to help with pain, although some have been treated with steroids and antiparasitic medications.
Make sure all raw vegetables are washed thoroughly, Handle slugs and snails with gloves and wash hands diligently. The University of Hawaii recommends boiling snails for at least 3-5 minutes prior to preparing for consumption. And keep rodents, snails and slugs away from your food and kitchen counters.
For more on prevention of Rat Lungworm infections, read: Avoid Contracting Angiostrongyliasis (Rat Lungworm Infection): Wash Fresh Fruits and Vegetables Before Eating!
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A recent chemical attack in northern Syria killed dozens and wounded more. According to the Syrian Observatory for Human Rights (SOHR), victims were having difficulty breathing, foaming at the mouth, seizures, bleeding from the nose and mouth, fainting, and some progressed to losing consciousness and dying. Based on these observances, sarin gas is suspected.
Sarin is a liquid that is clear, colorless, odorless and tasteless. It can also be vaporized and used as a gas in chemical warfare. It is an extremely potent nerve agent.
Sarin acts to inhibit cholinesterase. To understand its effects, let me briefly break it down.
Cholinesterase is an enzyme in the body used to break down acetylcholine.
Acetylcholine is a neurotrasmitter, that is present in every synapse that bridges the nerve signals to the muscles and other nerves.
Cholinesterase is a “checks and balance” type enzyme that prevents acetylcholine from building up and causing continual stimulation of muscles and nerves.
If acetylcholine remains unchecked, continual stimulation of muscles and nerve fibers can occur, interfering with body processes and causing among many effects, inability to properly breath and ultimately death.
Sarin inhibits cholinesterase so it can’t inhibit acetylcholine, allowing the latter to build up, causing disastrous effects.
Within seconds of exposure, Sarin gas can cause a variety of symptoms. These include:
Low Blood Pressure
Loss of Consciousness
Those who survive could have symptoms for weeks and sometimes long term neurological effects.
Sarin is man made. Its an agent in liquid form that can be aerosolized. It can be introduced to populations in food, water supply, by direct contact with the skin or even inhaled.
Firstly, we need to reduce exposure by immediately removing the clothing and washing off the body to reduce the amount of the chemical being absorbed.
Atropine is considered the antidote for nerve agent poisoning. It acts by blocking acetylcholine receptor sites so the signals stop firing.
Pralidoxime is also used to help reactivate cholinesterase. It works by cleaving the bond made by the nerve agent/organophosphate and the cholinesterase so it is free to work again to control acetylcholine levels.
Both are given by injections and are available as autoinjectors.
Sarin was first developed as a pesticide during Nazi Germany in 1938 by Gerhard Schrader and his team. The compound made was found to be 500 times more deadly than cyanide. So the chemical’s future of becoming a pesticide was thwarted because it couldn’t be used around humans. Its been told that the team of scientists working on Sarin were incapacitated for a month.
The Nazis instead chose to develop it as a chemical warfare agent and named it Sarin after the scientists, Schrader, Otto Ambros, Rüdiger and Hermann Van der Linde. Fortunately it was never used during WWII.
However, in 1988 the Iraqi’s used it against the Kurds, killing 5000 and injuring tens of thousands more. In 1995, the religious movement Aum Shinrykio released the gas on multiple subway trains in Tokyo, killing 12 and injuring thousands.
Non-steroidal, anti-inflammatory drugs (NSAIDs) include ibuprofen and diclofenac. These medications are seen in products under the brand name Motrin and Voltaren, respectively. This class of medications is one of the most popular as they help consumers treat a variety of ailments including helping to relieve pain, inflammation and lower fever. Moreover they are inexpensive and many do not require a prescription at the lower doses.
However, their chronic use has been linked to serious medical complications such as ulcers, kidney failure and cardiac issues. This week, a study published in the March issue of European Heart Journal – Cardiovascular Pharmacotherapy found NSAID use (specifically Ibuprofen and diclofenac) to increase the chance of cardiac arrest.
The researchers from the Copenhagen University Hospital Gentofte in Denmark reviewed close to 30,000 cases of people who suffered cardiac arrest out of the hospital during the years 2001 and 2010 and found NSAID use. Diclofenac, specifically, carried a 50 percent increased risk of cardiac arrest.
COX-2 selective inhibitors, such as Celebrex and Naproxen (Aleve) were NOT associated with increased risk in this particular study.
According to the study author, Professor Gunnar H. Gislason, professor of cardiology, “the findings are a stark reminder that NSAIDs are not harmless. “Diclofenac and ibuprofen, both commonly used drugs, were associated with significantly increased risk of cardiac arrest. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors.”
He continued by saying, “Naproxen is probably the safest NSAID and we can take up to 500 mg a day. Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population. Safer drugs are available that have similar painkilling effects so there is no reason to use diclofenac.” He suggested no more than 1,200 mg of ibuprofen per day.
This is not the first study that has demonstrated Naproxen to have lower cardiovascular risk. In fact the FDA was asked to remove the warning from its label, yet its panel voted to keep the NSAID related cardiovascular risk warning, with committee member, Donald Miller, chair of the pharmacy practice department at North Dakota State University in Fargo, saying “there is certainly a lot of evidence that naproxen is safer than other [NSAIDs] in terms of causing heart attack and stroke, but being safer doesn’t mean it is perfectly safe. I think that is the big issue.”
NSAID use has risen exponentially as more people are living longer and feeling the effects of aging in their joints and back. Moreover, narcotics are becoming less accessible and providers are offering these non-addictive substitutes instead; however, because these are non-narcotic, and many are available over the counter, those who self-medicate may inadvertently take too much since “it wouldn’t be over the counter if it wasn’t safe."
One theory is the medication may cause suppression of prostacyclin, a cardioprotective lipid (prostaglandin), that inhibits platelet activation and vasoldilation (relaxation of the blood vessels). NSAIDS have also been known to raise blood pressure, possibly by this inhibition of vasodialation. This type of stress on a heart, especially if its vulnerable to abnormal heart rhythms or heart disease, can cause cardiac arrest.
But we don’t want to be fearful that taking anti-inflammatories will stop our hearts. Being proactive with our heart health is paramount, and this study reminds us to use caution with over the counter medications.
Firstly, we must know our risk factors. These include:
As you can see, many of us can be at risk for heart disease. Therefore, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.
Reduce your risk by doing the following:
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