A Hilo woman will have to wait about two weeks to find out if she’s contracted rat lungworm disease after nearly ingesting a half-inch slug on New Year’s Eve.

The health food store Island Naturals maintained its green placard, indicating the highest rating from the Department of Health, after Chaunda Malia Rodrigues discovered the slug in an avocado sandwich she bought from the deli.

The day of the incident, Rodrigues bought two avocado sandwiches from the Island Naturals Hilo location and took them home for herself and her husband. The first half of the sandwich she ate with no issue. She even shared a bit of avocado with her baby.

“I bit into the second half and something was stuck in my jaw,” Rodrigues said.

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She was mortified when she pulled half of a slug from her mouth. The second half was still in her sandwich.

“I threw up, flossed, rinsed out my mouth multiple times,” Rodrigues explained.

Her immediate concern was the possibility that she, her husband and her baby might have contracted rat lungworm disease.

After a call to Hilo Medical Center that same day, she learned that preventative measures against the disease were essentially non-existent. Doctors informed Rodrigues there was no way they would be able to determine if she had rat lungworm within the first few hours after contact with a potential source.

“Rat lungworm is serious,” she said. “They (doctors) don’t see it that way until I have symptoms or neurological damage.”

Rodrigues eventually decided to go to the emergency room anyway. She, her husband and her child were prescribed a deworming medication called albendazole.

“My hope is it becomes common practice to just deworm yourself,” she said. “These are microscopic creatures that can affect you for the rest of your life.”

At this point, all she can do is continue to take the deworming pills and wait.

Rodrigues took to social media the day of the incident to tell her story and remind people to be cautious of local produce. Anything that is grown on the islands must be thoroughly washed, just in case.

“Even if you expect establishments to clean their produce, especially the ones they put in sandwiches, it may not happen,” she added.

Rodrigues took the 2 1/2-inch slug to Dr. Susan Jarvi, professor at University of Hawai‘i at Hilo and head of the Hawai‘i Island Rat Lungworm Working Group.

Late Friday night, Jarvi confirmed to Rodrigues the slug she pulled from her mouth was carrying the parasitic DNA and that she had been exposed to rat lungworm.

Island Naturals

Rodrigues called Island Naturals about the slug immediately. The on-duty manager apologized and informed her that the head manager would get back to her. The manager also advised that Rodrigues call the hospital.

Rodrigues then made a complaint to the Department of Health. The full complaint can be read here. Inspectors went to the store and found two minor, unrelated violations that were quickly rectified.

Russell Ruderman, owner of the health food store and a state Senator for the Puna district, first learned about the incident on Jan. 1 when he was notified of Rodrigues’ Facebook post. He spoke to her the next morning.

BEWARE of all produce and local products with produce in it. Today I bought 2 of our favorite sandwiches from Island… Posted by Chaunda Malia Rodrigues on Tuesday, December 31, 2019

“I do want to say that I deeply regret this and it’s a terrible mistake,” Ruderman said.

Ruderman explained it was a “perfect storm of failures” on the part of Island Naturals, as their normal local supplier of lettuce was unable to provide product, as was their mainland supplier.

“An employee took it upon themselves to use this lettuce that we never use for this purpose and failed to wash it properly,” Ruderman said. “I don’t consider this an excuse, but an explanation of what happened.”

Ruderman said the store is no longer using local leaf lettuce for food products prepared in house — they will only use produce from their mainland supplier. Local produce will continue to be sold in the store, however, Ruderman said they’re going to carefully control the suppliers they use.

Island Naturals also reviewed their cleaning policies. Ruderman said staff is already instructed to wash each leaf separately.

“We wash everything, whether or not the farmer says they’ve washed it,” Ruderman said. “We’re ground zero for rat lungworm.”

Ruderman has been passionate about getting funding research for the disease and providing education to the public. He’s pushed for five to six years on the issue and two years ago secured consistent funding for the research lab run by Jarvi at UH-Hilo in the Daniel K. Inouye College of Pharmacy.

“This is a little bit ironic since I’ve been a leader politically and through Island Naturals on this issue,” Ruderman said of the incident.

The senator hopes to continue the conversation in the community and government on how to make local produce safe.

“I do believe local produce is safe if treated properly,” he said.

Rat Lungworm Disease

The DOH recorded eight cases of the disease last year, all occurring on the Big Island. Rat lungworm affects the brain and spinal cord. The infection can cause a rare case of meningitis. Other symptoms include stiffness of the neck, tingling or painful feelings in the skin or extremities, low-grade fever, nausea and vomiting. Sometimes, a temporary paralysis of the face may also be present, as well as light sensitivity.

Albendazole is one of the primary treatments once a person has been diagnosed with rat lungworm, however, there is no evidence that the drug is useful prior to being symptomatic.

Dr. Kenton Kramer, associate professor in the Department of Tropical Medicine at John A. Burns School of Medicine at UH-Mānoa, said physicians are somewhat reluctant to prescribe albendazole because there isn’t evidence that it works, although it doesn’t hurt to take it.

The worm ends up in the human brain for at least three weeks, which can cause inflammation creating headaches. If treated quickly and properly, Kramer said, there shouldn’t be any lasting effects.

Jarvi has been doing research on rat lungworm since 2011-12, noting there has been an increase of cases on an annual basis. Jarvi is currently trying to develop a method for identifying rat lungworm through blood.

“A definitive test (for rat lungworm) is obtaining cerebral spinal fluid,” Jarvi said.

She hopes to create a testing method that is less invasive. Currently working with veterinarians, Jarvi has been provided blood samples of dogs suspected to be infected with the disease. Her testing has identified the parasite in 30-40% of the animals.

While still at the research stage, human blood is also being tested. Preliminary data has been published and a second study is finishing. A third trial is underway that will hopefully fill in some of the information doctors need to continue developing an accurate test.

“We are accepting human samples but these are targeted at certain individuals in certain situations, and people need to be formally enrolled in the study after meeting criteria thresholds, and they must sign IRB-approved consent forms at the Jarvi lab to be included in the trial,” said Kirsten Snook who works with Jarvi at UH-Hilo.

This unfortunate incident with Rodrigues occurred days before the 6th International Workshop on Angiostrongylus and Angiostrongyliasis. Experts from eight different countries will be in Hilo to discuss rat lungworm starting Monday.

“The more people who know about rat lungworm, the better,” Jarvi said.