Maui News

New Treatment Guidelines for Rat Lungworm

August 30, 2018, 8:31 AM HST
* Updated August 30, 8:40 AM
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PC: (left) Juvenile Parmarion martensi on a nickel (credit: HDOH); (right) Veronicella cubensis (Credit: Rob Cowie, UH Mānoa)

New preliminary guidelines for the clinical management of rat lungworm disease were announced today by the Governor’s Joint Task Force.

The new guidelines may be used by Hawai‘i physicians immediately and provide clear diagnosis, treatment, and management guidance for timely identification and care for patients who have contracted the disease, known more formally as angiostrongyliasis.

“One of the top priorities of the Joint Task Force has been to develop sound, evidence-based guidelines for physicians to use in diagnosing and treating angiostrongyliasis,” said Kenton Kramer, Ph.D., chair of the Joint Task Force and associate professor of the Department of Tropical Medicine, Medical Microbiology and Pharmacology with the University of Hawai‘i John A. Burns School of Medicine.

“The Clinical Subcommittee, made up of expert physicians and specialists from across the state, spent the last year researching and consulting with national and international specialists on the disease to carefully craft the new guidelines,” said Dr. Kramer.

Vernon Ansdell, M.D., an associate professor at UH-JABSOM and physician with more than 45 years of experience specializing in internal and tropical medicine, spearheaded the effort and chaired the Clinical Subcommittee.


“Prior to the extensive work completed by the subcommittee, there were no clear, reliable diagnosis and treatment protocols available to Hawai‘i physicians for this potentially serious and debilitating disease,” said Dr. Ansdell.


According to Dr. Ansdell, “Diagnosing angiostrongyliasis can be problematic because patients infected with the parasite do not always present the same symptoms. These preliminary guidelines provide critical guidance to physicians to help them make timely and accurate diagnoses and give their patients the best possible treatment available. Our next step is to offer physician training in all counties to increase awareness and understanding of this complex disease.”

Members of the Clinical Subcommittee will be offering  Continuing Medical Education courses through UH-JABSOM in all counties, starting in Hilo on Hawai‘i Island on Oct. 10, 2018.

CME courses will also be offered on Maui, Kaua‘i, and in Honolulu in early 2019 with the schedule and more details to be announced later this year.


“Updating and improving the guidelines for physicians to better diagnose and treat rat lungworm disease is a major accomplishment for the Joint Task Force,” said Health Director Dr. Bruce Anderson. “We are excited to be a partner in this process and look forward to supporting this project as the guidelines move toward publication and national recognition.”

The preliminary guidelines will be presented to a national audience during the Annual Meeting of the American Society of Tropical Medicine and Hygiene in November. Clinical Subcommittee members will also be working to undergo the rigorous academic process to expand the preliminary guidelines and submit for scientific peer review and official publication.

The Joint Task Force was established in May 2016 and consists of members from the medical, scientific, environmental, and public health communities.

The preliminary guidelines are posted on the Hawai‘i Department of Health website. It is also posted on the UH-JABSOM website.

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