07/04/2026
What to Know
Clinicians in Hawaiʻi should have a high index of suspicion for neuroangiostrongyliasis as rat lungworm disease is endemic in all of the islands in the State of Hawaiʻi. Early diagnosis and treatment are important to reduce the long-term sequelae associated with this disease.
*NEW Updated (07/15/2025) testing guidance for clinicians is available here. A more sensitive RT-PCR assay to diagnose neuroangiostrongyliasis is now available at the Hawaii SLD. The assay can be performed on CSF; there is no minimum CSF eosinophil threshold requirement to order this test.
Suspect cases should be reported to the Department of Health (DOH) Disease Reporting Line to facilitate prompt and accurate diagnosis.
Rat lungworm disease can be prevented by eliminating snails, slugs, and rats founds near houses and gardens, avoiding eating raw or undercooked snails or slugs, and thoroughly inspecting and rinsing produce using potable water.
The incubation period can range from a few days to more than 6 weeks, with the median time from exposure to symptoms being 1-3 weeks.
Individuals with symptoms should consult their healthcare provider for more information IMMEDIATELY!!!!!!!
Neuroangiostrongyliasis, also known as rat lungworm, is a disease that affects the brain and spinal cord. It is caused by a parasitic nematode (roundworm parasite) called Angiostrongylus cantonensis. The adult form of A. cantonensis is only found in rodents. However, infected rodents can pass larvae...
