rat lungworm disease

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Graham McCumber

Graham McCumber

Graham McCumber, a 23-year-old man living on the island of Hawai‘i developed a life threatening case of eosinophilic meningitis caused by infection with Angiostrongylus cantonensis (rat lungworm disease: RLWD). He was comatose for 3 months, incurring brain and nerve damage sufficiently extensive that he was not expected to recover. The case was complicated by secondary infections of methicillin-resistant Staphylococcus aureus, Clostridium difficile, and pneumonia, which resulted in an empyema requiring a thoracoscopy and decortication.

Graham was treated with prednisone, mebendozal, and pain medication for RLWD, and antibiotics and antifungal medications for the secondary infections. The administration of herbal supplements was requested by the family and approved, and these were administered through a gastric tube. Less than a month after being declared in a persistent vegetative state Graham was able to talk, eat, and had regained some muscle functions. After release from the hospital he continued the use of supplements and received treatments of intravenous vitamin therapy. Four years after onset of the illness he was able to ride a bicycle, is a part time student, plays guitar, and is fluent in two foreign languages.

Graham McCumber was hospitalized at the Hilo Medical Center on December 26, 2008. Before becoming ill he was healthy and active. Just prior to hospitalization he suffered from severe headache, stomach pain, and muscle and joint pain. He was taken to the emergency room twice, treated with morphine for pain, and released. He was admitted on his third visit when he was unable to urinate. Shortly after his admission he developed skin sensitivity such that even a light touch caused great distress. He was eventually diagnosed with eosinophilic meningitis resulting from parasitic infection by Angiostrongylus cantonensis, probably caused by accidental ingestion of an infected slug host. He was prescribed prednisone to suppress the immune system, as well as morphine and oxycodene for pain. On January 2nd, treatment with the anthelmintic mebendozal was begun (10 mg/kg for 14 days).

Graham began to show improvement. However 16 days after hospital admission on January 11th he began to experience double vision, increasing exhaustion, and stabbing head pain. The following day his manual dexterity decreased significantly and within 24 hours he was comatose. An MRI showed inflammation involving white fiber tracts and bilateral basal ganglia, as well as questionable hemorrhagic products scattered throughout white matter tracts of both hemispheres and within the cerebellum. He was intubated, ventilated, and flown to the Queen's Medical Center, Honolulu, for additional diagnosis.

Magnetic Resonance Imaging (MRI) of the brain showed what looked to be worm tracks in his brain. Medical records show his condition reported as "grave with a dismal prognosis and no hope of much recovery." Evaluation at the Queen's Medical Center showed a left side empyema, hydrocephalus, post encephalitis brain atrophy, and history of eosinophilic meningitis complicated with severe demyelinating encephalitis, and cachexia.

Two days later he opened his eyes and was occasionally able to respond to a request to squeeze the hand of a family member or nurse. Eleven days after Graham became comatose a tracheotomy was performed and a gastric tube was inserted. The family then requested the administration of supplements and Chinese herbs.

A physician suggested using a Chinese medication (Xing Nao Wan) that had been used in a similar case of A. cantontensis infection of a 23-year-old man in China, which had resulted in coma; however, after four months of treatment that patient recovered and was discharged from the hospital with mild memory loss.

Other supplements requested by the family were used as well; these were the blue-green algae spirulina (Arthrospira platensis) and chlorella (Chlorella vulgaris), as well as noni (Morinda citrifolia).

On January 27th, after the tracheal and gastrointestinal tubes were in place, Graham was flown back to the Hilo Medical Center. He was taken off the ventilator, as his breathing was not grossly impaired. However, the tracheal tube remained in place to ensure a clear airway. He remained in ICU for 4 days and was then moved to a nursing unit.

On January 31st, the supplements used in Honolulu were approved for use at the Hilo Medical Center. These supplements were administered three times a day through the gastrointestinal tube. Curcumin (Curcuma longa) was added to the regime as well as acupuncture treatments. Over a 3-month period, family members assisted with administration of supplements and Chinese medicine, and with medical necessities such as suction of the lungs, tracheal care, and gastrointestinal tube feeding. Graham also underwent daily massage and a range of motion exercises.

Shortly after Graham had became comatose on January 12th he developed complications including pneumonia, methicillin-resistant Staphylococcus aureus (MRSA), and Clostridium difficile infections. Antibiotics and anti-fungal medications were prescribed for these. The patient was inert as of the time he entered a coma and therefore was manually turned every 2 hours.

In early February, his left eye began to drift inward, a result of nerve damage caused by the parasite. In mid February his blood pressure and heart rate began to rise and he was put on blood pressure medication. Soon after it was determined he had an enlarged heart. A brain MRI taken on February 19th reconfirmed the Queen's Medical Center evaluation. A lumbar puncture performed on February 23rd had an opening pressure of 25 cm H20, WBC 203, 21% neutrophils, 40% lymphocytes, 33% monocytes, protein 102, and leukocytes 32.

A shunt to relieve fluid in the brain was discussed, but ongoing infections precluded the operation. Graham ran a persistent fever and was put on antibiotics. His fever did not respond to treatment, and a CAT scan revealed a pleural effusion. A percutaneous thoracentesis was performed on March 3rd but was unsuccessful. He was flown to the Queen's Medical Center, Honolulu, for a video assisted thoracoscopy including decortication for persistent empyema, and chest tubes were inserted on March 9th. An MRI taken at Queen's determined he had communicating hydrocephalus and he was declared to be in a persistent vegetative state. He was returned to Hilo Medical Center 5 days later.

From the end of January and into February, although clinically comatose, Graham showed some signs of cognizance, responding appropriately to some conversation by what was interpreted by nurses, nurse aides, and family members as laughter or sadness (crying). In mid February the hospital speech therapist began working with Graham on swallowing reflexes, with the desired goal of removing the tracheal tube. By the end of February Graham was able to chew and swallow ice chips, nod yes and no, laugh, and grip hands.

Progress continued into March. On March 3 the tracheal cuff was deflated for a short period of time, allowing Graham to breathe through normal airways. At this time he was beginning to move his hands. Progress was impeded by the need for a lung operation and insertion of chest tubes. Chest tubes were removed on March 22nd, and on March 23rd the tracheal cuff was deflated for the entire day and Graham was able to eat yogurt. Physical therapy was also begun on the same day. On March 27th the tracheal tube was changed to a fenestrated tracheal tube, and on March 29th Graham's status was upgraded and he was discharged to the long-term care ward at the Hilo Medical Center.

On March 30th a Passy-Muir Valve was provided to allow for speech therapy, and on the same day a standing table was used by physical therapists to help Graham stand for the first time. By this time he was regaining use of his forearms. On April 1st Graham spoke for the first time and was able to converse in short sentences. The pain in his legs that was present near the beginning of his illness had generally subsided, replaced by a feeling of cold and numbness on his left leg and arm and areas of his face, and he had lost use of two fingers on his left hand.

His short-term memory was greatly impaired but his long-term memory was intact. His gaze was disconjugate with some nytagmus present, and he had severe ataxia, some hallucinations, and insomnia. Over the course of the month his swallowing reflexes improved, and he was able to eat and drink. By the end of April, while still extremely weak, he was able to walk a short distance (6–8 m) with a walker and two assistants. He was released from the Hilo Medical Center on April 30th, 2009.

There are many claims for supplements that have not yet been validated scientifically. However, plant-based medicines have been used by various cultures for hundreds, if not thousands, of years. In this case, doctors had no hope for recovery, therefore various supplemental treatments were administered through the stomach tube on a daily basis as it was agreed that they may provide some benefits and would probably not cause harm.

Four months after release from hospital, Graham began vitamin therapy. The treatment and doses were prescribed by a licensed doctor and administered by a registered nurse. The therapy consisted of two intravenous nutrient infusions administered at alternating sessions as a drip. One was a phosphatidylcholine/glutathione mixture; the other consisted of high doses of vitamin C plus B vitamins and trace minerals, sometimes referred to as a Myers Cocktail after its creator, Dr. John Myers, of Johns Hopkins University.

The intravenous treatments were administered 3 times per week for 4 months. Within 14 days of beginning treatments Graham's left eye began to straighten and he remarked on improved vision and mental clarity. Additionally, both of his physical therapists commented that the ataxia and his ability to tell left from right had improved. Within 3 weeks of beginning the intravenous injections his sleeping and bowel and bladder symptoms showed signs of improvement, he was able to begin walking without two canes for support, and he was able to walk longer distances (∼100 m) without having to rest.

After discharge from hospital Graham still suffered from the severe and debilitating effects of the disease. His recovery, while painful and slow, has been steady. Four years after the onset of the disease he continues to take supplements. Those he consistently takes are fish oil, curcumin, vitamins B-1 and B-12, acetyl l-carnitine and 5HTP.

His use of prescription medications ceased within 6 months of being released from the hospital. He still experiences problems with balance and vision, and he still suffers from bouts of insomnia. Lack of energy and vigor were extreme issues for 3 years. However in the fourth year after the onset of the illness he has shown marked improvement.

He is currently enrolled as a part-time student at a local community college. His vision is somewhat corrected with glasses, which allow him to read and write. His balance has improved with physical therapy and an exercise regime that focuses on core strength. He is able to ride a bicycle to and from classes and for other purposes. He plays guitar and is fluent in two foreign languages. In light of the dim prognosis given at onset of the disease, the recovery is considerable, indeed, quite remarkable.

The protocol at Hilo Medical Center has now improved for victims presenting with symptoms of RLWD. Cases of RLWD on Hawai‘i island have resulted in permanent disability, making this serious disease worthy of further research to develop effective treatment, particularly for the long-term neurological effects.

Rat Lung Worm Disease - Monsters Inside Me

This information is not meant to be used for self-diagnosis or as a substitute for consultation with a health care provider. If you have any questions about the parasites described above or think that you may have a parasitic infection, consult a health care provider.

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