Management of Rat Lungworm Disease (Neuroangiostrongyliasis) Using Anthelmintics: Recent Updates and Recommendations

Abstract

While there have been legitimate concerns in the past regarding the use of anthelmintics for the management of neuroangiostrongyliasis (rat lungworm disease), recent studies demonstrate that they can be considered safe and efficacious, particularly albendazole, which is regarded as the choice anthelmintic for its management. However, physician hesitancy to prescribe, as well as problems of availability persist, at least in Hawaii, which is considered the epicenter of this disease in the US. As a result, many patients suffer a diminished quality of life or even death. Here, we discuss recent studies that provide insights into new treatments and preventative interventions, which can be more rigorously used for the management of neuroangiostrongyliasis. In summary, results from recent studies suggest that albendazole and avermectins are beneficial for post-exposure management, pyrantel pamoate is beneficial as a post-exposure prophylactic, and levamisole is deserving of further study for the treatment of neuroangiostrongyliasis.

Neuroangiostrongyliasis: Updated Provisional Guidelines for Diagnosis and Case Definitions

“…Headache is the most common clinical manifestation and can occur in the absence of other neurological signs or symptoms. Neck stiffness and fever are also present in 15% and 40% of cases, respectively, and occur more often in children [26,30]. Among less common manifestations, dysesthesias (paresthesias and hyperesthesias) and migratory myalgia may be valuable to indicate neuroangiostrongyliasis, which are to be properly investigated in prospective clinical studies [3,6].…”

“…CSF eosinophilia is another main indicator for NA and occurs in approximately 50% of patients [26]. To date, the definition of "CSF eosinophilia" remains controversial.…”

“…To date, the definition of "CSF eosinophilia" remains controversial. Some authors consider any number of eosinophils as abnormal, while other authors have selected 10% or an absolute number of 10 eosinophils as a threshold [18,26]. The degree of eosinophilia present may be a stronger indicator for NA, and patients with ≥40% are more likely to have NA [34].…”

“…Ocular examination, including anterior and posterior chambers, may also disclose larvae or even adult worms since If serology is positive 1 and CSF eosinophilia 2 is higher than 40%, consider NA as highly probable/suspected. 3 For details and treatment alternatives, see Sawanyawisuth, K. and Sawanyawisuth [14] and Jacob et al [26]. 4 Antigen detection in CSF (no test currently available) may be an additional criterion for confirmed diagnosis in the future (see Sears et al, for novel highly sensitive PCR [10]).…”