Angiostrongylus cantonensis (rat lungworm) in Florida, USA: current status

Stressed snails release Angiostrongylus cantonensis (rat lungworm) larvae in their slime

This study investigated the influence of stress on release of Angiostrongylus cantonensis larvae from a snail host, Parmarion martensi. We subjected 140 infected, wild-caught P. martensi to three stress-inducing treatments (heat, molluscicide, physical disturbance) and an unstressed control treatment for 24 h, after which larval presence and abundance in the slime were quantified by qPCR targeting the ITS1 region of the parasite's DNA, and compared among treatments. The significance of stress and host infection load on larval release was determined by generalized linear mixed models and permutation tests. The results indicated that stress significantly increased the probability of larval presence in slime and the number of larvae released, and highly infected snails were also more likely to release larvae. Among stressed snails, 13.3% released larvae into slime, the number of larvae present in the slime ranging from 45.5 to 4216. Unstressed controls released no larvae. This study offers a partial explanation for conflicting results from prior studies regarding A. cantonensis presence in snail slime and sheds light on the broader One Health implications. Stress-induced larval release highlights the potential role of slime as a medium for pathogen transmission to accidental, paratenic, definitive and other intermediate hosts. These findings emphasize the importance of considering stress-mediated interactions in host-parasite systems and their implications for zoonotic disease emergence. As stressors continue to escalate because of anthropogenic activities and climate change, understanding the role of stress in pathogen shedding and transmission becomes increasingly important for safeguarding human and wildlife health within the One Health framework.

Angiostrongylus cantonensis Infection in Brown Rats (Rattus norvegicus), Atlanta, Georgia, USA, 2019-2022

Rat lungworm (Angiostrongylus cantonensis), a zoonotic parasite invasive to the United States, causes eosinophilic meningoencephalitis. A. cantonensis harbors in rat reservoir hosts and is transmitted through gastropods and other paratenic hosts. We discuss the public health relevance of autochthonous A. cantonensis cases in brown rats (Rattus norvegicus) in Atlanta, Georgia, USA.

Rat lungworm survives winter: experimental overwintering of Angiostrongylus cantonensis larvae in European slugs

The rat lungworm Angiostrongylus cantonensis is a metastrongyloid nematode that causes neurological disorders in its accidental hosts, including humans. This invasive pathogen is native to Southeast Asia and adjacent regions and is gradually expanding its distribution to tropical and subtropical areas with new foci discovered near temperate regions. The parasite has a complex life cycle with a range of gastropods serving as intermediate hosts. A broad spectrum of poikilotherm vertebrates and invertebrates can serve as paratenic hosts. Since it has already been demonstrated that other, non-zoonotic metastrongyloids can survive in their intermediate hosts during the winter, the aim of our study was to evaluate the survival of A. cantonensis third-stage larvae in experimentally infected slugs (Limax maximus) kept at 4.5–7°C for 60 days. Third-stage larvae of A. cantonensis survived the period of low temperature and remained capable of infecting definitive hosts (laboratory rats) afterwards, even though their numbers dropped significantly. These results suggest that further spread to higher latitudes or altitudes is possible in areas with sufficient abundance of definitive hosts, since low winter temperatures are not necessarily an obstacle to the spread of the parasite.

Comparative biology of parasitic nematodes in the genus Angiostrongylus and related genera

The rise to prominence of some Angiostrongylus species through associated emerging disease in humans and dogs has stimulated calls for a renewed focus on the biology of this genus and three related genera. Although significant research efforts have been made in recent years these have tended to focus on individual species and specific aspects such as diagnosis and treatment of disease or new records of occurrence and hosts. This comprehensive review takes a comparative approach, seeking commonalities and differences among species and asking such questions as: Which species belong to this and to closely related genera and how are they related? Why do only some species appear to be spreading geographically and what factors might underlie range expansion? Which animal species are involved in the life cycles as definitive, intermediate, paratenic and accidental hosts? How do parasite larvae find, infect and develop within these hosts? What are the consequences of infection for host health? How will climate change affect future spread and global health? Appreciating how species resemble and differ from each other shines a spotlight on knowledge gaps and provides provisional guidance on key species characteristics warranting detailed study. Similarities exist among species, including the basic life cycle and transmission processes, but important details such as host range, climatic requirements, migration patterns within hosts and disease mechanisms differ, with much more information available for A. cantonensis and A. vasorum than for other species. Nonetheless, comparison across Angiostrongylus reveals some common patterns. Historically narrow definitive host ranges are expanding with new knowledge, combining with very broad ranges of intermediate gastropod hosts and vertebrate and invertebrate paratenic and accidental hosts to provide the backdrop to complex interactions among climate, ecology and transmission that remain only partly understood, even for the species of dominant concern. Key outstanding questions concern larval dynamics and the potential for transmission outside trophic relations, relations between infection and disease severity in different hosts, and how global change is altering transmission beyond immediate impacts on development rate in gastropods. The concept of encounter and compatibility filters could help to explain differences in the relative importance of different gastropod species as intermediate hosts and determine the importance of host community composition and related environmental factors to transmission and range. Across the group, it remains unclear what, physiologically, immunologically or taxonomically, delimits definitive, accidental and paratenic hosts. Impacts of infection on definitive host fitness and consequences for population dynamics and transmission remain mostly unexplored across the genus. Continual updating and cross-referencing across species of Angiostrongylus and related genera is important to synthesise rapid advances in understanding of key traits and behaviours, especially in important Angiostrongylus species that are emerging causative agents of disease in humans and other animals.

Neuroangiostrongyliasis: Global Spread of an Emerging Tropical Disease

Neuroangiostrongyliasis (NAS) is an emerging parasitic disease caused by the neurotropic nematode Angiostrongylus cantonensis. Since it was first discovered, in rats in southern China in the 1930s, this tropical to subtropical parasite has spread to much of Southeast Asia, the Pacific Islands (including Hawaii), Australia, Japan, South America, the southeastern United States, the Caribbean, Africa, the Canary Islands, and the Balearic Islands. The parasite completes its natural life cycle in snails and slugs (intermediate hosts), and rats (definitive hosts). Humans become accidental hosts after ingesting infective third-stage larvae contained within uncooked or undercooked intermediate or paratenic hosts, an event that sometimes results in NAS, also known as rat lungworm disease. Although A. cantonensis larvae cannot complete their life cycle in humans, their migration into the brain and spinal cord combined with a powerful inflammatory reaction often leads to eosinophilic meningitis and can, in rare instances, lead to coma, paralysis, and death or, in other cases, chronic, disabling neurologic sequelae. Symptoms of NAS are diverse, which often makes it difficult to diagnose. Treatment may include administration of analgesics, corticosteroids, anthelminthics, and repeat lumbar punctures to reduce intracranial pressure. Unfortunately, few medical providers, even in endemic areas, are familiar with A. cantonensis or its epidemiology, diagnosis, and treatment. As the parasite continues to spread and NAS affects more people, medical practitioners, as well as the general public, must become more aware of this emerging zoonosis and the potentially devastating harm it can cause.

Paratenic hosts of Angiostrongylus cantonensis and their relation to human neuroangiostrongyliasis globally

The nematode parasite Angiostrongylus cantonensis (rat lungworm) has a complex life cycle involving rats (definitive hosts) and gastropods (intermediate hosts), as well as various paratenic hosts. Humans become infected and develop rat lungworm disease (neuroangiostrongyliasis) when they consume intermediate or paratenic hosts containing the infective parasite larvae. This study synthesizes knowledge of paratenic hosts of A. cantonensis and investigates their role in causing human neuroangiostrongyliasis worldwide. A literature review was conducted by searching PubMed, JSTOR and Scopus, pooling additional information from sources accumulated over many years by RHC, and snowball searching. The review identified 138 relevant articles published between 1962 and 2022. Freshwater prawns/shrimp, crayfish, crabs, flatworms, fish, sea snakes, frogs, toads, newts, lizards, centipedes, cattle, pigs and snails were reported to act as paratenic hosts in various regions including South and Southeast Asia, Pacific islands, the USA and the Caribbean, as well as experimentally. Human cases of neuroangiostrongyliasis have been reported from the 1960s onwards, linked, sometimes speculatively, to consumption of freshwater prawns/shrimp, crabs, flatworms, fish, frogs, toads, lizards and centipedes. The potential of paratenic hosts to cause neuroangiostrongyliasis depends on whether they are eaten, how frequently they are consumed, the preparation method, including whether eaten raw or undercooked, and whether they are consumed intentionally or accidentally. It also depends on infection prevalence in the host populations and probably on how high the parasite load is in the consumed hosts. To prevent human infections, it is crucial to interrupt the transmission of rat lungworm to humans, from both intermediate hosts and frequently consumed paratenic hosts, by adhering to safe food preparation protocols. Educating the general public and the medical community about this largely neglected tropical/subtropical disease is key.

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Neuroangiostrongyliasis, an emerging parasitic disease of humans and wildlife.

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Caused by the nematode Angiostrongylus cantonensis (rat lungworm).

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Infection primarily via ingestion of stage 3 larvae of the parasite.

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People eat raw intermediate or paratenic hosts infected with stage 3 larvae.

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Comprehensive review of paratenic hosts’ role in neuroangiostrongyliasis globally.

Angiostrongylus cantonensis in a Red Ruffed Lemur at a Zoo, Louisiana, USA

A red ruffed lemur (Varecia rubra) from a zoo in Louisiana, USA, was euthanized for worsening paresis. Brain and spinal cord histology identified eosinophilic meningoencephalomyelitis with intralesional adult Angiostrongylus sp. nematodes. PCR and sequencing confirmed A. cantonensis infection, indicating this parasite constitutes an emerging zoonosis in the southeastern United States.

Rat Lungworm (Angiostrongylus cantonensis) in the Invasive Cuban Treefrog (Osteopilus septentrionalis) in Central Florida, USA

Cuban treefrogs, Osteopilus septentrionalis, were grossly examined for parasites and parasite species confirmed by PCR. Angiostrongylus cantonensis larvae were recovered from the hind leg muscle of O. septentrionalis. This is the first report of the zoonotic rat lungworm in the Cuban treefrog and new geographic location (Volusia County) in Florida, US.

Angiostrongylosis in Animals and Humans in Europe

Lungworms in the genus Angiostrongylus cause disease in animals and humans. The spread of Angiostrongylus vasorum within Europe and the recent establishment of Angiostrongylus cantonensis increase the relevance of these species to veterinary and medical practitioners, and to researchers in parasitology, epidemiology, veterinary science and ecology. This review introduces the key members of the genus present in Europe and their impacts on health, and updates the current epidemiological situation. Expansion of A. vasorum from localized pockets to wide distribution across the continent has been confirmed by a rising prevalence in foxes and increasing reports of infection and disease in dogs, while the list of carnivore and mustelid definitive hosts continues to grow. The tropically distributed rat lungworm A. cantonensis, meanwhile, has been recorded on islands south of Europe, previously the Canary Islands, and now also the Balearic Islands, although so far with limited evidence of zoonotic disease. Other members of the genus, namely, A. chabaudi, A. daskalovi and A. dujardini, are native to Europe and mainly infect wildlife, with unknown consequences for populations, although spill-over can occur into domestic animals and those in zoological collections. The epidemiology of angiostrongylosis is complex, and further research is needed on parasite maintenance in sylvatic hosts, and on the roles of ecology, behaviour and genetics in disease emergence. Improved surveillance in animals and humans is also required to support risk assessments and management.