What is the cause of death from eating slugs?

Death from Eating Slugs: Angiostrongylus cantonensis Infection

Eating slugs can cause death primarily through infection with Angiostrongylus cantonensis (rat lungworm), which leads to eosinophilic meningitis and potentially fatal neurological complications.

Pathophysiology of Rat Lungworm Infection

Angiostrongylus cantonensis is a parasitic nematode that causes angiostrongyliasis, with slugs and snails serving as intermediate hosts in its life cycle:

1. Transmission mechanism:

   • Slugs and snails (gastropods) are obligate intermediate hosts for A. cantonensis 1
   • Humans become infected by:
     • Accidental or deliberate consumption of raw/undercooked slugs or snails
     • Consuming produce contaminated with slug/snail slime containing larvae
     • Handling slugs/snails and transferring mucus from hands to mouth 2

2. Parasite migration:

   • After ingestion, larvae migrate from the gastrointestinal tract to the central nervous system
   • Larvae travel to the brain, spinal cord, and nerve roots 3
   • Humans are "dead-end" hosts as the parasite cannot complete its life cycle in humans

Clinical Manifestations and Disease Progression

The severity of infection depends on the number of larvae ingested, their location in the host, and the host's inflammatory response 2:

1. Early symptoms:

   • Severe headache
   • Vomiting
   • Paresthesias (abnormal sensations)
   • Weakness
   • Visual disturbances
   • Extraocular muscle paralysis 3

2. Diagnostic findings:

   • CSF pleocytosis (increased white blood cells in cerebrospinal fluid)
   • Eosinophilia in both CSF and peripheral blood 4
   • These findings are consistent with eosinophilic meningitis

3. Disease progression:

   • Most patients recover fully with supportive care
   • Heavy infections can lead to:
     • Eosinophilic meningitis
     • Focal neurologic deficits
     • Coma
     • Death 4

High-Risk Carriers and Geographic Distribution

1. Notable carriers:

   • The semi-slug Parmarion martensi is considered a high-risk carrier due to:
     • Climbing behavior
     • Abundance around human dwellings
     • High worm burdens (one specimen contained >6,800 infective larvae) 1

2. Geographic spread:

   • Originally from Southeast Asia
   • Has spread to South Pacific, Africa, India, Caribbean, Australia, and North America
   • Recently found in Continental Europe (Valencia, Spain) 5
   • In the United States, cases have been reported in Hawaii and several continental states 4

Prevention and Risk Reduction

To reduce risk of infection:

1. Food safety:

   • Thoroughly cook all intermediate hosts (snails/slugs) and paratenic hosts (freshwater shrimp, crabs, frogs)
   • Carefully wash all produce to remove any slugs, snails, or their slime
   • Practice proper food preparation techniques

2. Environmental control:

   • Implement slug and snail control measures around homes and gardens
   • Remove objects that serve as hiding places for gastropods
   • Consider iron-containing baits that are relatively safe for non-target organisms 1

3. Public education:

   • Raise awareness about the risks of consuming raw or undercooked gastropods
   • Educate on proper food preparation techniques

Treatment Approaches

There is no proven definitive treatment for angiostrongyliasis:

1. Supportive care:

   • Management of symptoms
   • Close monitoring for neurological complications

2. Corticosteroids:

   • May be helpful in severe cases
   • Can relieve intracranial pressure
   • May reduce neurologic symptoms due to inflammatory responses to migrating worms 3

Healthcare providers should consider angiostrongyliasis in patients presenting with eosinophilic meningitis, especially those with a history of gastropod ingestion or consumption of potentially contaminated raw vegetables, particularly in endemic areas or in travelers returning from these regions.