Daniel and Kelly’s Extraordinary Universe - Rat lungworm (featuring Dr. Chelsea Wood)

Episode Date: July 21, 2026

Daniel and Kelly chat with Dr. Chelsea Wood about rat lungworm - a particularly unpleasant nematode parasite that is spreading way outside of its native range.See omnystudio.com/listener for privacy information.

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Listen to everyone watches women's sports on the IHeart Radio app, Apple Podcast, or wherever you get your podcast. Howdy, Extraordinaries? Today, we are talking about a somewhat unpleasant parasite. And it's not just because I have a morbid fascination with parasites. We had a couple listener requests to talk about rat lungworm in particular. And this is a parasite that is spreading in its range. And it's an important human health concern. And I think more of us should be aware of it. So that's why we're talking about it today. Thanks. Trade and travel are transporting organisms all over the world. Here in Virginia, on my walk today, I came across a variety of different species that are native to Asia and are just absolutely ubiquitous on my property. For example, we have the Tree of Heaven, we have Japanese stilt grass, and recently we've acquired the spotted lanternfly. And don't get me wrong, no doubt people in Asia can rattle off a list of American species that now dominate their landscape as well. This goes both ways. And it's Kelly talking here, so you've got to know that I'm going to be bringing it back to parasites.

Trade and travel are moving parasites around as well. In my area, the local cattle folks are struggling with what to do about the invasive Asian longhorn tick. And on today's show, we're talking about a parasite that's spreading far and wide and poses a risk to human health in particular. That parasite is a nematode known as rat lungworm. And we have parasite expert Dr. Chelsea Wood on the show today to tell us all about it. about it. Welcome to Daniel and Kelly's invaded universe. I'm Daniel. I study particles and aliens and my favorite parasite is no parasite. And I do have a favorite parasite, but my favorite parasite in people is no parasite. I'll give you that.

Yes, all right. Thank you. We can agree on that at least. Yes, yes. Oh, and I'm Kelly, Kelly Weedersmith, who usually loves parasites, but the parasite we're talking about today, I'm not a huge fan of. It's hard to be a fan of this one, especially if you like salads or California or both. That's right. That's right. And this is a parasite that, you know, like, it's been on my radar because we grow leafy greens in Virginia on our farm. And every time I see a slug or a snail, I think to myself how much longer before I might have to worry that one of those slugs or the snails could be transmitting a parasite to me. And in particular, this rat lungworm parasite. But the real reason we're talking about it today is because we have two different listeners who have asked about this parasite.

One of them is a man named Scott who's been working on trying to get people in Hawaii more aware of the presence of this parasite because it's pretty common there. Good on you, Scott. Good on you, Scott. And another is Paul from New Hampshire who is generally interested in slugs and snails. As one is. As one is. And as y'all will notice throughout like about a month long period, I've been sort of sprinkling in slug and snail stories.

But at the end of a listener question request, Scott mentioned, and you know, there are probably some interesting parasites in snails and slugs like rat lungworm. And so, as part of my quest to answer Paul's question, we've got a whole episode on rat lungworm today. And at the end, we're going to give Scott some time to tell us about what he's been working on in terms of trying to get the word out about this parasite. And this is really valuable. I had never even heard of rat lungworm until today.

So despite my cringing on today's episode, I do think it is valuable to learn all about this. Plus, of course, there are fascinating scientific mysteries for those scientists among us who enjoy studying human misery. I don't know if we enjoy studying human misery, but would like to understand and alleviate human misery. So on today's show, we are bringing my roommate from grad school onto the show. We didn't live together for all of grad school, but some of it. And she has ended up

up being like an absolute superstar in the world of parasitology. And so I was like, you know what, we of course have to have Chelsea on to tell everybody about rat lungworm. And you should hear the admiration in her voice when she describes these terrible creatures. Well, let's jump right in. Dr. Chelsea Wood is an associate professor in the School of Aquatic and Fishery Sciences at the University of Washington. Her research program explores the ecology of infectious. disease in a changing world. And we would run out of time if I went through all of her honors, so I'll just pick two. She's been named a Sloan Research Fellow and a Cavley Fellow.

She is also the author of a kid's book for kids ages 8 to 12 on parasites. That's right. You can get kids books about parasites. And the book is called Power to the Parasites, everything you ever, never wanted to know about the creepy crawlies hidden in your home, your food, your pets, and maybe even in you. and she has an adult book about parasites, which sounds a little dirtier than I meant it to, a book about parasites that's not meant for children that's coming out early next year through basic books, Hichet. So welcome, Chelsea. Thank you, Kelly, and thank you, Daniel, for having me. I'm so excited to talk to you.

Are your books about explaining parasites or are they about inducing nightmares? Oh, a little bit from column A, a, little bit from Column B. The hope is that the nightmares turn into dreams. I love parasites, just like Kelly. And the goal of the books is to help people get to know them face to face the way that we know them. And so I would love for you to explain how you became a person who will say the words, I love parasites, unironically, like without having been, you know, dropped on your head multiple times. Help the audience understand me better by explaining how you got here.

Yeah, I mean, I don't think anyone's born a parasitologist. It's not like something kids dream about doing when they're very little. When I was growing up, I wanted to be a marine biologist. I wanted to swim with whales and dolphins, naturally. Lots of people do. Naturally. And I went to college with that intention and got through a lot of my bachelor's degree planning on being a dolphin trainer, whale scientist when I grew up.

And then I tried to do research while I was an undergraduate, and I was in a college that didn't have a lot of marine biology. And by didn't have a lot of marine biology, I mean it had no marine biology. Not the best career choice for someone who was bound and determined to be a marine biologist. But I made the best of it. And I worked in an engineering lab. I studied Lake zooplankton for a while. I ground up bark beetles.

It was all fun, but I wanted the dolphins. And so I asked my academic advisor to set me up with an internship anywhere. in the world with any marine biologist she knew. And she happened to connect me with a person who used to be her office mate, who was a marine biologist, but also studied parasites. Oh. Yes. I went into his lab, just like totally grossed out, pretty disappointed that I was going to be working on worms instead of dolphins, but like a little marine biology mercenary wanting to get my foot in the door. And I worked for him for a quarter and I fell in love. I found that the trematodes, the flatworms that I was working on, were just so fascinating.

And it took me a little while to kind of like change course to like re-envision what my future would be without snuggling dolphins. But now I get to snuggle worms, which is way better. Way better. I mean, they don't smell good, but like dolphins don't smell great either. No, they don't. They smell terrible. Yeah, there you go. But was your initial attraction to whales and dolphins because,

because of their, like, dignity and their grace and the idea of, like, swimming alongside of them? Or was it about the research questions? Or did you then discover, like, wow, I want to swim alongside worms, or worms have a grace all of their own? I mean, is this a change in you, or is this a change in what you were looking for? When I was interested in marine mammals, it was about wanting to swim with them. It wasn't about the research questions. And, you know, like with any scientist, you go through phases of development and your interests mature and change and you become less attracted to the superficial beauty of an organism and more attracted to the interesting questions that you have about

what that organism is up to in nature. And so I underwent that evolution and as I did, realized that the questions that were really exciting to me were not about whales and dolphins, but what lives inside of them. And you could also swim with dolphins. And you could also swim with dolphins in Wales without being a marine biologist, right? You sure can. Yeah. Yeah, but they don't like it if in the middle of those like experiences that you pay a bunch of money for you, like then open the dolphin up to check its parasites.

You know, they crown on that. So Chelsea and I don't go to places like that probably very often. We're not allowed. Yeah, no. So I had a similar trajectory, but it was charismatic African megafauna that I wanted to study. But instead, parasites. Way better. Way better.

Way better. Well, we've had quite a few listeners ask about rat lungworm. And I was like, all right, I could cover that. But I know Chelsea has, like, amazing stories about rat lungworm. So she's got to be the one who does it for us. And so rat lung worm it is. Let's start with, like, what kind of animal is rat lungworm? Rat lung worm, its scientific name is angiostrondulis cantinensis.

And it is a nematode, a round worm. It's parasitic, and it normally cycles between snails and slugs and rodents, but it can get into people, and that's where the trouble starts. So how big is this thing? Are we talking like a super tiny little worm or like some mega worm? Depends on the life stage. The nematodes go through a series of mults from juveniles or larvae into adults. The larvae are super tiny.

You can only see them under a microscope. the adults are quite big. You'll find them, you know, if you dissect an infected mouse, for example, you'll find them either in the brain tissues or in the lungs. And they are easily visible to the naked eye, like about the length of a thumbnail. Yikes. How do you feel when you see that? The first time I saw rat lungworm larvae, it was like a moment in my parasitology career because I've seen a lot of worms under the microscope. So I've dissected snails and fish and all kinds of different vertebrates.

And like, I've seen a lot of stuff. But I have never seen so many larvae as the rat lungworm larvae we pulled out of some snails and slugs in Honolulu a couple of years ago. It was just hundreds of thousands of tiny roiling larvae under the microscope. You could roll the stage in any direction, and you'd be going for, like, what felt like miles and miles, a carpet of baby nematodes. It was... Cue the nightmares. It was staggering. I actually did dream about them for a couple of days after I saw them.

And why are they called rat lungworm? Are they found in the lungs of rats? You're talking about snails and slugs here, so I'm confused. Yeah, they have a really interesting life cycle. Their larval stages are in snails and slugs. The snails and slugs get eaten by rodents. And the larvae, which are now in the rodent's gut, bust through the lining of the gut and find their way into the central nervous system of the rat or mouse.

What does that feel like, do you think? Bad, not good. Okay. Straight into the point. I like it. If it's anything like what humans experience, probably like fever-flu-like symptoms as the worms are migrating from the gut into the central nervous system. But then once they're in the central nervous system, they ride up the spinal column and into the brain,

and then they start literally consuming the brain tissue of the rodent host, burrowing holes, burrowing tunnels through the brain tissue. And they get fat on this brain tissue. Obviously, brain is really nutritious. So as a parasite, it's a smart place to go. Sorry, obviously brain is really nutritious. This is not obvious to me. What is nutritious about the brain?

Lots of protein, lots of fats, the things that parasites are looking for. And once they've finished maturing inside the brain, they will then migrate down into the lungs of the rodent host because they can't just hang out in one rodent for the rest of their lives. They need to get their babies into the outside world. So they have their larvae in the lungs of the rodent host. The rodent then coughs the larvae up, swallows them down, passages them through the gut tract, and the larvae come out in rat poop, which is eaten by snails or slugs, thus completing the lifecycle. Now I want something to crawl through my brain and eat the parts of it that remember this conversation,

so I don't have nightmares about it later. And is it bad for the snails and the slugs, too? Because it sounds like it's pretty miserable for the rats. Great question. I don't know if anyone's ever tackled that. Rat lungworm is a pretty understudied parasite, especially with respect to its impact on human hosts. I'm not aware of any studies that have looked at what impact parasitic infection has on the snails. People are too busy worrying about what's happening to the vertebrates.

Do they get, like, castrated, like with the trematodes, or we have no idea? They're not a castrating parasite. And so you're describing a life cycle with slugs and snails and then rats where they have this horrible thing that goes in their brain, and then in their lungs, they cough it up, and then it forces them to swallow it. nightmare. But it can also happen in humans, right? Is there a sort of similar life cycle there? Just go through the human brain and into the human lungs or is a different trajectory. Yeah. People accidentally or sometimes purposefully eat snails and slugs. It's easier than you think because these snails and slugs can be super tiny and kale has lots of little crevices in it. Right. So if you're, if you accidentally eat one of these snails or slugs, winds up in your gut,

busts through the gut wall, gets into the central nervouses. system up to the brain, and then it burrows lots of tunnels. We don't think that the parasite is capable of maturing in a human host. So we think that it either does not, or it has trouble getting from the brain to the lungs. But that's kind of irrelevant from the perspective of the patient, because the real impact of infection is on having a worm tunneling through your brain. So people who are infected will start by experiencing flu-like symptoms. That's when the worms are moving from the gut into the central nervous system. And that's the only moment when the disease is treatable. You can get those worms with an antiparasitic drug at that stage before it gets into what we call

the immune privilege site of the central nervous system. Getting drugs into the central nervous system is really difficult. And so treating the worms once they get in there is essentially we can only deal with the symptoms. We can't actually kill them. So flu-like symptoms, as you enter this two-week period when the worms are moving from the gut into the central nervous system. And then literally any symptom that can be produced by the brain can be produced by these worms, depending on what they decide to eat as they're up in your brain case. People describe feeling like their body's full of electricity. They describe not being able to wear clothes because just the touch of fabric on their skin is painful. They will say that they feel like they're being

stabbed or frozen or burned. And there is literally nothing that doctors can do for those patients other than try to manage the inflammation that the worms are causing. Doesn't it ever do anything good? I mean, brains could also make you feel good. Is there nobody out there who's just like constantly experiencing ice cream or something? I am not aware of any reports of people constantly experiencing ice cream. I like your optimism though, Daniel.

I'm struggling here, man. is nightmare material. I kind of wish we could release your video because the series of faces that you're making as the episode goes on is pretty fantastic. So the doctors can't do anything. How long does the parasite live? How long does this go on? We know in rats the parasite can live for years. We don't know for sure what goes on in people. Typically, the initial period of severe neurological problems can last for weeks to months, and sometimes the lingering effects go on for years. Sometimes people die. That's rare, but it does happen.

I have a friend here in Seattle who had rat lungworm. She contracted it on a vacation on the big island of Hawaii, and she got sick within days of eating a veggie wrap, which is how she thinks she was infected. And it took her a couple of weeks to get diagnosed, and then she was incapacitated by her infection for months. Wow. She lost her ability to speak and understand speech.

Her vision was affected. Her motor skills were affected. She used a walker for a period of time. And it took her years of physical therapy and steroids and other drugs to come back to some semblance of normal. And very luckily, she is healthy and healed now. but she was infected years ago and it took her years to recover.

And that's, it seems to be pretty typical. And when you say recover, the brain doesn't like repair those holes. You're talking about like retraining yourself to learn those skills again? I'm not sure about the neurobiology of the healing process. I don't think those holes get filled in.

I do think you retrain yourself to use the neurons and synapses that remain. But you'd have to ask a neuron. about the details. How do we figure out if somebody is infected? Is it like brain scans or blood tests? Yeah, how do you figure that out? A definitive diagnosis can only be reached with a spinal tap and then identification of the

worms in the cerebro spinal fluid. Spinal taps are not fun. They are procedures that doctors really hesitate to perform unless they're in really exigent circumstances. And even then you've got to get the worms in the CSF in order to know for sure. Other indicators are the proportion of eosinophils in the cerebral spinal fluid, the immune cells that respond to parasitic infection. And that's the only way that you know for sure. It's a challenging disease to diagnose because it looks like flu in the period when it's treatable. And after that, your only option is to perform a spinal tap. Doctors don't have a lot of good

training on rat lungworm, and so many patients go completely undiagnosed and might never know why there's some suffering from neurological symptoms. And so where is this thing native, and how big of a problem is it in its native range? It is native to East and Southeast Asia. It was first described from China in the 30s, and while that's its native range, it is now broadly distributed across the world. It's been introduced. Sorry, sorry to report. We're going to end with some good news in this episode, right? Right?

That's not what happens when you talk to parasitologists. Set your expectations low. It's now, it's present all throughout the equatorial Pacific. It's in Hawaii. Obviously, it was first reported there in 1961, and we know it's been there. since 1959, because that is when one very sick man wound up in Hawaii's state mental facility. And he had, Rat Lung Roman was the first patient described from Hawaii. It's also in parts of Europe, Jamaica, South Africa, Brazil.

It's been reported from the southeastern U.S. And there have been human cases from the southeastern U.S. And just a couple of months ago, it was reported for the first time in zoo animals in San Diego. No. So now it's in California. What? The last line of defense has been breached, people. That's right. All right. Let's take a break. And when we get back, we'll talk a little bit about how this parasite is getting from place to place.

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Listen to Unshaken with Gary Vee, on the IHeart Radio app, Apple Podcasts, or wherever you get your podcasts. And we're back. Daniel and I took a little bit of time to try to get that yuck out. And we are doing our best to not make, yeah, we're doing our best to not make too many faces, as Chelsea describes this. So the people who live in Hawaii must be particularly frustrated to have this parasite because they also didn't originally have rats, right?

And so, like, how much of this system has been introduced into Hawaii and, like, how did it get there? Almost all of it. Rodents are not native to Hawaii. The Polynesian rat was introduced by Polynesian Voyagers about 1,100 years ago. And then European colonists introduced the black rat, Norway rat, and house mouse. So those rodents are now all extremely common across the Hawaiian Islands. Most of the snails and slugs that are host to rat lungworm are also non-native to Hawaii. Oh, come on.

And the worm itself is non-native. Yeah, it is an entirely novel ecosystem that's been assembled to support the transmission of this parasite. You said it was first described in the 30s, but it must have been around a long time, right? Yeah, this is, this worm isn't new. It has evolved from a large tree of other nematodes. And while we obviously don't want to be infected by it, it is natural and normal. in East and Southeast Asia. What's not natural or normal is the fact that it's now been imported into ecosystems all around the world.

And so if you live in Southeast Asia, are people just regularly getting, like, is it as big a problem in its native range as it is in, like, Hawaii, for example? It doesn't appear to be, and this is a frontier area of research. So, you know, this is something that we still have some uncertainty about. We think that early life exposure to the worms protects, against catastrophic infection later in life. So people who have no exposure to rat lungworm and then suddenly get a big dose of it are the ones who are winding up with really severe neurological problems. But this is an emerging area of research and that's not a solidified hypothesis yet. How would that work? Your immune system is somehow trained and then when they're burrowing through

your body looking for the brain, they get attacked by the immune system? Precisely. Yeah. Wow. Gosh, so I can imagine maybe one day there'd be like a vaccine before you go to Hawaii or a vaccine for everybody living in Hawaii, which would at least make it less bad. If we could develop a vaccine against a worm. Yeah, right, which we haven't done yet, right? I know they're working on it for hookworm, but we've not had any success right.

Not yet. But remind me, and I know we did a whole episode on why it's hard to get vaccines for parasites, but this is something where your immune system can be trained to respond. What's the challenge in developing the vaccine? Okay, I don't develop vaccines, so I'm way out of my depth here, and Kelly, you should step in and correct me. My understanding is that worms are so closely related to us that biochemically, we have so many similarities that things that hurt them also hurt us. And that's why it's just logistically much more challenging to develop a vaccine without unacceptable side effects for a worm relative to something like a virus. We had John Hodden on the show, and he talked about this for like an hour, and he said a lot of what,

you said. He also said that part of the problem is just that like worms are really big. And like nematodes, for example, the outside of them has this like, you know, hard outer coating. And so it's hard for the immune system to do much of anything to them. And so you have to try to find a way to like, I don't know, get inside of the nematode and then attack it from within. And it's just really complicated for for lots of reasons. But the immune system knows how to do it because in Southeast Asia, people who are exposed as children have protection. I'm just reaching here for some optimism. Help me out. Let's go with maybe, which is about as, does that seem reasonable, Chelsea?

The solution to worms is more worms. What? No. We need more worms to eat these worms? Is that what you're saying? No, more worms for us earlier in life to provide immune protection against later catastrophic infection. I'm not actually advocating for this, by the way.

No one to go out and get worms. Do not take medical advice from this show, but maybe take your baby to Hawaii. So how is this changing the lives of people who live in Hawaii? Like, has it changed their diet? Like, what is, yeah, what are their lives like? Well, public health outreach about rat lung worm is pretty minimal in Hawaii. So a lot of people are totally unaware that it's being transmitted locally, that it's a risk. There's a tremendous amount of agriculture locally in Hawaii because otherwise food needs to transit over these huge distances in order to reach the whole.

Hawaiian Islands. So there's lots of lettuce and kale and other leafy greens being grown locally that people are eating without any awareness that there could be snails or slugs that represent a risk to them. That's a problem. People who are aware are trying to be careful, but there's only so much you can do. And actually, I met one patient who is also a professor at the University of Hawaii Manoa. She's an ecologist. She was aware of rat lungworm when she went to a farmer's market and bought kale. And she washed it very thoroughly. And nonetheless, she was infected and nearly died of her infection, was hospitalized for a month and still suffers the after effects of her infection. Wow. So people try, but there are limits. You can't check every kale crevice. There's

no way to ensure that your leafy greens are completely safe. What if we irradiate the kale? Particle physics to the rescue. I'll leave that to you, Daniel. That can be your next practice. Bring your salad to the large Hedron Collider, and I will kill those worms. And you mentioned, you know, like someone had a veggie wrap, and in some rating of yours that I'm familiar with that folks can find in early 2027, like you mentioned that you can get it in a smoothie. Like, you know, you put like kale in a smoothie. You don't even think about it. And now you've got parasites that way. Like there's so many different routes that you might not even think about to get it, which is why none of us are going to sleep tonight.

and why we're never getting kale advertisers after this episode. Yeah, that's right. Big kale is going to shun us. Okay, so you went to Hawaii to meet people who study this and to like sort of find out what it's like for people in Hawaii. And so you and I, when we used to be roommates, we'd go out for sushi and you would eat all kinds of sushi, right? And so you don't seem like a kind of person who is worried about parasites in their food.

Although I know sushi is usually farsen beforehand. But like, did this change your eating habits when you were in an area where you knew that it was? 100%. There's a big difference between going out for sushi and eating a salad in Hawaii. Rat lungworm is a catastrophic infection, potentially life-ending, certainly life-altering. It is not a parasite that I would touch with a 10-foot pole. It's very, very dangerous. And probably, you know, of all the parasites that I have encountered in my life.

career, the one I at least like to be infected with myself. You have a ranking of like most to least? I sure do. Wow. Okay. Where is Loa Loa? I would 100% take Loa Loa. Absolutely.

Wait, what's a Loa Loa? Oh, that was on, we did the list of the three parasites that creep Kelly out the most. And Loa Loa Loa was on there because it moves around the inside of your eye and people can see it moving in your eye. And I thought that was pretty gross. But that sounds cool to you, Chelsea? It's gross for sure, but it's really low pathogenicity. You know, there's very few effects of being infected with Loa Loa Loa. And then you get to, like, have a little pet that you keep with you all the time.

You're never alone. Never alone. So what do we know about how this parasite gets from one place to another? Like, do we know how it got to Hawaii or how it got to Louisiana? Anna? We have no idea how it got to Hawaii, which is a question that I find really interesting because there are several very different potential answers. It seems pretty likely that it could have arrived from Southeast Asia during World War II or the Korean War because there was a tremendous amount of movement of material between those regions. And we know that rodents

came and went. It's also possible that snails and slugs came and went in things like tires or vehicles that were being moved from one place to the next. So that's really reasonable. But it's also entirely possible that the parasite arrived with Polynesian rats when they were introduced 1100 years ago by Polynesian voyagers. So those are two very different answers to that question. And I find it really interesting that we don't know how it arrived, given how much impact it's had and how that information would really help us better understand how to move materials responsibly across the face of the earth moving forward, given that we don't want rat lung worm to continue to expand in its range.

Can I ask a question about that comment you made? You said that Polynesians introduced Polynesian rats. Were the Polynesians ships large enough for the rats to hide on them? Apparently so. Apparently so. That I don't know whether it was intentional or not, but I've always just assumed that they were stowaways. like in any other ship.

Wow. Because in Moana, it's just a raft. That's why it's confusing. Kelly's revealing the depth of my research on this topic, yes. I've actually had rats in the home, so thank you very much. I have a little bit of experience. I'm grateful they didn't have rat lungworm, though. Hopefully.

Yeah, so now when you travel to other parts of the world, like, I don't know, it's in Louisiana and Florida, for example, do you, like, are you, like, are you totally, totally off salads now is what I'm asking. How do you balance this risk when you go from place to place? I'm really, really careful about fresh leafy greens when I travel in a place that has rat lungworm. I did not eat anything green while I was in Hawaii. The only exception is I was hanging out with Rob Cowie, who's a malacologist, a snail researcher at the University of Hawaii, and one of the folks there who's studying rat lungworm. And he had my husband, my husband, and me over for dinner one night and served us a salad. And I looked at him and I was like, you have to be joking. I am literally here to study rat lung room with you. Like, there's no way

you're feeding me this right now. And he's like, no, no, no, it's totally, it's fine. I know that this lettuce came from California. So I know that it's safe. So you can eat it and it's okay. And so I was like, all right, you're the expert. Put some salad on my plate. Pass it down the table to another dinner guest, Vernon Ansdell, who's a physician and rat lungworm expert in Hawaii based in Honolulu. And he took that bowl and passed it right on down the table without giving himself any salad. And I just, I like was internally panicking. I didn't want to be rude and not eat the salad. So I ate it. Oh. And then I didn't sleep for a couple of days after that. Yeah. Yeah. So anyway, I'm very careful about green things when I'm in Hawaii.

Except for when Rob tricks me into eating a salad. Not cool. Not cool. Wow. You're peer pressured into parasite roulette there. That's terrifying. And then, you know, in the southeastern U.S., yeah, I avoid leafy greens, especially local ones. The reality is that the vast majority of salad that is eaten in North America comes from the Central Valley of California.

So so far, that's safe. and that means that salads that you eat anywhere in North America are probably from California and therefore safe. But to me, it's, you know, I'll gamble with a lot of different parasites. I eat sushi because I don't care if I get sushi worm. It's fine. It's worth it to me to eat sushi. Might even be kind of awesome. Might even be kind of awesome.

I mean, if you could collect it somehow. All right, sorry, maybe not. Maybe it's just me. Speaking alone here. No, no, you're not at all. I mean, anisacidosis, which is. Sushi worm disease. Not fun. Vomiting, diarrhea, abdominal pain. In really severe cases, you're hospitalized and they have to do an endoscopy to actually visualize and remove the worm. Would that be cool?

No. I wouldn't enjoy it in the moment. Would I love to have a picture of a worm from my own gut? Also, no. Yep. Not going to lie. It would be pretty amazing. Yeah, that would be pretty cool. No, it would not be pretty amazing. Wow, this is a litmus test for people. personality. I think I'd rather have a tapeworm, though. Absolutely. Like that, I'd rather collect a tapeworm. Yeah. No question. Okay. So, so you don't worry about salads because most of the salads have come from central California, but you pay attention to where you're going and you change your behavior accordingly. Would that be a reasonable summary? Yeah. I don't eat salad in Hawaii. I wouldn't eat leafy greens that are uncooked in East or Southeast Asia. And I'd be cognizant of it

in the southeastern U.S. where salads are most likely sourced from California, but could be from local greens. So you're saying if somebody served you two salads, one grown in California and one grown in Virginia, you would eat the California salad? So far, Virginia is okay. Yeah. So Daniel and I have a California versus Virginia thing going on, and he was trying to catch you there. Trying to score point here, yeah.

Yeah, yeah. Okay, so it's called rat lungworm, but you've already mentioned that it can get into mice, and now we know it can get into people. So as it gets introduced throughout the world, are there other animal brains it's eating, like other than humans and mice and rats? Like, how bad is this for, like, the rest of the ecosystem? Yeah, any mammal can be infected

and suffer some of the same effects as people and rats. In Hawaii, there are lots of veterinary reports of paralyzed dogs who experience that paralysis as a result of rat lungworm infection, horses too. And often our reports of rat lungworm from the continental U.S. are from zoo animals. And that's because they're highly observed by really well-trained veterinarians, and they're bored. And so if a snail or a slug comes into their enclosure, they're likely to eat it, touch it,

mouth it, and become infected themselves. The reports from California that came out of San Diego recently were from zoo animals. All right. Well, let's take a break, bit of a palate cleanser again. And when we get back, we'll do our best to see if we can find some sort of positive angle to end on for Daniel. And we'll see where that gets us.

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Listen to Unshaken with Gary Vee. on the IHeartRadio app, Apple Podcasts, or wherever you get your podcasts. We're talking about the spread of rat lungworm. And so, Chelsea, you said something about how, if we knew how it got from place to place, there would be something we could do about it. Are there inroads for ways we can keep it from spreading to places that it hasn't gotten to yet? Yeah, so we've talked about war and how war. moves, materials over these large spans of space and can bring animals that are from one place to

another. What we haven't talked about yet is trade, and the trade in horticultural products is thought to be one of the pathways by which the worm has made it into the southeastern U.S. Trees, shrubs, herbaceous plants come in soil, snails and slugs can be in soil, and that is one pathway by which the parasite is transported from one part of the world to another. The trade in horticultural products is regulated, and of course, people are trying to prevent the spread of invasive snails and slugs themselves, but our screening procedures are not perfect. Better protections on how biological materials are moved across national boundaries would reduce the likelihood that the worm is going to make it into new places.

But if you can't even rinse kale and inspect it in your own sink and be confident that there's nothing in there, how could inspectors check every plant? I don't think they can. Okay. And once it gets established somewhere, is there any hope of kicking it out? It depends on where you are. Eradicating rats and mice is famously difficult. Not possible except in small areas or on small islands. There are some islands where rats have been introduced and later eradicated.

It costs a ton of money and it takes a ton of effort, but it is possible. But if we're talking like an area of a large landmass, getting rid of rats or mice or snails or slugs is really just not practical. The best intervention is to make sure that people are taking measures to protect themselves and that the food supply is protected. Okay. Yeah. that was the most positive we were able to come up with. Sorry, guys. I am not a beam of light here.

Neither am I. And I have to hammer on that a little bit. You're saying protect themselves. But again, like, what can we do to protect ourselves other than not eat salads? Buy lettuce from places that are safe. Californian lettuce so far is both the easiest to get and the safest. Wash all of your leafy greens extremely thoroughly. Inspect those greens.

carefully. If you live in an endemic region and you're growing your own greens, what I'd recommend is like filling up the sink with water and letting the lettuce soak for an hour or so, so that any snails or slugs that are on it are dislodged and you can see them more easily, and then rinsing it really, really carefully and inspecting all the crevices. And it also means protecting kids from their own curiosity. A lot of pediatric rat lung cases in Hawaii are kids who were playing in the backyard and picked up a snail or slug, mouthed it, or even just handled it and then put their hands in their mouths. So watching over kids, especially in places where rat lung worm is known to be transmitted when they're playing

in nature or in the backyard. So this doesn't seem very hopeful. I mean, in five years, in 20 years, in 50 years, is rat lung worm just going to be everywhere? Is carefree eating of salads just going to be a historical anecdote? I might have answered this question differently a couple of months ago. It's a subtropical parasite, and I would have expected it to remain only in regions that are very warm and very moist. It made sense to me that it would wind up in the southeastern U.S. It's well within the bounds of the humidity and temperature that the parasite evolved in. The fact that it showed up in San Diego is upsetting.

Yes. Because that is a very different. habitat than where the parasite has been found before. And we don't know whether this is really limited or not. Like the first report from San Diego only came in a few months ago, so we don't know the full picture yet. But the fact that it shows up in a place that seems to be outside of the envelope of environments that it's previously been known to inhabit, kind of blows up my expectations about where we should expect to see it in the future. So what are the lessons from rat lungworm for what we should expect regarding other parasites spreading around the world?

Like, is rat lungworm the only parasite that's spreading around the world? Or is this happening with a lot of different kinds of parasites right now? The answer is all over the map. You know, parasite, when we say the word parasite, we're talking about this like sprawling tree of life. Paracetism has evolved 223 independent times across. the animal tree of life. Wow. That's 223 times when a free-living ancestor gave rise to a parasitic branch. And that means that there's this, like, crazy amount of diversity among the parasites.

They're not a monolith. They're all doing different stuff. Rat lungworm is a great poster child for those parasites that are benefiting from global change. We're, like, moving stuff all around the world, and rat lungworm is the beneficiary of all of that movement. It's not the only one. there are lots of other parasites that are similarly well positioned to take advantage of the fact

that we've now connected these really far-flung places. But there are other parasites that are doing the exact opposite thing. We don't pay attention to them because they're not causing outbreaks, right? They're not increasing in abundance. And so we have no reason to encounter them. But they are quietly diminishing, sometimes even to extinction. And that's the other side of the coin that we never see because it doesn't affect us personally. And that seems like a perfect segue into the amazing book that you wrote. Do you want to tell us a bit about it so that folks can immediately go pre-order it after listening to this episode? If this wasn't nightmares enough. Yeah, there are actually a lot more nightmares in Netherworld, the genius of parasites, which is the book that I've been working on

for the past couple of years, which is due to come out on the 16th of February 27, pre-orders should open been in mid-June. This book is kind of the culmination of my career to date in parasitology. It's what I've learned about the future of parasitism. It's my answer to the question, is the world getting wormier or not? And yeah, the book is about how global change is influencing parasites, whether we should expect in the future more parasite outbreaks or fewer parasites in general. And the upshot is these parasites are just so diverse, there's no reason to expect them all to do the same thing. And the book covers many examples of parasitic outbreaks like rat lungworm and many others. But it also looks at the other side of that coin and investigates those parasites that are diminishing even into extinction and asks the question why and does it matter, should we care.

And can we do that to rat lungworm? After we wrap up this episode, folks should stay tuned because one of the listeners who reached out to us is a man named Scott who is actually working on trying to get people in Hawaii aware of rat lungworm. So he's like part of a group that's working on that. So we're going to give him some time to tell us about what he's been working on. But before we let you go, I want to know what is your favorite parasite. And if it's not rat lungworm, what is the creepiest parasite? Oh, boy. you're like asking me to choose amongst my children.

I know. No, I knew it was not an easy question. I knew. I really, I have a lot of favorite parasites, but the most beautiful, in my opinion, are the tapeworms in the order Trapanarenka. And I really love these worms. We come across them a lot in our coral reef fish project. We dissect lots of coral reef fishes, and we find these parasites as larvae. And I love them because they are set up perfectly for a life inside of a slippery shark gut. If you imagine yourself, inside a shark gut, it's dark, it's slippery, there's this never-ending tide of poop that's trying to sweep you out of the gut and into the environment, and you don't want that. No. The troponorinks avoid that by having these like four tentacles that are on their head end,

which we call a skullex. And the tentacles are. retractable so they can have them kind of like coiled up inside of their head. And whenever they wish, they can eject those tentacles. Each one is armed with thousands of backward facing hooks. So those tentacles, Daniel. Daniel, this is so fascinating. Daniel and I are having diametric responses right now. This is, okay. All right, I can handle it. I can handle it. Go ahead. You got this, Daniel. It's shooting these tentacles out of its head. All right.

It's shooting tentacles out of its head. They lay those tentacles down on the intestinal wall of the shark, dig in the hooks, and then retract them back into their head so that they're firmly anchored on the shark's gut wall. And they are... That's amazing. They're amazing. They're also just so beautiful because those tentacles are like curly-kewed,

kind of like the illustrations and the margins of a medieval manuscript, you know, all those like really elaborate ornaments. and they've got all these hooks that refract light when you see them under a microscope. So just imagine like a bedazzled medieval manuscript and you've got an idea of what the trapen rings look like. They're just gorgeous. I love the thought of them, swimming around with a bunch of sharks traveling hundreds of miles with their hosts, using these incredibly like well-adapted tentacles to get what they want in the world. I just, every time I see one, it's a really special.

moment. I can imagine. I'd love to see one in person. Come visit. Okay. You speak of this parasite admiringly, but you also call it beautiful. Are you really thinking it's like attractive? I mean, would you like wear as a piece of jewelry or are you just like impressed by its ingenuity and its ferociousness? She literally has one on her finger. All right. All right. There we go. It's a different kind of parasite, but yes. Right? Yeah. It's the haplazoon. You did, Zohon. Yeah, those are two trematodes that are permanently connected to each other. Nice.

Monagines, actually. Monagines. Oh, no, I've been embarrassed in public. All right, but I'm feeling like we should probably not get to a creepy parasite given Daniel's face when we were talking about the most beautiful parasite. And so I think maybe we should call it quits here and bid you farewell. Thank you so much for coming on the show. This was amazing.

folks should go out and pre-order Netherworld. This episode is coming out after the pre-orders go live, so you can all go and do that right now. And when the book comes out, we will have Chelsea back to talk more about parasites and their future. Thanks for being on the show. Thank you so much for having me, guys.

I really appreciate it. Hi, Daniel and Kelly. Thanks for the information on rat lungworm. It was very thorough and answered more questions than I thought I had. I've been on a diet and been told to eat more salad. Well, so much for that. Admittedly, I live in New Hampshire where the salad is likely safe, but it still gives one pause. And please, don't find a chocolate cake parasite.

Anyway, thanks for the great show. Aloha Kelly and Daniel. I really enjoyed the sending to Dr. Woods share her knowledge of the rat, longworm parasite, and the disease. It was very informative. Thank you so much for giving me this opportunity to share some about our efforts for disease prevention here in Hawaii. In our rural community of Hana, Maui, back in 2017, we had an outbreak of rat lungworm disease. And I have friends who are still experiencing some neurological symptoms years later, and there are still cases now and then. Through the Hawaii Farmers Union, we developed an educational outreach campaign aimed at rat lungworm disease prevention, targeting farmers and consumers.

While all mollusks can carry RLW, in Hawaii, the most high-risk vector is called the semi-slug, due in part to how its habits bring it into contact with human food sources where it can end up hiding in the lettuce or kale. As Dr. Woods mentioned, there is a great need for locally grown food in Hawaii, and we want to support our local farmers. So while we don't want anyone to get lungworm disease, of course, we also don't want the fear of the disease to do. discourage people from eating locally grown produce. So we did outreach to local farms to help them reduce the risk of contamination by aggressively going after rodents on their farms, creating buffer zones around their growing areas which

semi-slugs don't like to cross, putting out non-toxic iron phosphate slug bait, and doing manual semi-slug removal. This is especially important during the rainy season when slugs are most active and taken together, it can have a big impact on the presence of slugs. For the consumer, no matter how much we may trust the farmer, we have to take responsibility for our own safety. Cooking or freezing kills the parasite. So for kale and other leafy greens, cooking it will prevent the disease, and if you really want raw kale smoothies, you can freeze the kale first. I do eat local salads still, but I wash every leaf of lettuce in flowing water, which will knock off the semi-slug, and I carefully inspect them as I do. The good news, Kelly and Daniel, is that rat lungworm disease is an entirely preventable disease.

By taking proactive measures where produce is grown, we can greatly reduce the risk, and by ultimately taking responsibility for our food as consumers, we can, can still enjoy our delicious local greens while keeping ourselves safe from this nasty nematode. As part of our outreach, we created a website with basic clear information for farmers and consumers as well as patients, so I'd invite your listeners to visit ratlungworm.info. Again, thank you so much for spreading awareness about this parasite and the debilitating disease it can cause and for giving me my chance to add two cents to Dr. Wood's excellent information. Thanks everybody for listening. Please go and do us a favor and rate the show on whatever podcast app you're using.

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