The 90-Year Journey of Angiostrongylus Cantonensis: From Local Discovery to Global Health Threat (2025)

Imagine a tiny parasite, discovered nearly a century ago in a bustling Chinese city, that has since spread across the globe, threatening human health in ways that highlight our interconnected world. But here's where it gets controversial: is our obsession with exotic foods and global trade fueling this silent epidemic, or are we underestimating the power of nature's adaptability? Dive in as we explore the 90th anniversary of Angiostrongylus cantonensis—the rat lungworm—and uncover why this story could change how you think about infectious diseases forever.

The 90th Anniversary of Angiostrongylus cantonensis: From a Local Breakthrough to a Worldwide Health Concern

• Editorial
• Open access (https://www.springernature.com/gp/open-science/about/the-fundamentals-of-open-access-and-open-research)

• Published: 12 November 2025

• Shan Lv¹² &

• Xiao-Nong Zhou¹²³

Infectious Diseases of Poverty (https://idpjournal.biomedcentral.com/) volume 14, Article number: 115 (2025) Cite this article

Ninety years back, in the vibrant coastal metropolis of Guangzhou (formerly known as Canton), a nematode worm made its debut in the scientific world. Its initial findings appeared in a regional journal back in 1933 [1], and it was Professor H.T. Chen who officially named and characterized it as Pulmonema cantonensis in a French publication two years later, in 1935 [2]. Fast-forward to today, and Angiostrongylus cantonensis, commonly called the rat lungworm, represents a major international health issue. The condition it causes—eosinophilic meningitis, or angiostrongyliasis—is a prime example of how infectious diseases can emerge and challenge us globally. This ailment serves as a stark warning about the risky links between human well-being, animal health, and environmental balance. The transformation of A. cantonensis from a regional parasite affecting rats into a widespread source of eosinophilic meningitis is an engaging tale of scientific exploration, expanding epidemiology, and the pressing call for collaborative, multidisciplinary strategies. As we mark its 90th anniversary, this moment invites us to reflect on its history, evaluate its current influence, and plot a future path guided by the One Health philosophy.

This piece will retrace the worm's developmental path, beginning with Professor H.T. Chen's pioneering work up to its current status as an established threat in warm and subtropical zones worldwide. We'll examine the main drivers behind its international spread, such as international commerce, shifting climates, and changing human habits. Using China's journey as a detailed example, we'll demonstrate the fluid nature of this zoonotic disease and the growth of national control efforts. Our focus will emphasize the vital importance of the One Health framework—not just as a theoretical idea, but as a hands-on tool for monitoring, preventing, and managing the issue. Finally, we'll identify key areas for future studies that must be tackled to lessen the impact of angiostrongyliasis and stop it from turning into a major pandemic risk. The rat lungworm's tale goes beyond mere scientific interest; it's a compelling metaphor for our global village and a rallying cry for worldwide health unity.

Origins and Early Investigations: The Guangzhou Narrative

The scientific adventure of A. cantonensis kicks off with the diligent efforts of Professor H.T. Chen, a trailblazing parasitologist from China whose credentials were as impressive as his curiosity. After earning his Master's from the University of Minnesota and his Ph.D. from Harvard in the late 1920s, he journeyed back to his homeland armed with vast expertise and a sharp instinct for discovery. In 1933, he shared his early observations about a new nematode infecting rats in an English-language local publication, but at that stage, he chose not to assign it a formal zoological name [1]. This was the initial spark in a nine-decade investigation.

The official naming happened in 1935. Through an article in the Annales de Parasitologie Humaine et Comparée, a French journal, Chen carefully described and christened the parasite as Pulmonema cantonensis, honoring its origins in Canton (now Guangzhou) [2]. His thorough morphological analysis formed the bedrock for all future taxonomic studies. Just two years afterward, a researcher from Japan described a similar nematode as Haemastrongylus ratti [3], which we now recognize as synonymous with A. cantonensis. For decades after its identification, A. cantonensis was viewed mainly as a veterinary concern, a somewhat obscure inhabitant of the lung arteries in its primary rodent hosts, especially various species of Rattus rats.

The perception began to evolve during the mid-20th century. The parasite's zoonotic potential was dramatically exposed in 1944 on Taiwan, part of China. Doctors Nomura and Lin documented the first human case: eosinophilic meningitis in a 15-year-old boy, marking a pivotal shift [4]. This groundbreaking report transformed the worm from a mere animal nuisance into a direct danger to people. The 1950s and 1960s exploded with research, largely spearheaded by scientists in Hawaii, Australia, and Southeast Asia, who began unraveling the worm's intricate life cycle [5, 6].

For beginners, think of the parasite's life cycle like a relay race with unexpected twists. Humans aren't the intended final destination; we're accidental participants. Infection typically occurs when people eat undercooked or raw mollusks (like snails or slugs) that carry the worm's larvae, or when they consume contaminated items such as unwashed lettuce harboring tiny snails. Once inside, the larvae travel a path similar to what happens in rats, heading to the central nervous system. But in humans, they can't mature fully—they perish in the brain and spinal cord, sparking a severe inflammatory response known as eosinophilic meningitis, or neuroangiostrongyliasis. Grasping this cycle was essential for crafting effective diagnostic methods and prevention tactics. Discoveries of related species, such as A. mackerrasae in Australia and A. malaysiensis in Malaysia, added layers to the epidemiological puzzle and underscored the variety within the Angiostrongylus group [8, 9].

And this is the part most people miss: while humans suffer acutely, the worm thrives in its rat hosts without causing them lasting harm, illustrating how one organism's survival strategy can disrupt entire ecosystems.

Worldwide Expansion: Epidemiological Growth and Establishment

Starting from its likely roots in southern China, A. cantonensis has undertaken an astonishing global voyage, evolving from a limited regional pest into a worldwide worry. By the 1970s, it had firmly rooted itself in Southeast Asia and the Pacific Islands, including nations like Thailand, Vietnam, the Philippines, Indonesia, Papua New Guinea, and Hawaii [6]. These areas, blessed with humid, warm climates and traditions of consuming raw mollusks, offered the ideal ecological and cultural backdrop for the parasite to flourish.

The late 20th and early 21st centuries have seen a concerning surge in its geographical footprint, as depicted in Figure 1. The worm has been spotted in Africa (for example, Egypt and Nigeria), the Americas (such as parts of the southern United States, Brazil, and Caribbean nations), and even Europe (like Spain and Italy). This isn't coincidental; it's propelled by a mix of human-induced and natural forces, including climate shifts.

1. (I)

Global commerce and movement: International shipping acts as a prime carrier for the parasite's dispersal. Non-native snails, like the giant African land snail (Achatina fulica) and various Pomacea species (often called apple snails), excel as intermediate hosts. These creatures are transported worldwide through the pet industry, as food sources, or inadvertently via freight. Once they settle in new territories, they can pick up the infection from local rat populations, kickstarting fresh transmission loops. A prime illustration is the 2006 outbreak in Beijing, directly tied to imported Pomacea snails from southern China [10].

1. (II)

Environmental changes: Warming temperatures and unpredictable rainfall are broadening the habitats suitable for rodent hosts and mollusk intermediaries. Areas that were once too chilly for the worm's life cycle to complete are now becoming viable. Predictive models indicate that ongoing climate change could drive its spread to higher elevations and latitudes, potentially endangering millions more [11].

1. (III)

Behavioral and cultural shifts: Eating raw or insufficiently cooked hosts or paratenic animals (like frogs or prawns) poses the greatest risk. Dishes featuring raw snail salads, undercooked seafood, or even slugs accidentally ingested on produce are common pathways. The rise in demand for 'exotic' cuisines and eco-tourism might unknowingly expose tourists to the risk.

1. (IV)

Urban growth and city-dwelling rodents: Sprawling cities have boosted populations of rodents that coexist with humans, providing a constant reservoir for the parasite and ensuring its persistence, even in crowded urban settings.

The range expansion of Angiostrongylus cantonensis. Significant locations with names and the years of first detection are shown, categorized by discovery period.

Full size image (https://idpjournal.biomedcentral.com/articles/10.1186/s40249-025-01384-8/figures/1)

Advancements in molecular genetics have offered solid proof of this spread. Research, including Tian et al.'s work [12], shows a distinct pattern: greater genetic variety in Southeast Asia (its probable origin) versus lower diversity in newer areas like the Americas and Pacific islands. This 'bottleneck' effect strongly backs the 'Asian origin' theory and points to multiple separate introductions. For instance, the Pacific invasion might stem from World War II troop movements, while the American spread likely came through distinct trade channels [12]. Genetic differences between eastern and western groups also stand out, and A. malaysiensis has been observed extending beyond its traditional Malaysian home, further complicating the global scene.

The Chinese Case Study: Lessons from an Emerging Zoonosis

China's encounter with A. cantonensis provides a vivid snapshot of the global battle against this zoonotic threat. Marked by early infections, tragic outbreaks, and the rollout of a comprehensive national strategy, it offers precious insights for other countries grappling with similar issues.

The first verified human infection in mainland China was recorded in 1984 [13]. A 13-year-old boy from Xuwen in Guangdong Province showed meningitis symptoms. Epidemiologists traced it back to his habit of crushing Achatina fulica snails to feed family ducks. CSF (cerebrospinal fluid) tests revealed the worm's larvae, confirming the diagnosis. Fortunately, he recovered completely. This incident was a turning point, proving the parasite was a real public health danger in China.

The first fatality followed in 1995 in Guangzhou, when an 11-month-old infant from a disadvantaged neighborhood succumbed to the illness. Autopsy findings showed hundreds of adult worms in her lung arteries, and infected snails were found nearby [14]. This heartbreaking case spotlighted children's heightened risk and the dangers of inadequate sanitation and environmental pollution.

The first large-scale outbreak hit in 1997 in Wenzhou, Zhejiang Province—an area outside the usual southern hotspots. 182 patrons at a restaurant were exposed, with 105 of the 182 who ate a raw snail dish developing symptoms, and 47 confirmed cases [15]. None of the 77 who consumed cooked snails fell ill, solidifying the transmission link. A dose-response effect was evident: infection rates were 86.2% for those eating more than four snails versus 28.9% for fewer. Probes found the parasite in the eatery's Pomacea snails and nearby rats [16]. This event was an urgent alert about mass foodborne spread and the worm's ability to invade new territories.

The most significant outbreak occurred in 2006 in Beijing, China's capital, which isn't typically an endemic zone due to unsuitable snail habitats. Between June and August, 160 people were affected, including 100 hospitalizations. All traced back to two restaurant branches serving snail dishes from imported southern snails [17]. This incident in the nation's heart prompted a nationwide overhaul.

The 2006 national initiative marked a new era:

*

Initial nationwide survey (2006–2007): A thorough assessment of A. cantonensis distribution and its rat and mollusk carriers across China [10].

*

Standardized diagnostics (2010): Health officials issued uniform guidelines for angiostrongyliasis, improving detection and reporting.

*

Ongoing monitoring (2009–present): A surveillance network tracks human cases, snails in markets, and some environmental factors.

*

Building expertise: Efforts to educate healthcare workers, strengthen labs, and enhance prevention strategies.

One Health: An Integrated Strategy for a Knotty Challenge

The saga of A. cantonensis screams for a One Health approach—it's not optional, it's imperative. The worm's life cycle naturally weaves together human, animal (wild and domestic), and environmental health. Its rise and spread are fueled by human actions that throw ecosystems off balance. Tackling it demands collaboration across disciplines.

Defined by the One Health High-Level Expert Panel (OHHLEP), backed by the Quadripartite (including FAO, WHO, UNEP, WOAH), One Health is an integrated, balanced effort to optimize health across people, animals, and ecosystems [18]. It emphasizes true collaboration over mere coordination.

Implementing One Health for A. cantonensis involves these pillars:

1. 1.

Unified monitoring systems: Merge data from human health (meningitis cases), veterinary science (neuroangiostrongyliasis in dogs, horses, wildlife), and environmental checks (mollusk and rat surveillance). This real-time integration detects spillover before it hits humans.

1. 2.

Cross-sector partnerships: Governance must enable cooperation between health, agriculture, and environment sectors. Frameworks like the International Health Regulations (IHR) and Performance of Veterinary Services (PVS) can align under One Health Governance (OHG). The Quadripartite's One Health Joint Plan of Action (2022–2026) puts this into practice with groups on implementation, surveillance, and drivers [19].

1. 3.

Interdisciplinary inquiry: Research should bridge fields—ecologists on mollusk dynamics, climatologists on change impacts, sociologists on food habits, economists on intervention costs. The worm's cycle epitomizes the human-animal-environment nexus.

1. 4.

Ecological focus: Beyond human-animal concerns, manage ecosystems actively. Examples include targeted actions in Hainan, Shanghai, and Yunnan, combining snail control, rodent management, and monitoring. It also means addressing biodiversity loss, which can heighten zoonotic risks.

One Health's benefits are immense: the World Bank estimates annual gains of $4–35 billion through reduced pandemics, better health, and efficient systems [20]. For angiostrongyliasis—at the crossroads of trade, climate, food, and health—it's the only way forward.

But here's where it gets controversial: critics argue that One Health might overemphasize ecosystems at the expense of urgent human needs. Is it practical in resource-limited settings, or does it spread efforts too thin? What do you think—does this approach truly unite us, or does it complicate an already tangled web?

Future Research Directions: Mapping the Next Decade

As we celebrate 90 years since A. cantonensis's discovery, let's gaze ahead with ambitious research goals. Though progress has been made, key gaps persist. Filling them is vital for lasting control and halting further spread.

1. 1.

In-depth genomic and phylogeographic studies: The Asian origins are clear, but dispersal details need finer resolution. Conduct large-scale nuclear and mitochondrial DNA analyses, focusing on underexplored spots like the Philippines, Indonesia, Myanmar, and India. Create networks for sample sharing to clarify introduction events in the Americas, Africa, and Europe.

1. 2.

Vulnerability mapping and risk assessment: We need dynamic, global risk models incorporating climate forecasts, trade routes, host distributions (rats, Achatinaspp., Pomaceaspp.), and socio-economic factors. This will help predict hotspots and guide policies.

1. 3.

Integrated surveillance for humans, animals, and wildlife: Animal impacts are significant but underappreciated. Neuroangiostrongyliasis is deadly in pets (like Australian and U.S. dogs), livestock, and wildlife [21, 22]. Robust systems could warn of human risks early [23, 24]. Involve vet labs and raise awareness.

1. 4.

Improved diagnostics and species ID: Angiostrongylus species look similar, risking misidentification. Use DNA sequencing routinely alongside morphology to ensure accuracy.

Closing Thoughts: A Plea for Collective Effort

The 90-year odyssey of A. cantonensis—from a solitary find to a planetary menace—is a testament to scientific wonder, the parasite's resilience, and the fallout of our global ties. This worm isn't merely a pathogen; it's a herald of ecosystem vitality and our societal fragilities.

We're at a crossroads: continue fragmented efforts and let it proliferate, or unite decisively. We urge experts, practitioners, vets, ecologists, policymakers, and communities to forge a fresh, united front. Together, like a well-coordinated team, we can curb angiostrongyliasis and foster a safer, healthier planet.

What are your thoughts? Do you agree that globalization is the main culprit, or should we blame climate change more? Is the One Health model revolutionary or just another buzzword? Share your views in the comments—let's discuss!

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Authors and Affiliations

1.

National Institute of Parasitic Diseases at Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research); Key Laboratory on Parasite and Vector Biology, National Health Commission; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai, People’s Republic of China

Shan Lv&Xiao-Nong Zhou

2.

School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China

Shan Lv&Xiao-Nong Zhou

3.

Hainan Center for Tropical Diseases Research (Hainan Sub-Center of Chinese Center for Tropical Diseases Research), Haikou, People’s Republic of China

Xiao-Nong Zhou

Authors

1. Shan Lv
2. Xiao-Nong Zhou

Contributions

LS and XNZ wrote and revised the first draft. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiao-Nong Zhou.

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Not applicable.

Competing interests

Xiao-Nong Zhou is an Editor-in-Chief of the journal Infectious Diseases of Poverty. He was not involved in the peer-review or handling of the manuscript. The Chat-GPT 4.0 help to improve the language and figure.The authors have no other competing interests to disclose.

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Lv, S., Zhou, XN. The 90th anniversary of Angiostrongylus cantonensis: from local discovery to global endemic. Infect Dis Poverty 14, 115 (2025). https://doi.org/10.1186/s40249-025-01384-8

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Received: 19 October 2025

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Accepted: 20 October 2025

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Published: 12 November 2025

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Version of record: 12 November 2025

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DOI: https://doi.org/10.1186/s40249-025-01384-8