“It was a perfect two weeks,” Lape said. “What we came home with wasn’t perfect.”

Lape, 57, and Manilla, 65, contracted symptoms of a sickness neither had heard of before: rat lungworm, a disease caused by a parasitic worm that affects the brain and spinal cord. Both were hospitalized, and while Lape is now out, Manilla is still fighting the aches and pains at California Pacific Medical Center in San Francisco.

“It turned our lives upside down and inside out,” Lape said. “We literally both walked away from flourishing careers and are just now starting to think of putting our lives back together again.”

An unusual number of rat lungworm cases on Maui in recent months has stirred public concern over the disease that causes a rare type of meningitis and miserable symptoms.

Ben Manilla and Eliza Lape share a moment during their wedding on Maui in January. Both were hospitalized after contracting rat lungworm disease on Maui. Manilla is still in the hospital, and while Lape has improved, she still feels some of the effects. * KEVIN BROCK photo

Rats host the worm and pass the larvae through their feces, which slugs feed on. Humans can get infected by consuming raw produce or water contaminated by the slug, or by eating raw or undercooked snails, slugs, prawns and land crabs.

On Maui, six cases have been confirmed this year, while three cases are under investigation. Last year, the state had 11 cases, all on Hawaii Island, state Department of Health spokeswoman Janice Okubo said Monday.

“The cluster of cases, though not all confirmed, are very concerning,” Okubo said. “The recent cluster of cases this year on Maui suggests that something may have changed on Maui to increase the risk there similar to the Big Island.”

Lape and Manilla live in the San Francisco Bay Area and came to Maui in January. They’d visited Molokai around the same time last year and “had a wonderful time being in old Hawaii,” Manilla said.

“We were looking for a place off the beaten track,” Manilla said. “We found a place in Hana a couple miles out of town and decided to set up a house exchange.”

In November, shortly before their Maui trip, Manilla asked Lape to marry him. The couple thought, “Hell, as long as we’re going to Hawaii, we might as well get married there,” Manilla said.

So they eloped, enjoying a private ceremony at Hana Ranch on Jan. 10 with just the two of them, a photographer and someone to officiate.

But before the couple returned to California on Jan. 16, Lape started to get strange symptoms: terrible headaches, sharp pains “that felt like somebody took a hot knife and stabbed me,” tingling sensations and “a feeling of wanting to crawl out of my body.”

Back home, Manilla also developed the sensation of wanting “to jump out of my body.” He had “incredible pain” in his shoulders and lost his fine motor skills, unable to write or hold a fork or cup. A lecturer at the University of California at Berkeley’s Graduate School of Journalism, Manilla tried to write something on the board one day and found he couldn’t hold the marker.

An infectious disease expert at the University of California at San Francisco diagnosed the couple’s condition. He sent blood tests to the Centers for Disease Control and Prevention, which confirmed rat lungworm. It shocked Lape and Manilla, who considered themselves “pretty healthy individuals” who’d never gotten any sickness as terrible as rat lungworm.

Neither knows exactly how they got it. In talks with the state Department of Health, they retraced everywhere they’d gone and everything they’d eaten.

“We were eating food from the garden, we were eating food from food stands, people were bringing us fruit and vegetables,” Lape said. “We have no idea, frankly, where we picked it up.”

There’s also no telling how long Manilla will be in the hospital. Since contracting the disease, he’s dealt with several operations, two bouts of pneumonia and a blood clot. He still has shoulder pain, tremors and difficulty with fine motor skills. An audio producer for 25 years, he “just walked away from everything.”

“I haven’t responded to any emails,” he said. “A lot of people don’t know what’s happened. I just kind of vanished. . . . I just need to take care of myself and get better before I start getting back into the work mode.”

Lape has improved and plans to return to her job as a communications consultant next week. However, she doesn’t have the stamina she used to have and is “still feeling weird things in my body occasionally.”

The couple wanted to share its story to help people be more aware, Lape said. Despite their ordeal, she doesn’t hesitate at the thought of coming back to Maui. She just says they would do it differently – cooking fruits and vegetables instead of eating them raw and making sure their water is filtered or bottled.

“What’s most important is preventing the infection by taking specific precautions,” Okubo said.

She recommended carefully storing, inspecting and washing produce; watching children outdoors to make sure they don’t put a snail or slug in their mouths; and controlling slug, snail and rat populations around homes and gardens.

The department also recommends that people wear gloves and wash their hands if handling snails or slugs. It also cautions against eating raw or undercooked snails or slugs, frogs or shrimp/prawns. When preparing food, suspect snails, prawns, fish and crabs should be boiled for at least 3 to 5 minutes, or frozen at 5 degrees Fahrenheit for at least 24 hours, which kills the larval stage of the worm.

Those with catchment tanks should also “take measures to keep slugs and snails out and filter water appropriately,” Lissa Fox Strohecker of the Maui Invasive Species Committee wrote in a March 13, 2016, column for The Maui News.

Health care providers are advised to monitor patient symptoms and report anyone they suspect may be infected. The most common symptoms include severe headache and neck stiffness, but symptoms vary widely.

For more information, visit health.hawaii.gov/docd/files/2015/07/angio-fact-sheet-20150716.pdf or cdc.gov/parasites/angiostrongylus/index.html.

* Colleen Uechi can be reached at cuechi@mauinews.com.