I'm not sure what is ment by the disease presents differently here in Hawaii. How so? What immediate treatment do you think has been missing? My understanding is the disease is usually self limiting as the worm cannot reproduce in humans as it can in rats so it's the death of the worm and subsequent inflammation that causes the disease symptoms. Treatment to kill the worn with antihelminthics causes concentration of the inflammation time frame and an increase in severity of symptoms. This is a world wide disease so there is some information history.