TWiP solves the case of the middle-aged man with eosinophilia and a history of sexual activity with paid sex workers in Okinawa, and presents a new case for you to solve.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Letters read on TWiP 249

New Case

Woman in 30s or 40s goes to Belize and after returning notices a lesion on her face. She goes to see several physicians and despite a number of topical creams the ulcer on her face does not heal. She is then referred to our office where a certain parasitic infection is considered and we involve our friends at Columbia to help us with the diagnosis..

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Music by Ronald Jenkees

TWiP reviews the observation that infection of Azlheimer’s disease mice with Toxoplasma gondii reduces brain amyloid density globally and regionally.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Toxoplasma reduces amyloid in brain (J Inf Dis)
• Hero: Theodor Hiepe (Parasitol Res)

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Music by Ronald Jenkees

TWiP solves the case of the Manhattan man with pain on urination or ejaculation, and presents a new case for you to solve.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Hero: Charles Louis Alphonse Laveran
• Letters read on TWiP 247

New Case

A middle-aged male is referred to evaluation because of eosinophilia. This man is married, living here in the NY tristate area, and this was picked up on ‘routine blood work’ by his primary care doctor. This man had been in the military, serving as a marine, with time spent in Okinawa, Japan. This individual does report sexual activity with paid sex workers while in Okinawa  but has been monogamous with his current wife for many years. A number of investigations are done with a test coming back showing serological evidence of a prior parasitic infection and he was treated with an antiparasitic medicine with resolution of the eosinophilia. The eosinophilia returned and he was referred to us. Blood work is now down showing evidence of a viral infection that might explain why the eosinophilia returned after treatment. Pt is HIV negative. This was prior to the COVID-19 pandemic. He is on no medications and in general feels fine.

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Music by Ronald Jenkees

Founder of Floating Doctors Ben LaBrot joins TWiP to solve the case of the 1 year old in northeastern Panama with a fatal leg infection, followed by a discussion of the history and mission of Floating Doctors.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Ben LaBrot

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• Join the MicrobeTV Discord server
• Floating Doctors
• Letters read on TWiP 245

New Case

A man in his early 20s comes in reporting pain when he urinates or ejaculates. He reports that he is sexually active. He does confide that he has been in a relationship with a woman but he had a sexual encounter outside this relationship about 2 weeks ago when they were on a break and he did not wear protection. He feels like he needs to urinate more often and describes thin white discharge from the penis. He reports that he has no history of any sexually transmitted infections and had no medical issues prior to this.

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Music by Ronald Jenkees

Lilach Sheiner joins TWiP to talk about her career and her work on engineering Toxoplasma gondii secretion systems for intracellular delivery of multiple large therapeutic proteins to neurons.

Hosts: Vincent Racaniello, Dickson Despommier, and Christina Naula

Guest: Lilach Sheiner

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• Join the MicrobeTV Discord server
• Engineering T. gondii for protein secretion (Nat Micro)

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Music by Ronald Jenkees

TWiP solves the case of the Woman with White Worms, and submits a new case involving a 1 year old in northeastern Panama with a fatal leg infection.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Enterobius, the pinworm (TWiP 19)
• Hero: Mary Pritchard

New Case

This case comes from Panama mid summer 2024. A provider for Floating Doctors working in the coastal region in northeastern Panama. This case involves a one year old, so the history is a bit difficult, but there may have initially been a scratch or some sort of break in the skin. Otherwise healthy but over a period of time this area expands and becomes a deep necrotic wound on the leg. Several other nearby wounds develop and become deep and infected. By the time this one year old is seen by the provider much of the leg appears eaten away. This is just the tip of the iceberg as a number of others develop similar wounds in the area. No prior medical history.

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Music by Ronald Jenkees

TWiP reviews a study showing that intestinal helminth infection impairs vaccine-induced T cell responses through an IL-10 pathway, which compromised protection against antigenically drifted SARS-CoV-2 variants.

Hosts: Vincent Racaniello, Daniel Griffin and Christina Naula

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• Join the MicrobeTV Discord server
• Worms impair COVID vaccines (Sci Trans Med)
• Heligmosomoides image (Wiki Commons)

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Music by Ronald Jenkees

Sean Murphy joins TWiP to discuss his career and the work of his laboratory to assess the daily natural history of asymptomatic Plasmodium infections in adults and older children in Katakwi, Uganda.

Hosts: Vincent Racaniello, Dickson Despommier and Christina Naula

Guest: Sean Murphy

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• Join the MicrobeTV Discord server
• Daily natural history of Plasmodium infections (Lancet Microbe)

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Music by Ronald Jenkees

TWiP solves the case of the AIDS patient who developed fever and watery diarrhea after drinking NYC tap water, and present a new case for your sleuthing.

Hosts: Vincent Racaniello and Daniel Griffin

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• Join the MicrobeTV Discord server
• Cryptosporidium (TWiP 18)
• Letters read on TWiP 239

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New Case

Man in his 70s originally from Mainland China, then Hong Kong who has been living in the US for decades is admitted to the hospital with fever for 6 days. He reports that he saw his primary care physician in Queens and was referred to the hospital after blood work revealed a sodium level of 123 and an increased monocyte count. Pt reports drenching sweats, lots of outdoor activity walking in local parks in Queens. He reports he does not feel particularly sick.
PMH-HTN, BPH
PSH-neg
Social-retired, no wife, has one son, no pets, no exotic exposures or recent travel
VS febrile to 39.5, tachycardia, meets sepsis criteria
PE -unremarkable
Labs, nl wbc, eos-0, elevated neutrophils and monocytes, Na-123, elevated AST, elevated ALT, low platelets, low Hct, CT Chest A/P unremarkable

Send your guesses to twip@microbe.tv with TWiP 239 in the subject line

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Music by Ronald Jenkees

Michael Barrett joins TWiP to discuss progress in the elimination of human African trypanosomiasis caused by Trypanosoma brucei gambiense.

Hosts: Daniel Griffin, Dickson Despommier and Christina Naula

Guest: Michael Barrett

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• Join the MicrobeTV Discord server
• Elimination of human African trypanosomiasis (PLoS NTD)
• Hero: David Livingstone

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Send your guesses to twip@microbe.tv with TWiP 237 in the subject line

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Music by Ronald Jenkees

Marilyn Fabbri joins TWiP to reveal the case of a patient who became very ill after he and a number of friends attended a large dinner where venison and boar were served.

Hosts: Daniel Griffin, Dickson Despommier and Christina Naula

Guest: Marilyn Fabbri

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• Join the MicrobeTV Discord server
• Toxoplasma gondii (TWiP 12)
• Parasitic Diseases Lectures #15: Toxoplasmosis
• Letters read on TWiP 237

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New Case

Man in his 60s with HIV/AIDS CD4 count less than 50, CD4% less than 5% and elevated viral load (VL) with report of prior CNS toxoplasmosis requiring a craniotomy, disseminated Mycobacterium avium complex (MAC), comes in with fever and very watery diarrhea x 4 days. He reports that he lives in Georgia but comes up to NY for his HIV care and stays in NYC.

Send your guesses to twip@microbe.tv with TWiP 237 in the subject line

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Music by Ronald Jenkees

Marion Avril of MalarVx, Inc. joins TWiP to discuss an accelerated prime-and-trap regimen using repRNA-based circumsporozoite vaccine.

Hosts: Dickson Despommier and Christina Naula

Guest: Marion Avril

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• repRNA-based CSP malaria vaccine (NPJ vaccines)
• Hero: Mwelecele Ntuli Malecela

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Send your guesses to twip@microbe.tv with TWiP 235 in the subject line

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Music by Ronald Jenkees

TWiP solves the case of a man in his 50s reporting months of abdominal discomfort, who takes mebendazole and some time afterwards vomits a worm into the sink.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• The giant intestinal worm, Ascaris lumbricoides (TWiP 21)
• Parasitic Diseases Lectures #24: Giant Intestinal Worm (YouTube)
• Letters read on TWiP 235
• Hero: Ernst A. H. Friedheim

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New Case:

I first learned about this case from a colleague at work who tells me that their friend has just gotten really sick. The friend is described as having had multiple illnesses over time but that he has never been as sick as he recently got. He reports that the illness began as a diffuse myalgia with fever, there was some sore throat, noted swelling in the neck, and overwhelming fatigue. He tells some of his friends that he is feeling really terrible and it turns out that some of his friends also feel poorly. It turns out that about a week prior to the onset of his symptoms he and a number of friends attended a large dinner where venison and boar was served. 

This individual is then seen in our office. Some testing is done. He feels really terrible and despite being reassured that he should get better without treatment he is given therapy.

Send your guesses to twip@microbe.tv with TWiP 235 in the subject line

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TWiP discusses hookworm infection and the phase 1 clinical trial for a hookworm vaccine that could one day protect children from the hookworm anaemia, and reduce transmission of this infection.

Hosts: Dickson Despommier, Daniel Griffin, and Christina Naula

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Links for this episode

• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Hookworm vaccines in school-aged children in Gabon (Lancet Inf Dis)
• Step forward towards hookworm vaccines (Lancet Inf Dis)
• Hookworm vaccine protects dogs (FASEB J)
• Hero: Muriel Robertson

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Music by Ronald Jenkees

TWiP solves the case of the physician with no significant previous medical history who is currently doing their fellowship training develops diarrhea, and presents a new clinical case for our astute listeners to solve.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Hero: Keith Vickerman
• Letters read on TWiP 233

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New Case study:

I was recently asked about this case while I was off visiting Denmark. A man in his 50s has been reporting months of abdominal discomfort and decides to go discuss this situation with a local pharmacist. He describes this discomfort, some nausea, and some bloating of the abdomen. The pharmacist recommends that he take mebendazole. He takes the mebendazole and some time afterwards he vomits a worm into the sink. The worm does not have any obvious segmentation and appears completely nonsegmented and is moving around. One end is very pointy and the other little less so. 

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Music by Ronald Jenkees

TWiP reviews the cellular lives of Wolbachia, a gram-negative bacteria that infects many arthropods and filarial nematodes with very different outcomes – parasitism or mutualism.

Hosts: Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Cellular lives of Wolbachia (Nat Rev Micro)
• Hero: Patricia F. Walker

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Music by Ronald Jenkees

TWiP solves the case of the Woman With White Worms, and presents a new clinical case to decipher.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Hero: Ann Bishop

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New Case study:

A physician with no significant PMH who is currently doing their fellowship training develops diarrhea. The diarrhea is significant enough that they are beginning to feel weak, lightheaded, and end up going to the local ER. The physician lives in NYC, works most of the time but did just get back from a week-long vacation in Florida with their long-term partner where they got a chance to swim in the pool and get some sun. They returned feeling well and then noted the onset of the diarrhea. The diarrhea was watery, with some abdominal cramping but no noted blood or actual fever. The stool did not have a strong smell and no floating stools were reported. The physician was given IVF and returned home feeling better but now gets a call that there is a parasite on the stool testing and is recommended to take a medicine they have never heard of 3x per day for 3 days. 

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Music by Ronald Jenkees

Maria Adelaida Gomez joins TWiP to discuss her career and the work of her laboratory on understanding the healing process during cutaneous leishmaniasis.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

Guest: Maria Adelaida Gomez

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Links for this episode

• CIDEIM
• Healing in cutaneous leishmaniasis (J Immunol)

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Music by Ronald Jenkees

Eyal joins TWiP to solve the case of the Female Traveler with Intermittent Fever and Ring Enhancements in the Liver.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

Guest: Eyal Leshem

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Case Study for TWiP 229

Woman in her 40s is referred to me to be seen in the office from one of my colleagues. She reports that she has been having recurrent issues with worms exiting her anus and vagina since 2018. She reports that she lives with her husband and 4 children and they have never reported any issues. She reports that initially she took something over the counter and things resolved. She then a couple years later has this problem again and this time discussed the problem with her housekeeper from El Salvador who gave her an antiparasitic tablet from her home country. This problem has now recurred and she was referred to a GI doctor who she explains laughed at her and suggested she see a psychiatrist. She come in now very upset and tearful. She relates that she has this itching that wakes her up at night and was able to take pictures of something she found on the anus. She has photos as well as a video of a thin white 1 cm motile thing with on end coming to a point. 

She reports a normal nonrestrictive diet. She reports no travel outside the US or even outside the local area. No PMH, no PSH, family history of different cancers. She does not work outside the home. She reports no pets. She has an unremarkable exam and labs only notable for low vitamin D. 

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Music by Ronald Jenkees

TWiP discusses a tapeworm that causes extreme lifespan extension in infected ant workers, and a candidate antibody drug for prevention of malaria.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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Links for this episode

• Extreme lifespan extension in tapeworm-infected ant workers (Roy Soc Open Sci)
• Candidate antibody drug for prevention of malaria
• Ceilidh goes viral (YouTube)

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Music by Ronald Jenkees

Jim Small joins TWiP to solve the case of the 41 year old Man with sudden GI distress and itchy hives, followed by a discussion of parasites and childhood stunting.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

Guest: Jim Small

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Links for this episode

• Parasites and childhood stunting (Trends Parasitol)
• Letters read on TWiP 227

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Music by Ronald Jenkees

TWiP reviews some parasite stories of 2023, including progress in the control of malaria and polio, and review a connection between parasites and childhood stunting.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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Links for this episode

• Second malaria vaccine (Nature)
• Malaria report 2023 (WHO)
• Malaria and climate change (WHO)
• Parasites and childhood stunting (Trends Parasitol)
• Sea creature spotted off Japan identified (Science)

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Music by Ronald Jenkees