This Week in Parasitism (Science)
TWiP is a podcast about the tiny creatures that live in and on us.

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

Hosts: Daniel GriffinDickson Despommier and Christina Naula

Guest: Michael Barrett

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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

Direct download: TWiP238.mp3
Category:Science -- posted at: 9:00pm PDT

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 GriffinDickson Despommier and Christina Naula

Guest: Marilyn Fabbri

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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

Direct download: TWiP237.mp3
Category:Science -- posted at: 9:00pm PDT

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

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Music by Ronald Jenkees

Direct download: TWiP236.mp3
Category:Science -- posted at: 2:18pm PDT

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 RacanielloDickson DespommierDaniel Griffin, and Christina Naula

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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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Direct download: TWiP235.mp3
Category:Science -- posted at: 9:00pm PDT

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 DespommierDaniel Griffin, and Christina Naula

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Music by Ronald Jenkees

Direct download: TWiP234.mp3
Category:Science -- posted at: 12:33pm PDT

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 RacanielloDickson DespommierDaniel Griffin, and Christina Naula

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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. 

 Send your questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP233.mp3
Category:Science -- posted at: 9:00pm PDT

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 DespommierDaniel Griffin, and Christina Naula

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Music by Ronald Jenkees

Direct download: TWiP232.mp3
Category:Science -- posted at: 9:00pm PDT

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

Hosts: Vincent RacanielloDickson DespommierDaniel Griffin, and Christina Naula

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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

Direct download: TWiP231.mp3
Category:Science -- posted at: 10:41am PDT

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 RacanielloDickson DespommierDaniel Griffin, and Christina Naula

Guest: Maria Adelaida Gomez

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Music by Ronald Jenkees

Direct download: TWiP230.mp3
Category:Science -- posted at: 10:55am PDT

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

Hosts: Vincent RacanielloDickson DespommierDaniel 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

Direct download: TWiP229.mp3
Category:Science -- posted at: 11:40am PDT

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

Hosts: Vincent RacanielloDickson DespommierDaniel Griffin, and Christina Naula

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Music by Ronald Jenkees

Direct download: TWiP228.mp3
Category:Science -- posted at: 11:07am PDT

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 RacanielloDickson DespommierDaniel Griffin, and Christina Naula

Guest: Jim Small

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Music by Ronald Jenkees

Direct download: TWiP227.mp3
Category:Science -- posted at: 6:35pm PDT

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 RacanielloDickson DespommierDaniel Griffin, and Christina Naula

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Music by Ronald Jenkees

Direct download: TWiP226.mp3
Category:Science -- posted at: 1:52pm PDT

Chuck Knirsch returns to TWiP to discuss the Neglected Tropical Diseases Roadmap published by WHO, which sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups.

Chuck Knirsch returns to TWiP to discuss the Neglected Tropical Diseases Roadmap published by WHO, which sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups.

Hosts: Vincent RacanielloDickson Despommier, and Chuck Knirsch

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  • Neglected Tropical Diseases Roadmap (WHO)
  • World malaria report 2023 (WHO)

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Direct download: TWiP224.mp3
Category:Science -- posted at: 9:15am PDT

TWiP solves the case of the Haitian female with AIDS and voluminous diarrhea, and review the pathogenesis, epidemiology, prevention and treatment of malaria and Chagas disease.

Hosts: Vincent RacanielloDickson DespommierDaniel Griffin, and Christina Naula

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Download TWiP #223 (63 MB .mp3, 88 minutes)

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Case Study for TWiP 223

46 yo man with minimal pmh, elevated cholesterol, ongoing right upper extremity swelling, 5-10 years intermittently. Goose egg swelling on hand, foot. Lasts for hours, every few months. Go to ER, right upper extremity. Lives in NYS suburbs, Is vet and epidemiologist. Has done extensive travel, Liberia, Ghana, DRC, Uganda, Rwanda, 2 week duration. Doing work, fair amount of animal contact with bats, rodents, birds. PE unremarkable except for swelling of right arm. Blood work unremarkable. 2.5 yr later notice prickling irritation under right eyelid, think they see undulation under skin. 

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Music by Ronald Jenkees

Direct download: twip223.mp3
Category:Science -- posted at: 2:25pm PDT

At the meeting of the American Society for Tropical Medicine and Hygeine in Chicago, Natasha joins TWiP to solve the case of the Man with a Generalized Seizure and Infectious Forms in the Brain.

Hosts: Vincent RacanielloDickson DespommierDaniel Griffin, and Christina Naula

Guest: Natasha Spottiswoode

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Case Study for TWiP 222

Haitian creole speaking, cachetic female in her 50s w/ hx HIV (noncompliant on medication), migrating from Haiti brought in by her daughter for dysphagia, cough x days, associated with NBNB vomiting, oral thrush extending to soft palate, concerning for oropharyngeal candidiasis. Weeks of nonresolving diarrhea. Admitted for failure to thrive and deconditioning, found to be Parainfluenza 3 positive), undergoing TB rule out. Diarrhea is voluminous, pt is dehydrated, there has been significant weight loss and lethargy over the last few weeks.

MHx:

HIV 

Shx:

Lives in haiti

Remarried, Last sexual encounter 2 years ago.

Denies illicit drug use. Drinks alcohol 

Allergies: No Active Allergies

Labs return with CD4 count in the 50s, elevated viral load. CD4 55/3%

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP222.mp3
Category:Science -- posted at: 5:31am PDT

TWiP solves the case of the Hiker from Queens who Denies Bug Bites, and reveal two different malaria experimental vaccines that target different parts of the parasite life cycle.

Hosts: Vincent RacanielloDickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 220

Sent by Michelle and Alexander from the First Vienna Parasitology Passion Club

A 36 year old male presents to the local ED with shortness of breath. Additional symptoms included a stinging pain in different parts of his extremities, fatigue, abdominal cramps and bowel irregularities. On exam he was resting comfortably and his vitals were normal, but the patient appears very distressed by his symptoms. His left eye showed signs of irritation, including redness and swelling. A detailed history reveals travel to the Caribbean about 4 years ago and several short trips to central and east Africa, all between 5 and 10 years ago. His initial labs were grossly unremarkable and a chest x-ray showed no abnormalities. The patient himself suspected a specific parasitic etiology of his symptoms, so we performed a number of serologies and stool examinations in search of  parasitic diseases. None of the tests revealed evidence of an ongoing infection. 

He is HIV negative and not sexually active at the moment. He has no pets and no other recent travel history. He eats a normal diet and has been out of work for two years.

Thank you for the opportunity to participate in this fantastic project! All the best, 

Michelle and Alexander from the First Vienna Parasitology Passion Club

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP220.mp3
Category:Science -- posted at: 4:19pm PDT

TWiP solves two cases this week, the Man with Issues after COVID-19, and the Man with Left Arm Weakness, then describe how the malaria parasite evades mosquito immunity by glutaminyl cyclase–mediated posttranslational protein modification.

Hosts: Vincent RacanielloDaniel Griffin, and Christina Naula

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Case Study for TWiP 218

A fun twist for today. Did I mention recently I was spending time with Paul Calle at the Central Park and instead of Jeff Bezos showing up for Dinner Chevy Chase was there.

Here we have the case of a 19 month old female who seems to be having some issues. Lots of increased respiratory effort even with minimal exertion. Some issue with loose stools and then followed by the onset of facial swelling.  No sig PMH or PSH, fairly confident there is not smoking or drinking of alcohol and certainly not HIV+. On exam the increased respiratory effort that is audible.

Directed testing reveals canine coccidia and giardia in the stool.

So what is going on? Should I be worried about my daughter who has had lots of exposure?

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP218.mp3
Category:Science -- posted at: 4:09pm PDT

Eyal joins TWiP to solve the case of the case of the Feverish Patient from Israel, and reveals his training and experience with travel medicine in Israel.

Hosts: Vincent RacanielloDickson Despommier, Daniel Griffin, and Christina Naula

Guest: Eyal Leshem

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Case Study for TWiP 216

This is a case from one of my colleagues in North West China. Many years ago when I was asked to teach at Kunming University I had a plan to climb in the beautiful Tianshan mountains and again a second time when I ended up distracted at the southern edge of the Gobi desert and instead spent time in a Tibetian monastery. Stories for another day. For today we have:

A man right around age 30 who presented with right lower extremity weakness, numbness and issues with bowel and bladder function. When he was just a few years old he had reported dog exposure and had a lesion removed from his liver. No reported dog exposure since he was young. He is found to have a mass in the right upper buttock. His wbc is normal but ESR and CRP are elevated. He has a CT which reveals cystic lesions and significant destruction of L5 through the sacrum and coccyx.

What could this be and what is recommended as next steps.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP216.mp3
Category:Science -- posted at: 9:00pm PDT

Kay Schaefer joins TWiP to solve the case of the German Male with Hematuria, and discusses Tropical Medicine Excursions, which provides patient-oriented training courses for healthcare professionals who wish to improve their clinical skills in tropical medicine and travelers’ health in the endemic regions of Uganda, Tanzania and Ghana.

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

Guest: Kay Schaefer

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Case Study for TWiP 214

Still in Uganda but now in a clinic in Entebbe. A boy, less than age 10, who grows up in very limited conditions, dirt floor home with other siblings presents with recurrent right upper abdominal pain, fevers, and first undergoes blood work that shows eosinophilia. He has an abdominal ultrasound performed which shows what looks like a mobile piece of spaghetti in the gallbladder with dilated ducts. He also has a stool examination performed.

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Music by Ronald Jenkees

Direct download: TWiP214.mp3
Category:Science -- posted at: 9:00pm PDT

Jessie Stone joins TWiP to solve the case of the Boy With a Swollen Belly, and discusses Soft Power Health, a clinic that she founded in Uganda to provide healthcare for people in need.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Jessie Stone

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Soft Power Health
Letters read on TWiP 213

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Case Study for TWiP 213

A 49 y.o. German male is seen with significant gross hematuria. He reports no travel outside Europe but does report that he visited France twice, 7 years before and 1 year before. He reports swimming in the Solenzara River in the southeastern part of the island, near a busy campsite. He might have gone into the Gravona River in western Corsica near Ajaccio, at a turtle park and near a campsite, and at the Tavignano River. The patient also reported swimming in the Restonica River. He reports never swimming in the Cavu River and using GPS data from his smartphone and camera, he reconstructed his bathing sites precisely and this history was confirmed.

Exam was unremarkable. Complete blood count was unremarkable and did not show eosinophilia.

This complaint triggered cystoscopy and biopsies that were sent for histological analysis. These findings triggered referral to the Tropical Medicine department at LMU Hospital Munich.

Now in the next episode we will have a guest to discuss this case as well as tell us a bit about themselves. I am hoping people will tell us what they think this might be but then perhaps do a bit of research and go into a little more detail.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP213.mp3
Category:Science -- posted at: 8:42am PDT

Shauna Gunaratne joins TWiP to solve the case of the Man from Mali with Painless Skin Lesions, and discuss her plans for a tropical medicine institute in New York City.

Hosts: Vincent RacanielloDickson Despommier, Daniel Griffin, and Christina Naula

Guest: Shauna Gunaratne

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Download TWiP #212 (51 MB .mp3, 84 minutes)

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Case Study for TWiP 212

14 year old boy with a history of slow progressive development of abdominal ascites over years.  Appears wasted and malnourished. Afebrile, no history of weight loss or night sweats, no history of TB exposure, HIV negative. Had an older brother who died the year before of apparently the same disease. Had lived early life by the shores of lake Victoria. Currently has really impressive abdomen.

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Music by Ronald Jenkees

Direct download: TWiP212.mp3
Category:Science -- posted at: 12:35pm PDT

TWiP solves the case of the Man from Hong Kong with Multiple Comorbidities, and discuss safety and efficacy of a monoclonal antibody against malaria in Mali.

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

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Case Study for TWiP 211

Man in his 20s originally from Mali who comes in with a dermatological complaint about 1 mo after he returned from spending time in Bamako, Mali with friends and family. Reports this has been going on for months and he is getting very frustrated as he is not getting any answers. He relates that this started with itching over a “blackhead” resembling a pimple that was itchy and very small. Over the subsequent months it started to get larger with ongoing itchiness but no pain. No erythema or warmth in the area. Other lesions developed in addition to the first one. There was no drainage from the skin lesions. He started putting triple antibiotic ointment on his lesions that he bought from a pharmacy.

He then went to his primary doctor who prescribed a topical medication and PO antibiotics but this did not help. 

He reports that when in Mali he stayed in his house with his parents, siblings, grandmother and other extended relatives – more than 40-50 people under one roof. food made by his family, reports consumption of only cooked meat, no uncooked meat. Ate salads and uncooked vegetables. No contact with any animals, no pets in the home. Denies any contact with any pets or farm animals such as pigs, cows, horses, cattle. Denies swimming in any lakes or ponds. No hiking or outdoor activities. No riding horses.

Was sexually active in Mali with women and is HIV negative. 

On examination he has a 10 cm lesion over anterior L thigh, with verrucous and vegetative appearance with yellow crusting over central area and heaped up lesion, not undermined. No erythema, warmth or drainage. Has a similar smaller lesion measuring about 3 cm on R flank. Has a 3rd smaller lesion with some mild crusting and about 2cm over R posterior thigh.

He ends up getting a biopsy that reveals:

HISTOLOGIC FEATURES That ARE NOT DIAGNOSTIC.  THERE IS NO EVIDENCE OF any specific organisms.  THE EXOGENOUS MATERIAL WHICH COULD REPRESENT SOME TYPE OF FOREIGN BODY IS NOT IDENTIFIABLE AS PART OF A FLY OR ARTHROPOD, NOR IS IT TYPICAL OF A SPLINTER AND ITS PRESENCE IN THE SPECIMEN MAKES IT PROBLEMATIC AS TO ITS SIGNIFICANCE. MICROSCOPIC DESCRIPTION: WITHIN THE DERMIS THERE IS A DENSE DIFFUSE MIXED CELL INFLAMMATORY INFILTRATE INCLUDING MANY PLASMA CELLS AND NEUTROPHILS. THERE IS EXOGENOUS MATERIAL.  PAS, GMS, FITE AND GRAM STAINS ARE NEGATIVE FOR INFECTIOUS ORGANISMS.

Additional testing is ordered that leads to the diagnosis.

He is planning on returning to Mali and perhaps sooner than originally planned if he does not get a diagnosis since he thinks the doctors in Mali would know what he has.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP211.mp3
Category:Science -- posted at: 11:07am PDT

The TWiP team solves the case of the Woman From Hawaii With Allodynia and abdominal pain, bilateral hip and leg pain, dizziness, and diffuse hyperesthesia.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 209

Man in his early 70s with PMH sig for HTN, DM-II, HLD, BPH is admitted to the hospital after coming from Guatemala to visit his son. He feels faint with standing and is noted to have a HR in the 40s and does not feel well when he stands. He is also noted to have diarrhea, but this has been going for an unclear period of time. On EKG he is noted to have a RBBB.

PMH  HTN, DM-II, HLD, BPH PSH neg

Allergies NKADR

Social -no toxic habits reported, reports living in Guatemala City but grew up in the rural areas. Enjoys fruit juice

FH-noncontrib

Exam: slow heart rate, orthostatic

A number of blood and stool tests are collected and he is referred to a tertiary care center for implantation of a cardiac pacemaker. At the tertiary care center the patient is seen by an Infectious Disease Specialist and a number of tests are ordered by the Infectious Disease Consultant but they are canceled by Cardiologist who writes in their note “no concern for an infectious process”. Now one of the tests collected at the first hospital returns with an interesting result that is later confirmed by a second test.

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Direct download: TWiP209.mp3
Category:Science -- posted at: 7:58am PDT

The TWiP team solves the case of the Woman Who Vomited Up a Worm, and discuss how malaria transmission intensity can modify the effectiveness of the RTS, S/AS01 vaccine in Africa.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 208

An adult female resident of Hawai’i presented to the emergency department (ED) with several days of fever, abdominal pain, urinary hesitancy, and generalized itchiness. white blood cell [WBC] count 14,000 cells/mL) without eosinophilia. Urinalysis suggested a urinary tract infection and she was treated for acute UTI and discharged home. 

The following day she returned to the ED because of worsening abdominal pain, bilateral hip and leg pain, dizziness, diffuse hyperesthesia, and allodynia (Pain from stimuli which are not normally painful)  (worse on her feet and legs.) Urine culture from her initial ED visit grew normal urogenital flora. Her leukocytosis increased and she now had eosinophilia (WBC count 15,500 cells/mL; absolute eosinophil count 574). Laboratory evaluation was otherwise unremarkable. CT scans of the brain, abdomen, and pelvis were normal.

She was hospitalized and her allodynia worsened despite treatment with analgesics. She also developed a sensation of “electric eels swimming through [her] body. Electromyography and nerve conduction studies were normal. The patient underwent a lumbar puncture and CSF examination was notable for eosinophilic meningitis with 138 WBCs and 13% eosinophils (absolute eosinophil count 18).

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Music by Ronald Jenkees

Direct download: TWiP208.mp3
Category:Science -- posted at: 8:02am PDT

Claire joins the TWiP team to discuss her training and experience as an infectious disease physician, and her transition to science communication, then we solve the case of the Honduran Male with Seizures.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

Guest: Claire Panosian

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Case Study for TWiP 207

Woman in 20s, spent time in Kenya 6 months prior, vomited up a worm. 0.5 cm in length. Sent to lab. Was moving. Earlier that day she went out with friends to sushi place, ate fish. Developed horrible abdominal pain, then vomited. 

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP207.mp3
Category:Science -- posted at: 9:00pm PDT

The TWiP team solves the case of the Ghanian Women With Leg Swelling, and relate how Anopheline mosquitoes are protected against parasite infection by tryptophan catabolism in gut microbiota.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 206

42 yo Spanish speaking male, originally from capital city of Honduras. Admitted to hospital after seizure. Grew up in Honduras, 20 year history of seizures. Now in NYC area. Treated with carbamazepine, 2x a day. Has not filled scrip for 3 months. Fast heartrate, o2 sat fine, no fever. No surgery, no toxic habits. Unremarkable physical exam. Undergoes blood work and head imaging. CBC normal, normal diff, slight elevation in blood glucose. Imaging of head reveals non-specific coarse calcification. Eats regularly.

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Music by Ronald Jenkees

Direct download: TWiP206.mp3
Category:Science -- posted at: 9:00pm PDT

The TWiP team solves the case of the Pregnant Ghanian Living Near a River, and reveal emodepside, a drug for treatment of onchocerciasis.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

Download TWiP #205 (56 MB .mp3, 93 minutes)

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Case Study for TWiP 205

Two women, 80s and 50s. Former had 9 children, lives in Ghanian village with large lagoon, many mosquitoes. Concerned about chronic swelling of left leg, groin area for much of her life. Walks barefoot. 50 yo with 4 children, both legs started to swell, cold, mosquito bites. With time left leg becomes hard, swollen, disfigured. Has gone to hospital for ulceration. Common problem in her village, mostly women but some men. Problems getting access to medications. 

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Music by Ronald Jenkees

Direct download: TWiP205.mp3
Category:Science -- posted at: 4:43pm PDT

The TWiP team solves the case Two Ghanians Near A Fast-Flowing River, and discuss a promising new drug for treatment of African trypanosomiasis.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 204

Pregnant woman, 20 yo, living in eastern Ghana near Volta River delta. Often in river. In second trimester. Comes in with abdominal pain, bloody diarrhea. Ovoid forms seen in stool, 160 microns, have single lateral projections. Other ovoid forms 45×30 microns which contain polar bodies.

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Music by Ronald Jenkees

Direct download: TWiP204.mp3
Category:Science -- posted at: 9:00pm PDT

The TWiP team solves the case of the Shopkeeper with Thirst, Rash, and low Blood Oxygen, then review a study on the effect on survival to adulthood in Tanzania of mosquito net use in early childhood.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 203

Two individuals, same issue. Small village in Ghana, near fast flowing river. Teenaged boy, father farmer. Boy develops severe itchy rash on right leg. Light and dark areas. They live nearby, father farms near river. After school they swim in river then travel. Father in 70s, has 2-3 cm nodule on left knee, second on in groin area, no other problems. Has some visual issues. Nodules are firm, fixed to the skin.Both have positive diagnostic skin snip.

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Music by Ronald Jenkees

Direct download: TWiP203.mp3
Category:Science -- posted at: 11:55am PDT

Sara from the Febrile Podcast joins the TWiP team at The Incubator to solve the case of the Man With an Egg Laden Colonic Mass, and Daniel presents a new puzzle for us to solve.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

Guest: Sara Deng

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Download TWiP #201 (72 MB .mp3, 60 minutes)

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Case Study for TWiP 202

Man 60 yo shopkeeper in Rohingya Camp displaced Myanmar natives. 3 months getting up at night, urinating, thirsty, losing weight. Develops rash on elbows, abdomen, very itchy. Rest of family has rash as well. Starts headache, fever, cough, trouble breathing, seeks medical care. O2 sat is in 80s. Past med/surg healthy individual, heavy smoker, HIV negative. Living in dwelling with tin roofs, dirt floors, many people crowded. Elevated WBC count; elevated glucose.

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Music by Ronald Jenkees

Direct download: TWiP202.mp3
Category:Science -- posted at: 7:16am PDT

The TWiP team solves the case of the Man with a Cat and Ring Enhancing Lesions, and discuss domestic mammals as reservoirs for Leishmania donovani on the Indian subcontinent.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 201

Older male, >65, abdominal pain over last several months, getting worse, otherwise feels well. No change in weight. Past medical, surgical unremarkable. Social: grew up in rural inland China. As adult lived in large city. Always active and healthy, eating fish and leafy vegetables. Move to US 10 years before illness. No pets. No toxic habits. HIV negative. Unremarkable exam. Labs: elevated white count, platelets low, not anemic. Differential on white count: neutrophils predominant. Gets belly CT: reveals mass in colon. Colonoscopy done, mass resected. Pathology: shows adenocarcinoma, but also eggs in sample. Slightly ovoid, 80 microns.

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Music by Ronald Jenkees

Direct download: TWiP201.mp3
Category:Science -- posted at: 7:01pm PDT

The TWiP team solves the case of the Traveler to Tanzania with a Purple Lesion, and discuss Mosquirix, the first vaccine approved for Plasmodium parasites.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 199

Gentleman in 40s, repeated intestinal issues, diagnosed with Giardia and treated, a year later again, again not feeling well. Stool testing shows Blastocystis and Endolimax nana. Lives in NYC area, single, active socially with different partners, no other medical problems, does take PREP for AIDS. Exam and labs normal except for stools. HIV negative. Treated with metronidazole, no impact on symptoms. Coincides with successful encounters.  

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Music by Ronald Jenkees

Direct download: TWiP199.mp3
Category:Science -- posted at: 3:34pm PDT

The TWiP quadfecta solves the case of the Traveler With Watery Diarrhea, and reveals that a heat-shock response regulated by a transcription factor protects human malaria parasites from the high temperatures of fever.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

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Case Study for TWiP 198

31 yo woman, previously healthy, traveled to Tanzania, went on 11 day long safari. One week later, at home, developed fever and severe headache, went into hospital. Thick blood smears negative, physical exam normal, small purple lesion near buttocks. Started on treatment for African tick bite fever. Did not get better, lesion grew in size. Biopsy of lesion, nothing remarkable on microscopy. Improved, sent home, 10 days another bout of fever that went down in 2 days. Lesion healed. PCR for plasmodium, Borrelia negative, but seroconverted for Rickettsia. Went home, a week later another 3 day bout of fever.   

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Music by Ronald Jenkees

Direct download: TWiP198.mp3
Category:Science -- posted at: 9:00pm PDT

TWiP solves the case of the Adventurous Eater with Areas of Swelling, and discusses an experimental Trypanosoma vivax vaccine comprising an invariant flagellum antigen.

Hosts: Vincent Racaniello, Dickson DespommierDaniel Griffin, and Christina Naula

Download TWiP #197 (39 MB .mp3, 64 minutes)

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Case Study for TWiP 197

Gentleman in late 20s, has for weeks had watery diarrhea that is not getting better. Recently took trip to Oaxaca, Mexico. Stayed at nice hotel, all fruits, vegetables, salads well cleaned. Always ate at hotel. Developed diarrhea there. Went with three others, stayed at same place. No prior surgeries, no family history, no medications, no toxic habits. Daniel recommends one test and that gives diagnosis and therapy and he resolves.  

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Music by Ronald Jenkees

Direct download: TWiP197.mp3
Category:Science -- posted at: 10:51am PDT

TWiP solves the case of the Homeless Man With Skin Issues, and discusses an experimental mRNA based malaria vaccine.

Hosts: Vincent Racaniello and Daniel Griffin

Download TWiP #196 (49 MB .mp3, 81 minutes)

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Case Study for TWiP 196

30 yo woman having areas of swelling in different parts of body, blood work shows elevated eosinophils. History: prior had been travelling around SE Asia. Had some loose stools on return, some tingling in fingers, otherwise fine. Adventurous eater, fish, pickled fish, salads. Previously in good health, no surgeries, all in family healthy. No meds. Lives alone. Went to Indonesia and Thailand. Toxic habits: no smoking, drinks periodically, HIV negative. On exam: swollen area on arm, biopsy is done. Pathologist report: cross section has what appears to be larval nematode.  

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Music by Ronald Jenkees

Direct download: TWiP196.mp3
Category:Science -- posted at: 7:30am PDT

Christina returns to the TWiP trifecta to solve the case of the Beachgoer with Red Lines on Her foot, and an experimental malaria vaccine based on the junctional region of the circumsporozoite protein displayed on a virus-like particle.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Christina Naula

Download TWiP #195 (46 MB .mp3, 76 minutes)

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Case Study for TWiP 195

Gentleman in 60s, does not have permanent home, comes in with skin issues. Pruritis all over. Wearing heavy coat, unwashed polyester shirt. 1 cm diameter patches, erythematous, areas where open from scratching. Cover much of torso. Solve case by examining his clothes.  

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Music by Ronald Jenkees

Direct download: TWiP195.mp3
Category:Science -- posted at: 4:13pm PDT

TWiP solves the case of the Long Island Man with Unilateral Eye Pain, followed by a discussion of how enteric helminth coinfection enhances host susceptibility to West Nile virus by a tuft cell-IL-4 receptor signaling axis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Christina Naula

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Case Study for TWiP 194

Woman in 40s, on return from Puerto Rico where she often went. Went to local beaches, brought their dogs. Noticed problem on foot, raised red serpiginous lines, slowly moving all over the foot. Bloodwork showed elevated eosinophils. 

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Music by Ronald Jenkees

Direct download: TWiP194.mp3
Category:Science -- posted at: 11:31am PDT

Audun returns to help solve the case of the Ecuadorean Gentleman Treated for COVID-19, followed by a discussion of the interaction of Blastocystis with the intestinal microbiota and the immune system, and of course a new clinical case from Daniel.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Audun Lier

Download TWiP #192 (46 MB .mp3, 76 minutes)

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Case Study for TWiP 193

Male, 50s, seen by physician for unilateral eye pain, blurred vision, watery drainage. Soft contact lens wearer. Given eye drops, oral medication, sent for another opinion when does not resolve. Has hypertension, hyperlipidemia, no surgeries, no allergies, is on hypertension/statin med. Works in store. No toxic substance use. HIV negative. Lives on large piece of land with his own well, away from city, own septic tank. Left eye is very red. Ophthalmologist report: decreased visual acuity in left eye, injection of conjunctiva, edema, erosions, send corneal scrapings for culture. Swims in Long Island Sound. No travel history. No pets. 

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Music by Ronald Jenkees

Direct download: TWiP193.mp3
Category:Science -- posted at: 9:00pm PDT

The TWiPers solve the case of the Teenager in Malawi with Red Urine, then Audun joins to present our clinical case for this episode.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Audun Lier

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Case Study for TWiP 192

Older gentlemen with chills, muscle aches, headaches, shortness of breath, family members same symptoms. Hypertension, diabetes. From rural Ecuador, worked in timber industry, worked on farm. No pets. COVID positive. Treated with steroids, ab. Got worse over next two weeks. Developed bloodstream infection and pneumonia. Saw serpiginous trail on diagnostic agar plate of sputum sample. Started on treatment and recovered. No eosinophils on admission, later developed eosinophilia. 

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Music by Ronald Jenkees

Direct download: TWiP192.mp3
Category:Science -- posted at: 9:00pm PDT

The TWiPers solve the case of the Rural Man from North Carolina with Blurred Vision, and discuss the results of single-cell RNA sequencing of Schistosoma mansoni.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 191

Visit in Malawi, capital, teenage son of USAID worker urine has started to turn red. New to Malawi. On weekends go 2.5 hr east to lake and place to swim, Lake Malawi. Given pills, taken morning and night, clears up. Rest of family has been swimming in Lake Malawi. All in family are healthy. 

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Music by Ronald Jenkees

Direct download: TWiP191.mp3
Category:Science -- posted at: 10:07am PDT

Christina from Glasgow returns to help the TWiPlets solve the case of the Ghanian Woman with Abdominal Mass, followed by discussion of the impact of COVID-19 on malaria morbidity and mortality in Africa.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Christina Naula

Download TWiP #190 (57 MB .mp3, 94 minutes)

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Case Study for TWiP 190

Male, 50 yo, rural NC, suddenly notices blurred vision right eye. Went away 1 hr later, normal vision. Returned next night, same eye, then corrected. Went to local doctor, sent to larger med center, went to Presbyterian Hospital NYC. Had exposure to various animals, normal diet. Dickson and Dr. Brown went to see this gentleman. Examined by head of ophthalmology dept. Dickson looked through ophthalmoscope and saw cause of his blurred vision in anterior chamber of eye. Next morning when were going to remove it, had penetrated optic nerve and disappeared. Sent home and never heard from again. Made living by selling hunting dogs, ran a kennel. 

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Music by Ronald Jenkees

Direct download: TWiP190.mp3
Category:Science -- posted at: 9:00pm PDT

Christina from Glasgow joins the TWiPlets to solve the case of the Elderly Gentlemen with Full Body Rash, and to present a new clinical case for listeners to solve.

Guest: Christina Naula

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Case Study for TWiP 189

At a clinic in Ghana, woman seen for hernia, large swelling in right upper abdomen that grew steadily in previous year. Exam found to have mass, too high for inguinal hernia. Thought to be in liver. Mother, subsistence farmer, 50s, not unwell, no jaundice, mobile, overweight. Lump was firm, did not appear to be fluid filled, did not reduce under pressure, smooth, over 20 cm. Concern was liver cancer. Due to remoteness of clinic not possible to order tests. One test was done which could deliver the diagnosis.

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Music by Ronald Jenkees

Direct download: TWiP189.mp3
Category:Science -- posted at: 7:53am PDT

Dickson, Daniel and Vincent solve the case of the Baby with Hydrocephalus, and present a new clinical case for listeners to solve.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 188

Man in 90s, suffering for months, healthy, hypertension, diabetes, large man, over 6 ft, 200 lb, rash. Full body rash for months. Gone through allergy med, cream, prednisone, some helped but regressed. Tried ivermectin 3 pills, got better for a few weeks, then rash worsened. Primary care doc did thorough exam, found abnormal area between toes, did scraping, sent to lab. When came back, asked some questions. Wife is also suffering. Gave larger dose of ivermectin, repeated 2 weeks later, wife also treated, and then recover. Not COVID-19, no HIV-AIDS, no drinking or smoking. Started before COVID, first in wife. Had gone on trip, not far away, stayed in hotel. No pets.

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Music by Ronald Jenkees

Direct download: TWiP188.mp3
Category:Science -- posted at: 7:20am PDT

Dickson, Daniel and Vincent solve the case of the Middle Aged Woman with Loss of Vision in One Eye, and discuss the role of heme oxygenase in the various protozoan infections.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 187

Pregnant newly married, living North Shore, first pregnancy. Affluent family, measured successful lawyer who cooks. Organic eating. Boy born at 9 mo, has midwife, has delivery at home. Baby has enlarged head. OB diagnosed with hydrocephalus. Mother healthy. No meds. Works in retail store, lives with husband, not working for second half of pregnancy. Drank alcohol rarely. No significant travel. Patient reports having no pets but her brother owns small farm, and husband likes serving rare meats, all kinds, which she has eaten since she married him. Will do ultrasound, CT, blood work.

Music by Ronald Jenkees

Direct download: TWiP187.mp3
Category:Science -- posted at: 7:17am PDT

Dickson, Daniel and Vincent solve the case of the Elder Gardener Feeling Poorly, and discuss the three-dimensional ultrastructure of Plasmodium falciparum during cytokinesis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 186

Middle aged woman quite upset, referred to Daniel. Sheltering at home, one day looking at her children, noticed problem with vision. When covers right eye, notices area of loss of vision in left eye. No other associated symptoms. Admitted to hospital, blood tests, eye exam (lesion in back of eye had developed). Blood: WNV serology, another was done but he’s not saying. Comes back positive. No cat or dog exposure. Healthy, no prior medical problems, no surgeries, no toxic habits, HIV unknown, married. 

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Music by Ronald Jenkees

Direct download: TWiP186.mp3
Category:Science -- posted at: 6:57am PDT

Dickson, Daniel and Vincent solve the case of the Wife of a Guy with Cyclospora Diarrhea, and discuss the discovery of an intrinsic oscillator that drives the bloodstream stage cycle of the malaria parasite.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 185

Seeing this type of case 1/week for last several weeks. 75 yo female, admitted with fever, body aches, cough, loose stool for 2 week, sodium 118. Sheltering in place in Long Island, some gardening, no travel. Blood testing detected low sodium. COVID-19 negative, no other symptoms. Blood work: wbc 2000; hematocrit 24; platelets 40; sodium 120s. Unremarkable physical exam. Lyme test negative; other tick borne diseases negative.

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Music by Ronald Jenkees

Direct download: TWiP185.mp3
Category:Science -- posted at: 8:00pm PDT

Dickson, Daniel and Vincent solve the case of the Safari Goer With Watery Diarrhea, and explain how a microsporidian endosymbiont of Anopheles mosquitoes might impair the transmission of malaria.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 184

69 yo female with several months of abdominal symptoms started in S. Africa, water shortage as described for her husband in the previous TWiP. Husband had C. cayetanensis. Her symptoms improved; her stool was positive for B. hominis and E. nana. Given many different treatments. Then comes to see Daniel. Some abdominal discomfort, mucosy stools. All past med/surg unremarkable, nothing in family, sent for repeat labs, stool O&P all normal including GI PCR

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Music by Ronald Jenkees

Direct download: TWiP184.mp3
Category:Science -- posted at: 6:11am PDT

Dickson, Daniel and Vincent solve the case of the Ugandan Volunteer With Morning Bites and discuss integration of HIV-1 into the Schistosome genome, with a sprinkling of COVID-19 throughout.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 182

60 yo female comes in with husband, grew up in Lima Peru. Having issue had when child, would get itchiness around anus, mother would have her eat pumpkin seeds. Every 2-3 weeks wakes up with severe itching. Put in q-tip and extracted something, has video of it. ONP stool cultures negative. Referred to Daniel. Negative medical history, no allergies, no surgeries, no medications. Does travel, mainly to Uganda. HIV negative, no toxic habits. Husband reports no symptoms. Has children/grandchildren.

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Music by Ronald Jenkees

Direct download: TWiP182.mp3
Category:Science -- posted at: 9:52am PDT

Dickson, Daniel and Vincent solve the case of the Two Volunteers With Watery Diarrhea, discuss diagnosis of SARS-CoV-2 in the New York area, and reveal an approach to preventing honeybee colony collapse by imbuing their gut bacteria with the ability to produce antiviral and antiparasite double-stranded RNAs.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 181

Risks of being helpful. Volunteer from previous case. Diarrhea is gone, now has second issue. Since coming to Uganda noticing on waking in AM often has series of 1 cm red raised lesions in a line, 3-4, on torso. Swollen and itchy. New ones in the AM. Manager says welcome to Uganda. They move out of room, leave bedding behind. Lesions stop. What is going on and when can they move back into room?

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Music by Ronald Jenkees

Direct download: TWiP181.mp3
Category:Science -- posted at: 8:33am PDT

The TWiP professors solve the case of the Ugandan Child with Splenomegaly, and reveal that mutations in the P. falciparum genome that confer artemisinin resistance interfere with endocytic uptake of hemoglobin.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 180

Uganda with a twist. Meets two people with watery diarrhea, 12 episodes/day, loss of appetite. No fever, no blood in stool. Living for months at staff guest house. One week prior to onset went on weekend trip to area with waterfalls. Were served outdoor meal: meat, salad, fruit. Recommends empiric treatment trimethoprim/sulfamethoxzole for 7 days. Prompt resolution of diarrhea. A few days later, upon drinking coffee with milk gets severe cramps. 20s, long term female volunteers. 

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Music by Ronald Jenkees

Direct download: TWiP180.mp3
Category:Science -- posted at: 10:02am PDT

The TWiP DVD solve the case of the Child Who Passed Worms, and discuss a non-human primate model for severe malarial anemia.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 179

From Uganda, eastern up in mountains, rainy season. 6 yo girl brought in by mother on Monday, reporting several days of feeling poorly, headache, fever, muscle aches. Negative malaria smear on Monday. Wednesday returns, feeling worse, fever higher, headache worse. Lungs clear, belly (pain on left side) has large spleen. Living in good conditions, well dressed, dirt floor house, concrete walls. Toilet is hole in back. Same dietary habits, high in carbs. No mosquito netting. Water from stream. No siblings. HIV negative.

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Music by Ronald Jenkees

Direct download: TWiP179.mp3
Category:Science -- posted at: 8:43am PDT

The Knights of the TWiP solve the case of the Man Who Lost Weight, and discuss a Plasmodium protein kinase that is a malarial drug target.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 178

Eastern border of Uganda with Kenya, in mountains. Drinking water from nearby stream. Two young boys come to clinic, without parents. Sent in by grandmother because 1 yo brother has been passing worms. Long, white, flat. Shown photos in PD7, pinkish worm, 8 inches long, round. He points to those, what he has been seeing in brother’s stool. 1 year old seems small, protuberant abdomen; brother small for stated age, bit of protuberant belly. Diet: high carbohydrate, flour deep fried; yams; cabbage; some rice; soybeans; pumpkin; bananas.

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Music by Ronald Jenkees

Direct download: TWiP178.mp3
Category:Science -- posted at: 9:48am PDT

The TWiPsters solve the case of the Rashy Schoolteacher, and reveal a drug from rotifers that live on the snail intermediate host which paralyzes schistosome cercariae and prevents infection of mice.

Hosts: Vincent Racaniello, Dand Daniel Griffin

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Case Study for TWiP 177

49 yo man sent to Daniel for ID consultation. Reports in August visited Hawaii with family, then flies to CA. Family event there. Take him to Pakistani restaurant. One day later has gastrointestinal issues, nausea, diarrhea. Goes to urgent care, send stool for O&P. Look at stool, shows chilomastix mesnili. No medicines, will be ok. Over this period of 1 week he loses 15 pounds. Gains 5 back. End of October feels fine, no bloating or diarrhea. No symptoms but goes to gastroenterologist. Stool test returns with D. fragilis; and chilomastix mesnili. Now sees Daniel. Not on any meds. No allergies, no toxic habits, athletic. No illness in family. Normal exam. He ate salads in Hawaii.

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Music by Ronald Jenkees

Direct download: TWiP177.mp3
Category:Science -- posted at: 10:20am PDT

The TWiPpers of the bite fantastic solve the case of the Indian Man Who Hiked, and discuss the effects of schistosome soluble egg antigen on infection of lymphocytes with HIV-1.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 176

Recent case, woman in late 20s, schoolteacher. Outer boroughs of NYC. Wakes up on Saturday, completely rash-y, head to toe. Goes to urgent care center, say is allergic, give anti histamines and steroids. Persists after a few days, goes to allergist. Only allergen positive, dust mites. Few days later goes to GP, still itchy and rash-y. He does more thorough exam, notices she has small red lesions on fingers and between fingers. Several children in classes she is teaching has similar malady. Given therapeutic, rash goes away. Otherwise healthy, HIV negative. Partner not around at the time this develops.

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Music by Ronald Jenkees

Direct download: TWiP176.mp3
Category:Science -- posted at: 2:25pm PDT

The TWiP'ers solve the case of the Sudanese Boy With Fever, and reveal antibodies against that slow invasion of red blood cells potentiate other malaria-blocking antibodies.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 175

70 yo man born in India, came to US 1985. Has not gone back for 2-3 years. Admitted with acute onset of fever, cough, not eating well. Was fine until a week ago, had lost consciousness, fever 102F. Negative cultures for urine and blood. Some kidney stones, type II diabetes, elevated cholesterol, no surgeries. No family medical issues. Started on vancomycin on zosyn. Works in post office, lives with house in private home. No toxic habits. Has history of hiking trip 1-2 months prior, in Rhode Island, in June. No pets, animals. Exam unimpressive. Labs: crit 25, hemoglobin 9. Platelets 39. Bilirubin 5.3. Liver enzymes slightly elevated. Chest CT clear, blood smear: anisocytosis, microcytosis, polychromasia, 4.3% reticulocytes. Daniel orders one test, 90 minutes later starts treatment. HIV negative.  

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Music by Ronald Jenkees

Direct download: TWiP175.mp3
Category:Science -- posted at: 11:31am PDT

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPloid organisms solve the case of the Doctor with Chronic Epigastric Pain, and reveal how levels of linoleic acid in the intestine enable the sexual cycle of Toxoplasma gondii in cats.

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Case Study for TWiP 174

12 yo male living in refugee camp after fleeing Sudan. Presents to doctor with history of fever for many months, every other day; chronic abdominal pain. Tried antimalarials, no effect. Broad spectrum antibiotics, no effect. Exam: fast heart, clear lung, enlarged liver, enlarged palpable spleen. Camp has limited resources, no more diagnostic tests. Tried intravenous amphotericin. Child improves.  

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Music by Ronald Jenkees

Direct download: TWiP174.mp3
Category:Science -- posted at: 4:12am PDT

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The podcastellani hosts solve the case of the Sailor With Dysentery, and reveal the first virus discovered in Plasmodium species.

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Case Study for TWiP 173

Successful individual in NY area with 9 months of epigastric pain. Did upper endoscopy, saw in stomach several small mobile white serpiginous moving objects. 2.8 mm. Seem to be trying to burrow into gastric mucosa. One grabbed and sent to lab. History: curious habit of curing his own protein sources. 

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Music by Ronald Jenkees

Direct download: TWiP173.mp3
Category:Science -- posted at: 6:43am PDT

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The metacyclic TWiPomastigotes solve the case of the Child With a Painless Leg Lesion, and reveal how to kill mosquitoes with a genetically modified fungus.

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Case Study for TWiP 172

Retired US Navy physician, lives aboard his sailboat, just finished doing remote medical volunteer work in C. America. In DR when has sudden onset of dull prog worsening epigastric lower abdominal pain. Over next 12 hr intensifies, near tears, went to local medical center. Admitted, given IV, probiotics. Febrile, elevated WBC 20,000, platelets low, white counts left shift. Initially some constipation, then diarrhea with some blood. Discharged without diagnosis; still fever and chills; rash rose colored spots on torso. Daniel gets involved; 3 day course of azithromycin, symptoms continue; then metronidazole, feels better, fever, pain, symptoms resolve. Wife is ok. Three men working on his boat, one had bloody diarrhea before the patient did. Keeps a bowl of nuts around.

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Music by Ronald Jenkees

Direct download: TWiP172.mp3
Category:Science -- posted at: 10:33am PDT

The Leishmaniacs solve the case of the Child With Band Keratopathy, and reveal a eukaryotic parasite with functional mitochondria but without mitochondrial genomes.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 171

By boat to remote village, young boy (<10) brought in by Mother, concerned about painless ulcer on leg. Hard nodular border, 2-3 cm. Originally seen by floating doctors a few months before, now back as ulcer is not healing. Non-tender, there is an area of hard, different color skin that surrounds lesion. Some nodularity, clean lesion, no undermining.

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Music by Ronald Jenkees

Direct download: TWiP171.mp3
Category:Science -- posted at: 3:55am PDT

The TWiPlicates solve the case of the Child With Retinal Granuloma, and discuss an association of the complement protein collectin-11 with the pathophysiology of Chagas disease.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 170

3 yo girl, same context: mobile clinic in Bocas del Toro archipelago. Small village on remote island. Initially had red eye, rubbing a lot, mother noticed she seemed to have vision loss. On exam ophthalmologist did fundoscopic exam, sees band keratopathy, calcium on the cornea, and outer retinal punctate lesions.

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Music by Ronald Jenkees

Direct download: TWiP170.mp3
Category:Science -- posted at: 8:37am PDT

The TriTWiPomonads solve the case of the Child Who Passed a Worm, and reveal recombination between bovine and human schistosome species.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 169

9 yo boy brought into mobile clinic set up in small village Bocas del Toro archipelago. Initially had red painful eye a few months ago, lasted 1-2 weeks. Eye no longer red but has issues with vision in the eye. On eye exam, some peripheral vision, but no sharp clear vision. Notes retinal retraction, seems quiet granuloma over macula of affected eye.

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Music by Ronald Jenkees

Direct download: TWiP169.mp3
Category:Science -- posted at: 6:27pm PDT

The Giardians of the Galaxy solve the case of the Woman With a Colonic Stowaway from Hispaniola, and discuss activation of intestinal tuft cells by Trichinella spiralis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 168

18 month old child, on medical mission for previous year with older sibling and 2 parents. Back in US for 2-3 months, just as leaving remote location were given dose of allbendazole. Call comes to Mom, child is at child care and has passed something. It is serpiginous, 5-6 inches in length, moving a bit. Not flat, but round. Child otherwise fine.

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Music by Ronald Jenkees

Direct download: TWiP168.mp3
Category:Science -- posted at: 8:05am PDT

The Tremendous Trio solve the case of the Woman With Foul Steatorrhea, and reveal breakdown of the glycocalyx associated with severe and fatal malaria.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 167

Woman 30 yo, traveled to DR, went to tourist part. On return for yearly physical, asked about her chronic constipation. She said does not have it any more, has normal bowel habits. A few weeks after her return this occurred. Primary care doc was intrigued, sent off some tests. Found Entamoeba hartmanni. What might the doc have done? What were the consequences of infection?

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Music by Ronald Jenkees

Direct download: TWiP167.mp3
Category:Science -- posted at: 11:19am PDT

The Podfessors solve the case of the Teenager With Swollen Scrotum, and continue the story arc of Daniel's favorite cells, B-1 cells, and their association with protective immune responses in human Chagas disease.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 166

Recent consult from gastroenterologist. 61 yo woman on trip to Thailand, Cambodia for a few weeks. Developed diarrhea, took azithromycin, 3 days. Diarrhea continued, back in states now ongoing a few weeks. Left lower abdominal pain, bloated, gassy, loose stools, stick and foul smelling. Not sexually active, but is relevant. Not restrictive in what she ate. Drank bottled water. Did not eat raw items.

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Music by Ronald Jenkees

Direct download: TWiP166.mp3
Category:Science -- posted at: 10:56am PDT

The TWiP legends solve the case of Surfer Sans Septum, and discuss how two symbiotic bacteria in the tsetse fly allow colonization with Trypanosoma brucei.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 164

Welcome to Uganda. Mother brings in 4 yo female child, end of rainy season, concerned that has one day of fever, headache, cough. On exam looks ill, unremarkable except rapid heart rate, localized crackles in right lower lung. Several children in family. Spends day swimming in local stream. Take care of animals. Help gather drinking water in morning. Live in dirt floor home, thatch roof, with animals around. Saw many others with same problem. What tests do you want to do?

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Music by Ronald Jenkees

Direct download: TWiP164.mp3
Category:Science -- posted at: 7:14am PDT

The doctors of awesome solve the case of the Woman Who Visited Lebanon, and reveal that immunoglobulins protect the olfactory organ of trout against infection with the Ich parasite.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 163

From here in US before leaving for Uganda: male has lesion affecting nose. Has been having problem with nose for 2 yr, in 40s, surfer, hit nose with board. Southern eastern Costa Rica. After that had blood and scabs from nose. Inside of nares, scab formed. Did not improve with time. Saw ENT doc on LI, said he hit nose and needs reconstructive surgery. Entire septum destroyed. 20+ years ago had non healing ulcer on left hand, saw physician in CR, was treated for 20 days.

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Music by Ronald Jenkees

Direct download: TWiP163.mp3
Category:Science -- posted at: 7:58am PDT

The TWiP professors solve the case of the Baby With Pericardial Effusion, and discuss whether the flagellate without a flagella, Dientamoeba fragilis, causes human illness.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 162

A fresh case. Woman in late 30s born in Palestine, moved to NY. Presented for care with sore throat, swollen lymph nodes. Married Lebanese man, he’s still there, travel back in forth. Had been in Lebanon for 3 weeks before illness. Ate special raw meat dish while in Lebanon. No other animal exposure. Small children at home, works in office. No medical/surgical history, no meds. On exam, has posterior cervical lymphadenopathy. Otherwise normal exam. HIV negative. Low grade fever.

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Music by Ronald Jenkees

Direct download: TWiP162.mp3
Category:Science -- posted at: 9:01am PDT

The TWiPsters solve the case of the Brazilian Immigrant With Heart Problems, and describe how genome organization controls trypanosome antigenic variation.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 161

Daniel was asked to see 30 yo female from Bolivia, had to travel back during 3rd trimester. Was there for most of 3rd trimester. Child born in US, pericardial effusion, ascites, moderate PDA. Heart function is ok. Woman was healthy, no issues during pregnancy. Baby’s  white count elevated, diagnostic evaluation. It is a parasite.

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Music by Ronald Jenkees

Direct download: TWiP161.mp3
Category:Science -- posted at: 8:12am PDT

The TWiPlets solve the case of the Electrician from Tamil Nadu with a Liver Mass, and reveal that dogs and humans share a common Chadian Guinea worm.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 160

Referred to Daniel for consult, 40 yo immigrant from Brazil, a farmer had worked there, family in US. While here 1 y ago sees physician for increased heart rate, arrythmia, premature ventricular contractions, A-fib and flutter, treated by cardiologist then gets implantable defibrillator. Diagnostics: EKG, right bundle branch block; Echo shows heart is dilated with apical aneurysm; thrombosis.

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Music by Ronald Jenkees

Direct download: TWiP160.mp3
Category:Science -- posted at: 8:42am PDT

The TWiP triptych solve the case of the 9/11 Survivor infested with parasites, and discuss the effect of community ivermectin treatment for onchocerciasis on Loa loa infections.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 159

Going back to India, gentleman in 20s seen during rainy season in south. Week of feely achy, fever, severe pain in right upper part of belly. Vomiting, no diarrhea. Married, no children, works indoors in trades - electrician. Drinks large amount of palm date liquor. Previously healthy, no allergies, no medical issues. No travel. On exam: right lung base decreased breath sounds; upper right area of belly can feel liver coming down. Area of intercostal tenderness. Elevated white count; left shift, eosinopenic, alk phos up. Chest xray: shows effusion in right base. Ultrasound of liver: fluid filled single lesion. Lesion aspirated.

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Music by Ronald Jenkees

Direct download: TWiP159.mp3
Category:Science -- posted at: 12:34pm PDT

The TWiP hosts solve the case of the Thai Woman With Red Bumps, and reveal that a master manipulator contacts ant brain tissue to control its behavior.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 158

Male in 50s comes to see Daniel, concerned that is infested with parasites. Retired firefighter, 9/11 survivor. Several years of skin issues not resolved. 2009 dating Haitian girl, goes to Haiti to assist with disaster relief efforts, there notices itchy rash, worse at night, elevated eosinophils.  Prior biopsy showed arthropods with compound eyes. Treated with oral ivermectin, topical permethrin. Ulcers form, preceded by small white objects that pop off skin and these can swim in water. Repeat cystoscopies triggered by hematuria. Multiple biopsies and skin scrapings, all unrevealing. Had episode with forked headed worms came out while on toilet. Became temporarily blind. Another physician suggested were drug related. Brings Daniel video of swimming, skin scrapings. Spent time in Egypt where he swam in fresh water. Has issues with substance abuse. Family history unremarkable. One exam, has ulcerated areas widely. CBC eosinophil 700. Calcification at bladder periphery. Many negative tests returned. Review of many biopsies, stool ONP, all unremarkable.

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Music by Ronald Jenkees

Direct download: TWiP158.mp3
Category:Science -- posted at: 6:58pm PDT

The Podfessors solve the case of the Itchy Child from Panama, and discuss competition for blood in human malaria-helminth co-infections.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 151

Woman in 30s, mother of last two boys we saw, same locale. Concerned about abdominal pain for 3 years. Fullness, bloating of lower abdomen. No blood in stool, but occasionally loose stools, difficult to clean, stick/pasty/greasy stool. Had visited hospital, underwent test, told it is an ovarian cyst and needs surgery. Took omeprazole, allbendazole, azithromycin, none helped. On exam, diffuse abdominal tenderness. Portable ultrasound: small ovarian cyst 1.5 cm, not tender.

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Music by Ronald Jenkees

Direct download: TWiP151.mp3
Category:Science -- posted at: 8:33am PDT

Shivang joins the TWiP triumvirate to solve the case of the New Yorker With Rash and Pins and Needles, and reveal how agrochemicals increase risk of human schistosomiasis by causing high snail density.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Shivang Shah

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Case Study for TWiP 149

31 yo man ulcer on let, 4 cm diameter. Raised borders, reddish and hard. Feels well, concerned not resolving. Started as bump, slowly enlarged, ulcerated, 1 month now. Healthy, no prior med, diabetes in mom. Works in field with machete, lives with family, social drinking, smoking. Lives in isolated villages on Northern Panama archepelago, many animals and insects. Homes are raised, slats on floor. No fever, normal bp hr, breathing low teens. Healthy athletic young man, otherwise good health except for ulcer on left leg. Non tender, no pain, base of ulcer red; no purulent material, borders raised but not undermined. Feels hard around edge, no scab. Did dermoscopic exam: erythema, small yellowish teardrops, small white starbursts.

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Music by Ronald Jenkees

Direct download: TWiP149.mp3
Category:Science -- posted at: 3:00am PDT

The TWIPniks solve the case of the Man With Diarrhea and 100 Micron Objects In Stool, and discuss the reticulocyte receptor for Plasmodium vivax.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 146

27 yo male lawyer comes NY area to be seen, has 4 cm ulcer on right foot. Painless, has raised borders, minimal surrounding erythema. Going on for quite a while. Initially was papule, enlarged, ulcerated, this enlarged and has been more than 4 weeks. No past med probs, allergic to penicillin but just upset his stomach. No meds. Social habits: drinking. Own apt in NYC. Travel: 1 month before papule was whitewater rafting in Costa Rica, noticed when he got back. Wore sandals, got lots of insect bites. Afebrile, normal BP, fit athletic young man. Non tender lesion, base is red, white fibrous coating. Border raised but not undermined. No surrounding swelling, no eschar over wound, open non healing.

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Music by Ronald Jenkees

Direct download: TWiP146.mp3
Category:Science -- posted at: 8:36am PDT

The Estimados Profesores of TWIP solve the case of the Man With Motile Objects, and reveal the secreted and excreted proteins of Giardia parasites.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 145

Male 40s, visiting NYC on business. Lives in Thailand, seeks medical attention for diarrhea and abdominal pain. Diarrhea is continuous, even at night. Feels swollen. Stool cultures come back negative. CBC reveals eosinophilia. Clinician orders stool O&P. See something in stool: large elliptical objects, over 100 microns.

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Music by Ronald Jenkees

Direct download: TWiP145.mp3
Category:Science -- posted at: 7:00am PDT

The TWiPtomaniacs solve the case of the Boy With Visual Disturbances and Itching, and discuss identifying secreted and excreted proteins of Trichinella parasites.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 144

Individual in 30s, male, presented to physician with stomach upset, uncomfortable feeling in legs. Has motile objects in stools. From Vancouver BC, was eating salmon, reports was either dried/smoked or marinated. Not sure if this is relevant. Brought motile objects to physician.

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Music by Ronald Jenkees

Direct download: TWiP144.mp3
Category:Science -- posted at: 8:31am PDT

The TWiPsids solve the case of the Guatemalan Positive for Rhinovirus, and reveal how to kill all African trypanosomes with a primate apolipoprotein.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 142

Woman in 50s, immigrant from rural area with limited resources. Admitted to hospital with iron deficient anemia and eosinophilia. In US. Sent for colonoscopy. Note long slender serpiginous motile object, recovered, 4.5 cm long, one end slender, other large and curled but not blunt. Send worm to parasitology lab for identification. What might fit description? Is this usually associated with eosinophilia? What about anemia, is severe or mild? Would this person have come from outside the US to acquire this, or could they have acquired the infection in the US.

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Music by Ronald Jenkees

Direct download: TWiP142.mp3
Category:Science -- posted at: 9:13am PDT

The TWiPsters solve the case of the Child from DR with Poppy Seed Sized Things On His Head Hair Shafts, and reveal how the skin parasite landscape determines the infectiousness of Leishmania.

Hosts: Vincent Racaniello and Daniel Griffin

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This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. See what’s on the menu this week and get 3 meals free with your first purchase – WITH FREE SHIPPING – by going to blueapron.com/twip.

Case Study for TWiP 138

New Yorker, female teenager from an outer boroughs, visual loss in right eye noted during routine eye exam. Not sure when started. Left is 20-20, otherwise feels fine. No surgeries, no noted medical history, no medications, in school, living with family, no toxic habits. Travel: had been upstate NY in past year. No pets. Defect in right eye pupillary reflex, pallor to optic nerve. Serologies: toxocara, HCV, syphilis, all negative. Dilated fundal exam: sees 1850 microns motile worm in the eye. Not on surface, not Loa Loa.

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Music by Ronald Jenkees

Direct download: TWiP138.mp3
Category:Science -- posted at: 8:14am PDT

The TWiPtoids solve the case of the Man from India with a Neck Lump, and explore the role of a transmissible dysbiotic skin microbiome in inflammation during cutaneous leishmaniasis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. See what’s on the menu this week and get 3 meals free with your first purchase – WITH FREE SHIPPING – by going to blueapron.com/twip.

Case Study for TWiP 137

Little town in DR, fall of 2016, have already mentioned this patient; little boy 2-3 years old, not behaving well, warned if doesn’t behave, los gusanos will eat you! Mother asks Daniel to help son: lately is more irritable, troublesome, not well behaved; notices things in his hair. Has small poppy seed sized things on side of hair shafts. She picks them off in fingers and smashes them. What are they, what do I do? Simple dwelling, dirt floor, walls and tin roof, animals everywhere. No money for medicines, what can she do?

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Music by Ronald Jenkees

Direct download: TWiP137.mp3
Category:Science -- posted at: 9:11am PDT

The TWiP Titans solve the case of the Man from Queens with a Blister Burster, and explain the role of inflammatory monocytes during Leishmania infection of the skin.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. See what’s on the menu this week and get your first 3 meals free with your first purchase – WITH FREE SHIPPING – by going to blueapron.com/twip.

Case Study for TWiP 136

Patient seen by Daniel in India, 18 yo Islamic college student, left home, living in dorms in south, Hindu couple prepare meals, called dorm parents. He is being seen because developed lump in left side of neck, 1-2 cm mass. Previously completely healthy, no med/surg, no allergies. Prays multiple times a day, observes dietary restrictions. Afebrile, normal, but has 2 cm firm nontender lump inside interior portion of sternocleido mastoid muscle. Not tender. End of November, rainy season. No screens on dorm windows. No animal contact. Ultrasound done, and was helpful. Noticed in his neck over several weeks.

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Music by Ronald Jenkees

Direct download: TWiP136.mp3
Category:Science -- posted at: 2:12pm PDT

Dickson returns to the TWiP hosts to solve the case of the Woman from Colorado With Loose Stools, and explain how single-sex infection with female Schistosoma mansoni reduces hepatic fibrosis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. See what’s on the menu this week and get your first 3 meals free with your first purchase – WITH FREE SHIPPING – by going to blueapron.com/twip.

Case Study for TWiP 135

Patient seen in clinic by Daniel's colleague, living in Queens, needs home care. Man with wound on foot, needed daily care. Living 9 months, recently developed painful blister, he put his foot in water, got great relief, blister opened up. Open lesion did not look normal, there was something in blister. Went to see parasitologist, saw something there, wrapped it around piece of wood. Not previously seen a physician, no surgeries, knew little family history. New to our country, where could he have possibly come from? Rural part of some country. Resource limited region. How many days of treatment will he need?

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Music by Ronald Jenkees

Direct download: TWiP135.mp3
Category:Science -- posted at: 7:08pm PDT

Daniel and Vincent solve the case of the Haitian Girl Who Failed To Thrive, and visit two studies that address the question of whether infection with Toxoplasma gondii alters human behavior.

Hosts: Vincent Racaniello and Daniel Griffin

 

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Case Study for TWiP 134

Woman in 30s, coming in Colorado to be seen, reports foul smelling loose stools multiple times each day, cramping and nausea. Started a few weeks ago. No fever, summer, no unusual travel, skiing up in mountains, hiking, backpacking. Originally from NE, moved to Colorado one year before. Often drinks from streams. Treats water with iodine. On overnight trips pack food and cook on stoves. Sticky stools, trouble wiping clean. Yes, my stools do float. Color, not as dark. Well formed. No medical problems, no surgeries, no allergies. Takes no medications. Lives alone in private home. Drinks beer, no other toxic habits. None of her friends report similar problems. Sexually active, does not always use protection. Physical exam: unremarkable.

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Music by Ronald Jenkees

Direct download: TWiP134.mp3
Category:Science -- posted at: 7:31am PDT

Daniel and Vincent solve the case of the Woman With Anal Area Discomfort, and discuss the multiple functions of a clathrin adapter protein in formation of rhoptry and microneme secretory organelles of Toxoplasma gondii.

Hosts: Vincent Racaniello and Daniel Griffin

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Case Study for TWiP 133

Seen while working in remote mountain makeshift mobile clinic in Dominican Republic, on Haitian border. Traveled 3 h by pickup truck, remote mountain town, womens centers. Set up makeshift mobile clinic in this center. Mother concerned about 6 yo girl, failure to thrive compared with sister, protuberant belly, frequent abdominal discomfort, going on over 1 year. No surgeries, no meds, first time ever seeing medical person. Mother and sister are family. Three children in family. Father does timber work. Very impoverished region, living in dirt floor home, drinking untreated water from local stream, go to bathroom outside, could be contamination. Diet: carbohydrate, plantains, rice, beans. On exam: lungs clear, heart fine, belly protuberant, liver and spleen not enlarged, some edema. Mother said noticed long motile worm in girls feces. Firm belly, not painful to her.

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Music by Ronald Jenkees

Direct download: TWiP133.mp3
Category:Science -- posted at: 8:41am PDT

The TWiP-tastic peeps solve the case of the Thai Man Coughing Up Blood, and reveal potential therapies for trypanosomiasis that are inhibitors of protein import into glycosomes.

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

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Case Study for TWiP 132

Young NYC woman with son (10), chief complaint of discomfort and itchiness in anal area. Has tried to look but nothing abnormal. Married, no complaints from husband or child. Two older kids have no complaints. But son has also been scratching in anal area. Everything fine 3 months ago, sister came to visit with 3 young pre-school children, may have caught something from them. No past med or surg history, no allergies. No meds, work out of home, no toxic habits, no recent travel. Have dog. Do lots of volunteering with children. History of sushi consumption. She does not like raw fish but son does. Worse itching at night. Going on for a number of weeks. Reports being under a lot of stress recently due to family.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP132.mp3
Category:Science -- posted at: 9:57am PDT

Jonathan from the podcast Arthro-Pod joins the TWiPerati to solve the case of the Peruvian Woman With Inguinal Insect Bite, and discuss warm autoimmune hemolytic anemic that develops after babesiosis.

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

Guest:  Jonathan Larson

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Case Study for TWiP 131

Thailand. 39 yo man reports 7 months of coughing up bright red blood, several times with mucus. Otherwise feels well. Big fan of salted crab som tum. Fisherman, lives with family. Healthy, no past med/surg problems. No meds. On seeing him: afebrile, chest xray abnormal: area of increased opacification. Not a smoker. No toxic habits.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP131.mp3
Category:Science -- posted at: 6:06am PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPniks solve the case of the Man With AIDS, and explore how secretion of extracellular vesicles influences the social motility of Trypanosoma brucei.

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Case Study for TWiP 130

Back in Peru. 24 yo female seen in ER, lives in rural area outside of big city, adobe house in highlands, thatched roof, dirt floor, 3000 meters. Quite ill with skin lesion for 48 h. 2 days before was pulling on pjs, felt sharp sudden pain in right upper leg. Next day found small living creature in pajamas, inguinal region. Developed red lesion, enlarged, developed black central dot. Then begins vomiting, comes to hospital. No fever, breathing fast 20, hr 70, bp 160/10, on exam see in right inguinal region an enlarging, necrotic area 1-2 cm, starting to look sick. Whites at 26000, left shift, 200 platelets, eosinophils 4%, bilirubin 3.5, creatinine 4.9 (going into renal failure, not making much urine). Hematocrit 14, BUN 59.7, CPK 227, RBCs and leukocytes in urine. No health problems, no surgeries, first interaction with health system. No toxic habit. Brings in the small creature!

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Music by Ronald Jenkees

Direct download: TWiP130.mp3
Category:Science -- posted at: 11:04am PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiP Masters solve the case of the Australian Wildlife Carer, and review evidence that nodding syndrome may be caused by an autoimmune reaction to the parasitic worm that causes river blindness.

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Case Study for TWiP 129

Young male in 30s, presents to ER with male partner, NY area, chief complaint over 1 month significant diarrhea, watery, non bloody. Abdominal cramping. Feels poorly, low energy, fever. Some vomiting, lost noticeable amount of weight, can’t stay hydrated. Past: AIDS positive, not on meds, last CD4 <50, viral load elevated and uncontrolled. Non contributory family history, no meds. Social history: had worked in office, can no longer; lives with male partner; occasional alcohol, no pets, no other significant exposures. Partner also AIDS, also not on therapy. Physical: febrile, 38.5C, 115 bp, 95/65, 18 resp, thin male, clearly uncomfortable. Oral thrush in buccal mucosa. No subungual saliva. Lungs clear, abdomen diffusely tender, increased bowel sounds. Labs: elevated creatinine, BUN, decreased sodium, elevated WBC count with significant eosinophilia. No pets or houseplants. 

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Music by Ronald Jenkees

Direct download: TWiP129.mp3
Category:Science -- posted at: 2:00pm PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPerati solve the case of the Man Who Sat in Feces, and discuss a study on how Dickson's favorite parasite induces the formation of a collagen capsule.

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Case Study for TWiP 128

Daniel doesn’t expect anyone to get this. From Australia, 80 yo retired teacher from Atherton, northheast Australia, presents to clinic with generalized weakness, concern of chronic lyme or Q fever. Seen by neurologist, concern about motor neuron disease. 18 months of illness, insidious onset of limb (arms and legs) weakness. No issues with speaking, swallowing or breathing; no weight loss; no fever, sweat, chill. History of osteoarthritis, joint replacements; myocarditis; vertigo; allergic to pen and dox. Father, rhematoid arthritis, brother colon cancer. On a number of medications. Does extensive travel, when not traveling, is a volunteer carer in Australia (abandoned wildlife), over the past three years. Lives with husband. Marsupials, hand feeds puggles and juvenile spiny anteaters, has pet cockatoo. No history of polio, HIV negative. Neuro exam: diffuse non tender muscle with no rash. Normal upper and lower limb tone, strength is symmetrically reduced proximally. Reflexes good at knees, normal sensation to all modalities. Normal cranial nerve exam. Test results: has eosinophilia, elevated muscle enzymes, EMG shows myopathic changes, nerve conduction normal. Stop statin therapy, no change. This is a rare parasite.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Direct download: TWiP128.mp3
Category:Science -- posted at: 7:56am PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPsters solve the case of the Peace Corps Volunteer with a Liver Lesion, and discuss the dependence of Leishmania survival on the gut microbiome of the sandfly.

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Case Study for TWiP 127

The last of our trio for the Peace Corp, an eosinophilia case. 29 yo pc volunteer in Rwanda, male, 3 weeks of feeling poorly. Starts with rash on lower back and upper legs, maculopapular rash. Fatigue later, cough, then diarrhea, 51% eosinophils (9000). No significant exposure to fresh water. Stool sent for oandp. Said sat down and got something on behind, realized later was feces, this was where rash developed. OandP seeing larva in stool. HIV neg, no med issue, no surgeries, no Kava. 

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Direct download: TWiP127.mp3
Category:Science -- posted at: 4:47am PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiP Trinity solve the case of the Peace Corps volunteer with diarrhea, and reveal how immunizing against a virus ameliorates exacerbated leishmaniasis.

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Case Study for TWiP 126

Another Peace Corps volunteer in Fiji. 24 yo male, several days of fever, headache, dry cough, rash. Feels poorly, starts diarrhea. No blood or mucus, no vomiting but abdominal discomfort. Heart rate over 100. At private nearby hospital for evaluation: no prior med probs or surgeries. Social history: MSM, not always protected, drinks every weekend. Home blown away by cyclone. Alcohol: drinks beer, a lot. White rice, split peas, bread diet. Fan of cava, also drank unfiltered water. He is admitted, continues to feel poorly. Continued fevers, localized abdominal pain RUQ. On exam he has tender palpable liver, elevated WBC 17.8, eosinopenia, 0 cells. AST/ALT slightly above normal. Dengue, chick, lepto, blood all negative. Ultrasound of liver: shows 8x8 cm mixed echogenic lesion in right lobe. HIV negative. 

Send your case diagnosis, questions and comments to twip@microbe.tv

Direct download: TWiP126.mp3
Category:Science -- posted at: 8:22am PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPonderers solve the case of the Timber Worker with Severe Shaking Chills, and describe an experimental malaria vaccine comprising attenuated sporozoites produced by genetic engineering.

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Case Study for TWiP 125

Thanks to the Peace Corps - 24 yo female serving in Cameroon, teaching English and science at local school. Been in country 5 months, first 3 lived with host family, now in own home in community with electricity, 12 hr from Yaounde, capital. Reports intermittent diarrhea, loose stools, abdominal discomfort. No prior problems, no problems in family. No meds. No drinking or smoking. Lots of animals present, roam into class. Eating all local fare, cooks some, or buy locally. Eats fish, vegetables, no fish. Sleeps in house with mosquito nets. Not sexually active, AIDS negative. Young kids at school 6-12 yo, 20 in room. Does not eat at school. Not clear if water is treated. Not on antimalarials. Going on for a few a few weeks. No fever, no rash.

Send your case diagnosis, questions and comments to twip@microbe.tv

Direct download: TWiP125.mp3
Category:Science -- posted at: 11:42am PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The prolific podcast-shedding Hosts solve the case of the Global Health Intern with a snakelike lesion on her foot, and reveal the role of a single-stranded DNA binding protein in differentiation of trypanosomes.

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Case Study for TWiP 124

28 yo male from referral hospital near thai-burma border. Fever and chills 2 days, feels poorly, small amount of dark urine. Severe shaking chills, 1x per day, no rash. No diarrhea, difficulty breathing. Seen by local health care volunteer, went to hospital then tertiary hospital in Bangkok. Exposure history to pigs, dogs, insects, etc. Involved in timber industry and farming, sleeping out at night with no cover, clothes and sandals. No meds. Not married, family lives with him. Family is fine. Sleep in dwelling but no screens. No toxic habits, HIV negative, sexually active but not brothels. High fever, low bp, rapid heart rate, breathing rapidly, scleral icterus, dry mucus membranes, neck supple, lungs clear. 2/6 systolic murmur. Abdomen soft but tender, enlarged liver and spleen. Many cuts, bruises, bug bites. Labs: low platelets, low hematocrit, low glucose. Blood smear: abnormal, 5-10% infected RBCs with multiple band forms. 

Send your case diagnosis, questions and comments to twip@microbe.tv

Direct download: TWiP124.mp3
Category:Science -- posted at: 5:31pm PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPanorama solve the case of the Dutch Woman with Wormy Objects in Her Stool, dissect a study on cytoadhesion of malaria infected red blood cells, and introduce Parasitology Superheroes.

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Case Study for TWiP 123

Nurse in early 20s, recent grad, decides to spend year in global health internship in western DR/Haitian border. On her foot has skin issue: told is fungal infection, using antifungal cream, is getting worse. Several days, only on one foot. Healthy, no past med/surg/allergies, no meds, no HIV, lives with local family. Daughter, wife, husband, cat. No toxic habits. Originally from US, swims, walks barefoot to and from, shoes off in house. Easts local food, exposure to dogs, cats, sister. Very itchy, but not open; rash area is raised. Blistery in certain areas, involves different areas in different days, snakelike. 

Send your case diagnosis, questions and comments to twip@microbe.tv

Direct download: TWiP123.mp3
Category:Science -- posted at: 3:15pm PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPniks docs solve the case of the Female from Peru with Epistaxis, and discuss the effect of community deworming on immunosuppression.

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  • Community deworming and immune hyporesponsiveness (PNAS)
  • Paul C. Beaver (onetwo)
  • Photo by Oscar Adam Oscarson
  • Letters read on TWiP 122

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Case Study for TWiP 122
First of a series of cases with a theme, a 23 yo female international aid worker, chief complaint of diarrhea. Dutch descent, born in US, been in rural area of western DR, close to Haitian border. It’s been raining, houses have tin roofs, other flat concrete, rainwater pours off. Child comes by with mangoes, she buys one, washes it in rain water from the roof. Bites open mango, peels it, eats mango. The same night she is not feeling well, loose stools, abdominal discomfort. Next day, goes with group to border town; then has full fledged diarrhea. Looks into toilet, sees white objects 1 cm in length on stool, and they are moving. Uniform width, thinner than long, wormy looking. Has been participating in other activities in this area, swims in local river, walks barefoot, eating lot of local foods. Lunch: rice, beans, cooked meat, avocado. Dinner, yucca, fried salami, etc. Healthy before, no family history, not on meds, living with one of local families, no toxic habits. Dogs, cats, pigs, chickens around. One month earlier, cat in family home had kittens, she played with them. Very excited about that. Local physician contacted, he treats her. 

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Direct download: TWiP122.mp3
Category:Science -- posted at: 1:23pm PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPanosome docs solve the case of the Mali Man with Profuse Diarrhea, and review the presence of Trypanosoma cruzi in vectors, canids, and humans along the Texas-Mexico border.

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Case Study for TWiP 121

Back to Peru. 55 yo female from highland central valley area near Cuzco. Works in farming, no prior skin lesions but has multiple hypopigmented scars on exposed extremities (trauma during working), now reports many years of bloody nasal discharge. Seen in Lima by Daniel in outpatient clinic. No other medical problems, no surgeries, no allergies, everyone in family fine, husband and kids. Still working. No travel except to see doctor. Exam in right nare: ulcerated lesion inside nose, muco-cutaneous lesion. Simple test will decide. No anemia, no fever. Not eosinophilic, labs normal, HIV negative.

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Direct download: TWiP121.mp3
Category:Science -- posted at: 6:48am PDT

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiP triumvirate solve the case of the Thai Woman with Facial Swelling, and explain how Th17 T cells protect against the intracellular parasite Trypanosoma cruzi.

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Case Study for TWiP 120

A 48 yo man from Mali comes to hospital ER in Washington Heights in NY with profuse watery diarrhea. Born in Mali, came to US at 18, working in US as long haul truck driver for 30 y, frequently visits Mali, recently to attend his father’s funeral. Got symptoms one week after return (was there for 3 weeks). 3 liters diarrhea/day. No past med/surg history, not seen doctor in long time. No allergies. Unknown what father died of, Mother in Mali is ok. No medications. Some alcohol, marijuana use. Does report that has exposure to professional female sex workers, no condoms. Temp of 39 C, bp down 80/40, heart over 110, rapid breathing high 20s, cachectic. Wasted. Fungating lesion perianally. Undergoes HIV testing, clade B. T cells <100. 

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Direct download: TWiP120.mp3
Category:Science -- posted at: 6:56pm PDT

Hosts: Vincent Racaniello and Daniel Griffin

Vincent and Daniel solve the case of the Family with Eosinophilia, and discuss HIV-1 infection and genome integration in the blood fluke Schistosoma mansoni.

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Case Study for TWiP 119

This one will be kinder and gentler case. Back in Thailand but could be in several places. 25 yo Thai woman from Bangkok, to hospital, chief complaint facial swelling. Eats typical Thai diet (see previous episodes!) Som tum, etc fish that is not cooked. Migratory - moves around face. Not tender, but mild itchiness. For about a week, no pain. Healthy, no past med/surg history, family all fine. HIV negative, no drugs, no travel. On examination, has swelling on right side, 3-4 cm raised, little redness, firm, does not feel like fluid filled. No fever, no GI problems, no bloods. WBC up, eosinophils up. 

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Direct download: TWiP119.mp3
Category:Science -- posted at: 1:54pm PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The TWiPinella solve the case of the Woman from Guinea, and describe the use of CRISPR/Cas9 to identify essential apicomplexan genes.

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Case Study for TWiP 118

Little bit of a twist - a human family with eosinophilia. Conveyed by good friend/colleague ID physician. Australia, NSW, 45 yo Dad, having problem with mild abdominal distention. Seen by doc in Sydney, CBC shows eosinophil count of 10,500. Wife of same age reports feeling fine, but gets CBC and also shows eosinophils of 5,200. Two daughters, 17 and 19, no symptoms, bloods: 900 and normal eosinophils. One week prior to dads symptoms, sister in law came (also in NSW) and stayed, developed severe diarrhea, discomfort, bloating, weight loss, eosinohils 4,700. Eat raw fish (not known if fresh or salt) purchased at local markets. No overseas travel or out of urban environment. No pets, no home grown foods. Went back to previous labs and found normal eosinophil levels. Full workup for strongyloides, all negative. No HIV. No toxic habits, no remarkable medical history.

Send your case diagnosis, questions and comments to twip@microbe.tv

Direct download: TWiP118.mp3
Category:Science -- posted at: 11:00am PDT

Hosts: Vincent RacanielloDickson Despommier, and Daniel Griffin

The parasite prophets solve the case of the Thai Man with Abdominal Distention, and discuss the finding that metastatic leishmaniasis dependent on a virus can be prevented by blocking IL-17A.

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Case Study for TWiP 117

Woman 66 yo born in Guinea, grew up the moved to US past 10 years, just retired. Lives in Washington Heights. Mother having issues in Guinea, so went back for 3 months in 2016. Just came back a week ago, reporting headache, fever, feeling poorly. Staying in big city, with Mom (80s). Has own private toilet in nice home. No screens or bednets. Married for 40 years, recently divorces. Has had 10 children. Not sexually active. Starts with high fever, breaks, then 2 days later another for several hours, goes to ER. Given Ebola screening questions, negative, do some blood work, send her back out. 2-3 days later high fever, double vision, headache, comes to Columbia ER. No diarrhea, no urination discomfort. Has backache, feels that mouth is dry. Was admitted. Past med history: high bp, cholesterol, diabetes; not overweight; appendix out; has unknown reaction to novocaine. No smoking, drinking. Physical: 39.4 temp, 14-16 breath rate, heart rate over 100, rapid heartbeat, 2/6 systolic murmur with radiation to left carotid (flow murmur). No jugular venous distention. Abdomen right upper quadrant: slight enlargement of liver, not tender, can palpate spleen tip in left upper quadrant, slightly enlarged spleen. Normal bowel sounds, no rash. Blood: elevated white count, bands 9%. 0.1 eosinophils, platelets 79, hemoglobin 11. Bilirubin 1.5, bicarb 20, chest xray clear. Red cells: small, 79.4 mcv. Animals: don’t like animals! In middle of rainy season. Likes to walk outside in rain during day. No cats to keep out rodents. Food: all food is prepared in home. Eats all favorite foods: rice. No sick contacts, no exposure to health care setting, no bug bites. 

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Direct download: TWiP117.mp3
Category:Science -- posted at: 1:37pm PDT