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

Lee Gottesdiener joins TWiP to help solve the case of the 46 Year Old Man with Ongoing Upper Extremity Swelling, and review plant‑based production of a protective vaccine antigen against the bovine parasitic nematode Ostertagia ostertagi.

Hosts: Vincent RacanielloDickson DespommierDaniel Griffin, and Christina Naula

Subscribe (free): Apple PodcastsGoogle PodcastsRSSemail

Links for this episode

Become a patron of TWiP

Case Study for TWiP 225

41-year-old male mechanical engineer, former Army Ranger trainee, moved from Denver, CO to Chattanooga, TN. He was in his usual state of vigorous health, hiking, doing Spartan races, working on his semi-rural property,  and commuting to his place of work daily when about three months previous to his diagnosis, he began having episodes of sudden GI distress with diarrhea, followed by itchy hives in axilla and groin. He treated these episodes with Benadryl and got relief. At 10 PM one evening, he had another such episode, again took Benadryl, but began to experience gradual onset but relentlessly increasing shortness of breath and wheezing. He was taken at high speed to the Emergency Room by his wife. He reported that relaxation with a repetitive, meditative prayer seemed to control the symptoms but said it was like his throat was closing.

Past history includes variable exercise and cold-induced asthma treated with an inhaler as a child, with only rare episodes in adulthood related to high exposure to allergens like cat dander. Family history is not contributory. Diet was omnivorous. They had one dog, a labradoodle named Raphael, which they chose because he was “hypoallergenic.”

In the Emergency Department, he was treated with bronchodilators, intramuscular epinephrine, and antihistamines, and the symptoms abated.

The experienced ED physician ordered a diagnostic test, having seen other similar cases in the region. A lifestyle intervention was successful.

Direct download: TWiP225.mp3
Category:general -- posted at: 8:44am PST

Michelle and Alexander join TWiP to solve their case of the 36 Year Old Male with shortness of breath, stinging pain in the extremities, fatigue, abdominal cramps, and bowel irregularities, and discuss host cell invasion by Trypanosoma cruzi.

Hosts: Vincent RacanielloDickson DespommierDaniel Griffin, and Christina Naula

Guests: Michelle Naegeli and Alexander Grieb

Subscribe (free): Apple PodcastsGoogle PodcastsRSSemail

Links for this episode

Become a patron of TWiP

Case Study for TWiP 221

This is the case of a  man in his 50s, with no remarkable prior medical history, who received care at a hospital in northern California, USA, after experiencing a generalized seizure. Magnetic resonance imaging (MRI) demonstrated a solitary left temporal lobe T2 hyperintensity with gadolinium rim enhancement and surrounding edema. After receiving treatment with dexamethasone and levetiracetam, he was transferred to an academic medical center.

Examination by neurology consultants noted disorientation, inattention, moderate aphasia (difficulty communicating), and mild right hemiparesis. Cerebrospinal fluid (CSF) testing revealed increased nucleated cells up to 80/UL (60% lymphocytes, 17% neutrophils, 23% monocytes), protein concentration 38 mg/dL, and glucose concentration 100 mg/dL. 

They proceed to do a brain biopsy from the left temporal lobe lesion with cultures from the brain biopsy sample that did not grow bacteria, fungi, or mycobacteria. They performed metagenomic next-generation sequencing (mNGS) on a CSF sample and sent brain biopsy samples for universal broad-range PCR amplicon sequencing (uPCR) for bacteria, fungi, Mycobacterium tuberculosis, and nontuberculous mycobacteria. which is preliminarily reported as showing well-formed granulomata with acute inflammation. Rereview of neuropathology raised concern for certain round infectious forms that are about 50um in size with some surrounding clearing and a dark area within these forms.

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

Music by Ronald Jenkees

Direct download: TWiP221.mp3
Category:general -- posted at: 3:44pm PST

TWiP solves the case of the 19 month old Female Having Issues, and discusses the finding that selection for insecticide resistance can promote Plasmodium falciparum infection in Anopheles mosquitoes.

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

Subscribe (free): Apple PodcastsGoogle PodcastsRSSemail

Links for this episode

Become a patron of TWiP

Case Study for TWiP 220

73 y/o M w/ no significant PMhs who is referred to ED for fever, lethargy and progressive weakness as for the past 2 weeks. Thursday of the prior week he went to his PCP and blood work was performed. CBC demonstrated RBC inclusions. Labs also demonstrated anemia,  thrombocytopenia, mildly elevated total bili and ALT.  He was started on PO azithromycin and atovaquone on Saturday, however, he has not noted much improvement. He was seen in our office Monday and reports intermittent fever to 102, continued chills . Additional symptoms include dark urine, chills, occasional diaphoresis. Normally patient rides his bike 15 miles a day and runs 3 miles per day but states now he barely has the energy to walk a few feet and is now in a wheelchair. He report that he regular goes for Runs in parks in Queens.

He denies any bug bites, tick bites, rashes, blood transfusions in the past year.

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

Music by Ronald Jenkees

Direct download: TWiP219.mp3
Category:general -- posted at: 2:00pm PST

TWiP solves the case of the Man With Dog Exposure, and discuss rapid and spontaneous post-partum clearance of Plasmodium falciparum related to expulsion of the placenta.

Hosts: Vincent RacanielloDaniel Griffin, and Christina Naula

Subscribe (free): Apple PodcastsGoogle PodcastsRSSemail

Links for this episode

Become a patron of TWiP

Case Study for TWiP 217

We have two cases today!

A man in his 60s who provides IT support for a bank and all done via zoom and remote work is referred to me. He reports having issues after COVID diagnosis Sept 5th, 2022. He had 4 vaccine doses and with diagnosis was treated with Paxlovid. Feel better than about week 3 wakes up with URI symptoms for about one week and by the 28th was improving. He had cold agglutinins detected. Referred to ophtho by his primary with some eye discomfort and noted to have elevated intra-ocular pressure elevation. Sleep and fatigue were a problem but slowly improving. Cognitive issues noted but improving. 

He reports an issue a few years prior to this current problem where he developed fever, a sore throat, tender lymph nodes in the neck both in front and in the back. This resolved after about a week but was then followed by months of fatigue, sleep disturbances and not feeling well.  He reports no specific dietary preferences and reports no cat exposures. He saw several physicians and one did a number of blood tests. 

A man in his late 30s presented to an ER at an outside hospital prior to ultimately being transferred to an academic center in NYC.. He reports onset of left arm weakness that prompted him to come to the ER. He reports on pointed questioning that he had COVID about one month prior and felt he had fully recovered. He did have a headache that preceded the onset of weakness. The OSH triggers their stroke protocol and perform a head CT which reveals a hypodense lesion on the right side of the brain not consistent with a stroke.

A bit more history is obtained, some further testing is done,and based on this the patient is transferred on some sort of therapy.

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

Music by Ronald Jenkees

Direct download: TWiP217.mp3
Category:general -- posted at: 9:00pm PST

TWiP solves the case of the case of the boy in Uganda with a mobile piece of spaghetti in the gallbladder, and reviews papers on female genital schistosomiasis in rural Madagascar, and a volatile sex attractant of tsetse flies.

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

Subscribe (free): Apple Podcasts, Google PodcastsRSSemail

Links for this episode

•Female genital schistosomiasis in rural Madagascar (PLoS NTD)
•A volatile sex attractant of tsetse flies (Science)
Letters read on TWiP 215

Become a patron of TWiP

Case Study for TWiP 215

This case was shared with my by a former student of the Diploma in Tropical Medicine and Hygiene course I coordinate, Prof Eyal Leshem, who is the Director  of the Institute for Travel and Tropical Medicine at the Sheba Medical Center in Tel Aviv and Clinical Associate Professor at the School of Medicine at Tel Aviv University, Israel. This case is of a 24 year old male who presented to the emergency room at the end of February with a 4 day history of fever, starting three weeks after he returned from a long trip.

He reports traveling in India during October of the past year. From November to early January, he stayed in Papua New Guinea, from where he traveled to Thailand, returning to Israel in early February. On admission he reports a daily fever up to 40 degrees C, which I think is 104 Fahrenheit. He also mentions an itchy rash and dry cough.

We learn a bit more about this patient. In Thailand, he received a five-day course of doxycycline due to a febrile illness, which resolved after treatment. During his stay in Papua New Guinea he hiked in the jungle, was bitten by multiple insects and also report finding leeches attached to his lower legs. One insect bite on his hip took a while to heal. He also reports swimming in multiple rivers. While travelling, he did not have unprotected sexual encounters but he admits to eating street food and home made food regularly. He received pre-travel vaccines and when he was in Papua New Guinea took Atovaquone Proguanil prophylaxis daily, discontinuing therapy a week after he flew to Thailand. On physical exam he is alert and oriented, vitals normal, the examination is unremarkable except for three cropped vesicles on his penis, which the patients says are itchy. A healed insect bite on his lower hip is also noted. His white blood count and differential are normal without eosinophilia. His haemoglobin is 13 g/dl, which is borderline normal and his platelet count is lower than normal with a count of 100,000 per microlitre of blood.

What is your diagnosis? What test or tests would you like to order to confirm your suspicion. We would like you to be as accurate as you can when identifying the parasite causing this man’s symptoms. What are special considerations you need to think about for treatment?

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

Music by Ronald Jenkees

Direct download: TWiP215.mp3
Category:general -- posted at: 10:27am PST

From ASTMH2022 in Seattle, Aisha joins the TWiP team to talk about her training and her career, including delivering a baby on an airplane, and they solve the Case of the Heartsick Guatemalan Septuagenarian.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Aisha Khatib

Subscribe (free): Apple Podcasts, Google PodcastsRSSemail

Links for this episode

Become a patron of TWiP

Case Study for TWiP 210

We are consulted about a rash.  A male in his mid 60s originally from Hong Kong with PMH of T2DM, Hypertension, BPH, Hepatitis B infection, COPD (not on home o2), current smoker, ESRD  with right chest cath on dialysis (MWF) presented to the ED  c/o progressive SOB and DOE for 1 week. 2 weeks prior the patient missed 1 session of hemodialysis. Progressively worsening SOB, DOE, orthopnea began to develop starting one week ago with an associated productive cough with white sputum. Last dialysis was session was 3 days PTA. Pt also began developing nausea and vomiting for 3 days x12 times last week. Pt also started developing diarrhea. Pt has states to have a notable generalized pruritic rash for 3 months that has been worsening. He reports he has been seen by dermatology and was told that the rash is due to certain allergies from food and has been using an unknown cream for 1 month that does not relieve his symptoms. Pt recently admitted for management of bleeding permacath and acute hypoxic respiratory failure likely 2/2 COPD requiring intubation and vent support. Denies recent travel, recent antibiotic use, or sick contacts…but his nephrologist reaches out and is concerned about a certain diagnosis as he says three other patients that come for dialysis have recently been diagnosed with a certain diagnosis.

On exam ee has a diffuse symmetrical rash and is scratching the while time. On careful examination there are small linear scabbed areas between his fingers.

         9.3  

8.97  )———–( 210    

           28.4 

Absolute eosinophil count is >1000

134<L>  |  97  |  51<H>

—————————-<  184<H>

3.8   |  25  |  5.10<H>

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

Music by Ronald Jenkees

Direct download: TWiP210.mp3
Category:general -- posted at: 3:33pm PST

The TWiP team solves the case of the Gentleman from New York with Intestinal Issues, and review a 20 year study of butterflies, their associated parasitoid wasp and Wolbachia introduced into an island community.

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

Download TWiP #200 (41 MB .mp3, 68 minutes)

Subscribe (free): iTunes, Google PodcastsRSSemail

Links for this episode

Become a patron of TWiP

Case Study for TWiP 200

Man in 30s with HIV-AIDS, presents with lower extremity weakness, headache, fever, ends up in hospital. Lives with wife and her cat, doesn’t take his medications. CD4 less than 100. Told to take medicine every day, one 3x week, one weekly. Does not drink alcohol, only eats well cooked meat. Born and raised in San Juan. Has had multiple sexual exposures with multiple women over years. Thin coating on tongue, lungs bowel normal. Has weakness in lower extremities. Skin unremarkable. Labs: CT shows multiple ring enhancing lesions with surrounding edema, also on MRI.  

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

Music by Ronald Jenkees

Direct download: TWiP200.mp3
Category:general -- posted at: 7:35am PST

Dickson, Daniel and Vincent solve the case of the Female with Itchy Anus, and reveal the structure of a roundworm membrane protein involved in digestion of nutrients.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Subscribe (free): iTunes, Google PodcastsRSSemail

Links for this episode

Become a patron of TWiP.

Case Study for TWiP 183

70 yo male. Returns with wife from safari in S. Africa. Reports suffering from 2 weeks watery diarrhea. Severe water shortage in S. Africa, limited washing water, hand sanitizers to clean hands so problem with hand hygiene.  5 days after arrival he and wife have water diarrhea, 12 per day, nauseated, abdominal cramping. Ab no effect. Stool culture, ONP, negative. Healthy, no past med/surg, no allergies, nothing runs in family. Stool sent off for ONP acid fast stain, also GI PCR panel. Prompts treatment for 7 days trimethoprim sulfamethoxazole, resolves.

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

Music by Ronald Jenkees

Direct download: TWiP183.mp3
Category:general -- posted at: 3:04pm PST

The TWiP team solves the case of the Four Year Old with Fever, Headache, and Cough, and discuss the release of extracellular vesicles from Leishmania amazonensis that manipulate the host immune response.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Subscribe (free): iTunes, Google PodcastsRSSemail

Become a patron of TWiP.

Links for this episode:

Case Study for TWiP 165

Still in Uganda. Young boy came from a distance to see Daniel, teenager with large swelling in scrotum, left side, 4-6 cm diameter, superior to testicle. Not only young man in area with similar problem. Daniel asked, are there people with large swollen legs? He said yes, my brothers wife, left leg is large, swollen, irregularity. Nontender. Can be transilluminated, and it glows.

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

Music by Ronald Jenkees

Direct download: TWiP165.mp3
Category:general -- posted at: 1:30pm PST

The TWiP peeps solve the case of the Panamanian Mother with Steatorrhea, and reveal new monoclonal antibodies that effectively block malarial infection.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Become a patron of TWiP.

Links for this episode:

Case Study for TWiP 152

40 yo man in same Panamanian village, diarrhea for several weeks, notices blood mixed in with stool. Works in fields. No weight change, no fever, but tired. Drinking water from rooftop, lives in home with wooden slat floor, no electricity, many animals around, no one else sick in family. Lower belly tenderness, normal rectal exam. Farmer with 3 weeks of bloody diarrhea.

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

Music by Ronald Jenkees

Direct download: TWiP152.mp3
Category:general -- posted at: 11:20am PST

The three amigos of parasitology solve the case of the New York Lawyer With A Foot Ulcer, and discuss a survey of rodents for the raccoon roundworm in California.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Become a patron of TWiP.

Links for this episode:

Case Study for TWiP 147

Three year old boy, in tropical S. America, brought in by mother, says has been sick about a month. Previously healthy, 4 healty siblings, vaccines up to date, now has abdominal pain. Belly pain increases throughout day, poor appetite, constipated, has goat stools, pellets. Has had fever, seems swollen, face pale, urine dark, belly distended. Occasionally coughs. Living conditions: home has dirt floor where he spends most of day. On exam is febrile, doesn’t look well, no teeth, sleepy, not responsive, distended belly, pale, weight 13 kg. Diffuse scaly skin inflammation around perianal area, breakdown of skin around mouth. HIV, HTLV1 negative. Dogs, chickens, goats around, they come in house. Stool O&P sent out, contained something that gave diagnosis.

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

Music by Ronald Jenkees

Direct download: TWiP147.mp3
Category:general -- posted at: 12:39pm PST

The TWiPians solve the case of the Woman With Anemia, Eosinophila, and a Worm in Her Intestine, and discuss a study on the function and druggability of two malarial aspartate proteases.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Become a patron of TWiP.

Links for this episode:

Case Study for TWiP 143

From 1990s seen by a colleague, boy late teens, initially presented to ER in US chief complaint, visual disturbances and itching preventing sleep. Immigrated from Oaxaca, searching for work. Lived in modest dwelling with dirt floors, no running water, got from local river. Reports dogs, farm animals, many insects. On exam: tender nodules on head, skin irritated from scratching, small punctate lesions on right cornea. Is referred to specialists. Ophthalmologist called in, referred for further diagnostics.

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

Music by Ronald Jenkees

Direct download: TWiP143.mp3
Category:general -- posted at: 9:49am PST

The triple TWiP solve the case of the Peace Corp Veteran with Eosinophilia, and discuss the genome sequence of the hyper-prevalent parasitic eukaryote Blastocystis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Become a patron of TWiP.

Links for this episode:

This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. Get $30 off your first delivery and FREE SHIPPING by going to blueapron.com/twip.

Case Study for TWiP 140

From Dr. Arthur Mumelo, northern Kenya. One-year-old girl. Brought by mother with skin lesions that developed a week prior. The lesions are five in total – on the forehead, neck, back, chest and right arm. The lesions look like boils/furuncles but keep changing size and appearance – like something is moving under the skin. They are painful and itchy. Child is breastfeeding well. No other complaints. Child was born at Nyahururu County Referral Hospital. Gets vaccinations at Melwa Health Centre (Rural), vaccinations are up to date. They live in a wooden house with a dirt floor, roofed with corrugated iron sheets. The house has two rooms. They sleep on raised beds. There is a big community dam in the neighborhood, with stagnant water throughout the year. They don’t use mosquito nets. They have reliable clean water supply from the government. They have one dog but the neighbors’ dogs also visit their compound and living area. They hang their clothes on the clothesline after washing; never dry their clothes on the grass. Clothes not hot-ironed. On Examination; Child is breastfeeding well, afebrile, no pallor, no jaundice, not in distress. Occipital lymphadenopathy; tender, mobile. Furuncles on the forehead, chest neck, back and right arm. They are 1-3cm in diameter and 0.5 cm high, tender, have a central punctum from which serosanguineous fluid is discharging.  This is a rural health centre – the only labs done are a peripheral blood film – which showed increased eosinophils and neutrophils. HIV test – negative.

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

Music by Ronald Jenkees

Direct download: TWiP140.mp3
Category:general -- posted at: 1:11pm PST

Hosts: Vincent Racaniello and Dickson Despommier

Vincent and Dickson review a multistate outbreak of cyclosporiasis caused by the single-celled coccidian parasite Cyclospora cayetanensis.

The day after recording this episode, ProMedMail reported that the outbreak of cyclosporiasis had spread to Texas.

Links for this episode:

Contact

Send your questions and comments (email or mp3 file) to twip@twiv.tv

Subscribe (free)

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Direct download: TWiP057.mp3
Category:general -- posted at: 8:35am PST

Hosts: Vincent Racaniello and Dickson Despommier

Vincent and Dickson meet with Judith Straimer and Marcus Lee to discuss their method for site-specific genome editing in Plasmodium falciparumusing zinc finger nucleases.

Right-click to download TWiP #46 (46 MB .mp3, 64 minutes).

Links for this episode:

Contact

Send your questions and comments (email or mp3 file) to twip@twiv.tv.

Direct download: TWiP046.mp3
Category:general -- posted at: 6:52am PST

Vincent and Dickson review Wuchereria bancrofti, the nematode that causes lymphatic filariasis, also known as elephantiasis.

Direct download: TWiP025.mp3
Category:general -- posted at: 6:48pm PST

1