This Week in Parasitism

Eyal joins TWiP to solve the case of the Female Traveler with Intermittent Fever and Ring Enhancements in the Liver. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Eyal Leshem Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Become a patron of TWiP 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. Send your questions and comments to [email protected] Music by Ronald Jenkees

TWiP discusses a tapeworm that causes extreme lifespan extension in infected ant workers, and a candidate antibody drug for prevention of malaria. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Extreme lifespan extension in tapeworm-infected ant workers (Roy Soc Open Sci) Candidate antibody drug for prevention of malaria Ceilidh goes viral (YouTube) Become a patron of TWiP Send your questions and comments to [email protected] Music by Ronald Jenkees

Jim Small joins TWiP to solve the case of the 41 year old Man with sudden GI distress and itchy hives, followed by a discussion of parasites and childhood stunting. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Jim Small Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Parasites and childhood stunting (Trends Parasitol) Letters read on TWiP 227 Become a patron of TWiP Send your questions and comments to [email protected] Music by Ronald Jenkees

TWiP reviews some parasite stories of 2023, including progress in the control of malaria and polio, and review a connection between parasites and childhood stunting. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Second malaria vaccine (Nature) Malaria report 2023 (WHO) Malaria and climate change (WHO) Parasites and childhood stunting (Trends Parasitol) Sea creature spotted off Japan identified (Science) Become a patron of TWiP Send your questions and comments to [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Vaccine against cow parasite (Vert Farm Daily) Protective vaccine against bovine parasitic nematode Ostertagia ostertagi Hero: Dr. Katy Ewer Letters read on TWiP 225 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.

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 Racaniello, Dickson Despommier, and Chuck Knirsch Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Neglected Tropical Diseases Roadmap (WHO) World malaria report 2023 (WHO) Become a patron of TWiP Send your questions and comments to [email protected]

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 Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Click arrow to play Download TWiP #223 (63 MB .mp3, 88 minutes) Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Malaria (Lancet) Chagas disease (AJTMH) Hero: Joe Cook Letters read on TWiP 223 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Natasha Spottiswoode Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Treatment of Balamuthia encephalitis with nitroxoline (Emerg Inf Dis) Letters read on TWiP 222 Become a patron of TWiP 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 [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guests: Michelle Naegeli and Alexander Grieb Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode cAMP-dependent invasion by Trypanosoma cruzi (PLoS NTDS) Letters read on TWiP 220 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 [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Malaria transmission-blocking vaccine (Lancet Inf Dis) mRNA vaccine against malaria (Nat Immunol) Letters read on TWiP 220 Become a patron of TWiP 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 [email protected] Music by Ronald Jenkees

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 Podcasts, Google Podcasts, RSS, email Links for this episode Insecticide resistance in mosquitoes promotes Plasmodium infection (PLoS Path) Letters read on TWiP 219 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 [email protected] Music by Ronald Jenkees

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 Racaniello, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Malaria parasite evades mosquito immunity (Proc Natl Acad Sci USA) Letters read on TWiP 218 Become a patron of TWiP 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 [email protected] Music by Ronald Jenkees

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 Racaniello, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Post-partum clearance of P. falciparum (J Inf Dis) Letters read on TWiP 217 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 [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Eyal Leshem Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Letters read on TWiP 216 Become a patron of TWiP 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 [email protected] Music by Ronald Jenkees

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 Podcasts, RSS, email 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 [email protected] Music by Ronald Jenkees

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join MicrobeTV Discord server TROPMEDEX Letters read on TWiP 214 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode •Soft Power Health •Letters read on TWiP 213 Become a patron of TWiP 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 [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Shauna Gunaratne Click arrow to play Download TWiP #212 (51 MB .mp3, 84 minutes) Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Letters read on TWiP 212 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Monoclonal antibody against malaria trial (NEJM) Hero: Stephen Hoffman Letters read on TWiP 211 Become a patron of TWiP 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 [email protected] Music by Ronald Jenkees

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 Podcasts, RSS, email Links for this episode Aisha delivers baby on airplane (The Varsity) Helminth infections during pregnancy (J Travel Med) SARS-CoV-2 transmission during air travel (Curr Op Inf Dis) Letters read on TWiP 210 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 | 97 | 51 —————————- 3.8 | 25 | 5.10 Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Use coupon code MicrobeTV when purchasing a spike t-shirt from Vaccinated.us Accidental host (TWiP 207) Hero: Dan Colley Letters read on TWiP 209 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected]

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Malaria intensity modifies vaccine effectiveness (J Inf Dis) Letters read on TWiP 208 Become a patron of TWiP 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). Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Guest: Claire Panosian Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Claire's website Claire's videos (Vimeo) Letters read on TWiP 207 Become a patron of TWiP 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 [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Bacteria protect mosquitoes from parasite infection (Nat Microbiol) Letters read on TWiP 206 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Download TWiP #205 (56 MB .mp3, 93 minutes) Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Emodepside for onchocerciasis (PlOS NTD) Hero: Dr. Mwelecele Ntuli Malecela Letters read on TWiP 205 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Oral fexinidazole for African trypanosomiasis (Lancet) Hero: Madeline Albright Letters read on TWiP 204 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Mosquito net use in Tanzania (NEJM) Michiaki Takahashi (Wikipedia) Letters read on TWiP 203 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Guest: Sara Deng Click arrow to play Download TWiP #201 (72 MB .mp3, 60 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Febrile podcast Hero: Eloise Blaine Cramm Support MicrobeTV at Parasites Without Borders Letters read on TWiP 202 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Reservoirs for Leishmania (Transboundary Emerg Dis) Support MicrobeTV at Parasites Without Borders Letters read on TWiP 201 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Download TWiP #200 (41 MB .mp3, 68 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Accidental parasitoid introduction (Mol Ecol) Hero: Gerald Keusch Support MicrobeTV at Parasites Without Borders Letters read on TWiP 200 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 [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Historic malaria vaccine (Nature) Efficacy and safety of RTS,S/AS01 (Lancet) Letters read on TWiP 199 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Malaria parasite resists fever due to heat shock response (Nat Micro) Malaria beats the heat (Nat Micro) Letters read on TWiP 198 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Despommier, Daniel Griffin, and Christina Naula Download TWiP #197 (39 MB .mp3, 64 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Experimental T. vivax vaccine (Nature) Letters read on TWiP 197 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Entomophagy (TWiP 131) Malaria mRNA vaccine (NPJ vaccines) Letters read on TWiP 196 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter VLP-based malaria vaccine (Cell) Promise of a malaria vaccine (Ann Rev Micro) Hero: Maria Mota Letters read on TWiP 195 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Helminth infection enhances West Nile viruses pathogenesis (Cell) Hero: Franz Von Lichtenberg Letters read on TWiP 194 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Blastocystis interactions with gut microbiota and immune system (PLoS Path) Hero: Lucy Engel Graves Taliaferro Letters read on TWiP 193 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Hero: George B. Craig Letters read on TWiP 192 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter RNAseq atlas of S. mansoni (Science) Hero: Kathleen Hussey Letters read on TWiP 191 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter COVID-19 effects on malaria in Africa (Lancet) Hero: Clark Read Letters read on TWiP 190 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Support MicrobeTV through Parasites Without Borders Hero: Tony Fauci Tony Fauci on TWiV 219 and 641 Letters read on TWiP 189 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Letters read on TWiP 188 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Heme oxygenase-1 in protozoan infections (PLoS Path) Support Floating Doctors at PWB Letters read on TWiP 187 Become a patron of TWiP 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

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Three-dimensional structure of malaria parasite (PLoS Path) Support Floating Doctors at PWB Letters read on TWiP 186 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Intrinsic oscillator in malaria parasite (Science) Malaria parasite has intrinsic clock (Science) Letters read on TWiP 185 Become a patron of TWiP 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Contribute to Parasites Without Borders Microsporidian impairs Plasmodium transmission (Nat Comm) Hero: Eugene T. Lyons (obituary) Image credit: Josh Letters read on TWiP 184 Become a patron of TWiP. 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 Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Podcasts, RSS, email Links for this episode Structure of roundworm digestive complex (PLoS Path) Hero: Dr. Anthony Fauci Fauci Pharmacy (TWiV 219) Letters read on TWiP 183 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 [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB social media: Facebook, Instagram, Twitter Daniel on TWiV HIV-1 integration into Schistosome genome (PLoS Path) Image from John Southall's Treatise of Buggs, 1730. Letters read on TWiP 182 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB social media: Facebook, Instagram, Twitter Daniel on TWiV Special Engineered symbionts limit honeybee pathogens (Science) Letters read on TWiP 181 Become a patron of TWiP. 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? Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB social media: Facebook, Instagram, Twitter Endocytosis pathway mediates artemisinin resistance in malaria parasites (Science) Letters read on TWiP 180 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees