This Week in Parasitism

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB social media: Facebook, Instagram, Twitter Primate model of severe malarial anemia (Sci Rep) Ascaris skirt (and more!) Hero: Harold W. Brown Letters read on TWiP 179 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB social media: Facebook, Instagram, Twitter Protein kinase as malaria drug target (Science) Hero: Myron Schultz Letters read on TWiP 178 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Progress towards global eradication of dracunculiasis (MMWR) Rotifer compound that paralyzes schistosome cercariae (PLoS Biol) Image credit Letters read on TWiP 177 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Effect of schistosome soluble egg antigen on HIV-1 infection (PLoS P) Hero: Lawson Soulsby Letters read on TWiP 176 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Antibodies that slow malaria invasion (Cell) Hero: Sir Leonard Rogers (pdf) Letters read on TWiP 175 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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. Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode: Determinant of T. gondii sexual cycle(bioRxiv) A Year's Worth of TWiP by Kevin Carney Hero: William Trager Letters read on TWiP 174 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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. Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode: Matryoshka RNA virus of Plasmodium (bioRxiv) Hero: Rose Gana Fomban Leke Letters read on TWiP 173 Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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. Subscribe (free): iTunes, Google Podcasts, RSS, email Transgenic Metarhizium kills mosquitoes (Science) Hero: Veena Tandon Letters read on TWiP 172 Links for this episode: Become a patron of TWiP. 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Elmer Pfefferkorn, 87 Eukaryotic parasite without mitochondrial genomes (Sci Adv) Hero: Charles Wardell Stiles Letters read on TWiP 171 Case Study for TWiP 171 By boat to remote village, young boy ( Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Chagas disease pathophysiology and collectin-11 (PLoS NTD) Hero: Theobald Smith Image credit: Toxocara canis by Ben Liffner Letters read on TWiP 170 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: S. bovis and S. haematobiumhybrids (PLoS Path) Hero: Ann Bishop Letters read on TWiP 169 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: T. spiralisand intestinal tuft cells (PNAS) Hero: Carl Theodore Ernst Van Siebold Letters read on TWiP 168 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Glycocalyx and severe malaria (Clin Inf Dis) Hero: Bridget Ogilvie Letters read on TWiP 167 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? Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: B1 cells and Chagas disease (Front Immunol) Daniel discovers B1 cells (J Exp Med) Hero: Bridget Ogilvie Image credit Letters read on TWiP 166 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Crackles (Wikipedia) Extracellular vesicles released by L. amazonensis (Front Microbiol) Hero: Marietta Voge Image credit Letters read on TWiP 165 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 [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: A Tale of Three Species (mBio) V.B. Wigglesworth (Wikipedia) VB Nimble, VB Quick Hero: James Paget Letters read on TWiP 164 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? Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Mucosal Ig protect trout from Ich (PLoS Path) Hero: Sir Patrick Manson Letters read on TWiP 163 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Patients with Dientamoeba fragilis infection (Am J Trop Med Hyg) Hero: Dr. Eloise B. Cram Image credit Letters read on TWiP 162 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Trypanosome genome organization and antigenic variation (Nature) Hero: Arthur Looss Letters read on TWiP 161 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Chadian Guinea worms in humans and dogs (PLoS NTD) Hero: Karl George Friedrich Rudolf Leuckart Image credit Letters read on TWiP 160 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Ivermectin for onchocerciasis and loiasis (PLoS NTD) Hero: William Boog Leishman Thanks to Caitlin for the image Letters read on TWiP 159 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Imaging parasites in ant brain (Nat Rep) Brain worm turns ants into zombies (Nat Hist Museum) Hero: Giovanni Battista Grassi Image credit Letters read on TWiP 158 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

The TWiP professors solve the case of the Woman With Intracellular Ring Forms, and explore the role of Coxiella and Rickettsia endosymbionts in acquisition of Babesia by ticks. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Endosymbionts and Babesia in ticks (Front Microbiol) Q fever with Robert Heintzen (TWiM Special) Hero: Percy Garnham Image credit Letters read on TWiP 157 Case Study for TWiP 157 Back to Thailand. Housewife, complaint has multiple red bumps on body, intense itching, worse at night. On head, legs, upper chest. Also does not feel well, feverish, muscle aches, difficulty breathing. Moved into abandoned residence, symptoms began a few days later. Many coconut husks around. Thatched roof. Husband and children developed similar symptoms. No med/surg history, no allergies. No meds. Unused mattresses, rat nests around. No toxic habits, no travel. No pets. On exam: not febrile, not toxic, increased heart, breathing comfortably. Has multiple red papules, central punctum. Labs unremarkable. Diff: unremarkable 6% eosinophils. Skin scraping from lesion on chest done. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

The TWiP crew solves the case of the Ecuadorian with Immunodeficiency and Chronic Diarrhea, and discuss oral transmission of Chagas disease in mice. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Imaging Chagas after oral transmission (Sci Rep) NJ invasive species strike team and app Red Mother Hero: Angelo Dubini Image credit Letters read on TWiP 156 Case Study for TWiP 156 While on ID consultant service on LI during July, asked to see woman in late 70s admitted for fever, confusion, diarrhea. 2-3 days of abdominal pain, nausea, vomiting. Week prior was a family party, drank two large glasses Scotch. Had watery, nonbloody diarrhea 4-5 times per day; vomiting 2-3 times/day. Developed 103F fever, headache, lost appetite, 4-5 days did not eat. Hospitalized. No one else in party became ill. 2005 had episode of turning yellow after visiting Nepal. No surgeries, no allergies, no diseases running in family. ITP on prednisone, other drugs listen to podcast as well as PMH. Social history: worked in retail shop in Kathmandu, retired. Born west Bengal India, moved to Kathmandu as teenager, lived until 50s in nice part of town. Moved to LI 25 years ago, returns periodically to Nepal, last in 2017 for 2 months. Earlier this month had done 3 day camping trip with family on LI in tents. Brought water to drink, no contact with animals. Belly: small liver on percussion, no enlarged spleen, fluid wave, belly distended, white count elevated 38,000, no eosinophils. CAT scan of belly: cirrhotic liver, some acidic fluid. Notice intracellular ring forms less than 4% on smear. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

Justin joins the TWiP team to solve the case of the Gentleman with B cell Lymphoma, and consider the finding of Dracunculus species in river otters from Arkansas. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Justin Aaron Become a patron of TWiP. Links for this episode: Dracunculus in river otters (J Parasitol) Image credit Letters read on TWiP 155 Case Study for TWiP 155 Another challenging one. 60 yo man with poorly defined immunodeficiency: low Ig, low T cells, on chronic Ig therapy. Admitted with 1 yr chronic diarrhea. Had upper endoscopy, inflammation of duodenum, crypt hyperplasia, diffuse ulceration. Lower colonoscopy: granular appearance to cecal mucosa. Loss of haustral folds. Biopsies done and sent for culture. PMH: poorly understood interstitial lung disease. Unable to work, no toxic habits. Born Ecuador, moved to US in early 40s, living in Staten Island. No fever, bp low, hr >100, resp high teens. Remarkable: looks frail but not terribly ill. Labs: normal WBC, shifted to left with increase in neutrophils and eosinophils. Albumin low; respiratory pathogen positive for rhinovirus. Serum CMV: >4000 (virus measurement). Started on ivermectin, WBC rises, broad spectrum Ab. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

Vincent and Daniel solve the case of the Man in the City with Groin Rash, catch up on the long backlog of email, and present a new case, possibly the most complex one yet on the show. Hosts: Vincent Racaniello and Daniel Griffin Become a patron of TWiP. Links for this episode: Bloodless malaria diagnostic (BBC) Image credit Letters read on TWiP 154 Case Study for TWiP 154 Daniel's colleague will solve this case, in two weeks. 79 year old man history of chronic lymphocytic leukemia that became B cell lymphoma, had chemotherapy a few weeks before coming. Was discharged with scrip for prednisone, but pharmacy made error gave him enough to take every day for over two weeks. Patient has fevers up to 100 degrees at home, headache, develops dry nonproductive cough. Brought to ER by family, there reports has lost weight. No nausea, no vomiting, no abdominal pain or diarrhea. Admitted to hospital. Has fever, chest x-ray suggests pneumonia, started on ab. Fever and symptoms continue, stop steroids. Chest CT shows multifocal ground glass opacifications and nodules. Increase ab to broader spectrum, ID is consulted. Positive test for latent TB. History hypertension, coronary artery disease, enlarged prostate. Gets bactrim, antifungal, antiviral. Born in DR, living in US since 70s. Visits occasionally had been a few months before. Lives with wife, no pets, no smoking, no toxic habits. Heart rate in 90s, looking fatigued, coughing, scattered crackles in lung, old systolic murmur, no rashes, confused, but family says he is always like that. TB test is negative. Negative for strongyloides. WBC count has increased, 30% eosinophils (over 7000). Stool ONP ordered but becomes constipated. CAT scan of belly shows thickening of colon. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

Vincent and Daniel solve the case of the Panamanian Farmer with Three Weeks of Diarrhea, and discuss how microbes egested during bites of sand flies exacerbate the severity of leishmaniasis. Hosts: Vincent Racanielloand Daniel Griffin Become a patron of TWiP. Links for this episode: Sand fly microbesand leishmaniasis severity (Cell Host Micr) Letters read on TWiP 153 Case Study for TWiP 153 Man in clinic, in city recently, developed rash in groin area, concerned about this. Lives in open relationship with male partner, had sexual encounter with another male. Few weeks. Rash is in the pubic hair, is very itchy. Mostly around umbilicus, can see blue spots in this area. These are skin changes. Buys magnifying glass to look and describes seeing things which we see as well. No notable medical history. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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: Plasmodiumimmunity from injected sporozoites(Nature) New monoclonal prevents malaria infection(Nat Med) Parasite Hero: Carlos Chagas Image credit Letters read on TWiP 152 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 [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Competingfor Blood (Ecol Letters) Parasite Hero: William C. Campbell Image credit Letters read on TWiP 151 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

The TWiPers solve the case of the Panamanian Man With Leg Ulcer, and describe how a crab predator preferentially feeds on parasite infected prey - even though the parasite makes them faster! Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Parasite enhances susceptibilityto predators (Oecologia) Parasite Hero: Miriam Rothschild Image credit Letters read on TWiP 150 Case Study for TWiP 150 Up to Costa Rican border, travel by boat 2.5 hr, up stream through mangroves. Mobile med clinic in village in small island in archipelago. Mother concerned about two children, have a very itchy rash on trunk and arms. Worse at night, needs medicine. Boy is 6 yo, has rash on buttocks, arms, genital area. Nothing out of ordinary in medical history. Living in same village as previous case, few hundred people, home has slat wood floors, toilet is over water. Dogs, pigs, chickens; no electricity; water comes off roof. On exam see rash, on dermoscopy see 1 cm long brown lines, clotted blood deltas at end. In this area many kids have this rash. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Even dinosaurs had parasites (Cosmos Mag) Why some people are wormier than others (RSTMH) Angiostrongylus species in badger lungs (thanks, Rachel!) Spread of rat lungworm (Hawaii News Now) Aussie teenager swallowed slug (news.com.au) Agrochemicals increase snail numbers (Nat Comm) Parasite Hero: Émile Brumpt Image credit Letters read on TWiP 149 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

The TWiP-tologists solve the case of the South American Child With Belly Pain, and reveal how B1 cell IgE blocks parasite clearance by inhibiting mast cell activation by B2 cell IgE. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Do not eat raw earthworms! (Pediatrics) Would you let worms in your veins? (Science) Guinea Pig Doctors by Jon Franklin and John Sutherland Parasite Hero: David Bruce Letters read on TWiP 148 Case Study for TWiP 148 Will have a guest on next show to unveil! Female teenager living in NYC, previously in good health, rash for 2 week, abnormal feeling in legs. Initially had URT infection, no cough or fever. Rash is itchy, worse at night. But feeling of pins and needles, sharp stabbing in feet and legs. In ER told is zoster, started on gabapentin. Few days later fevers, pain getting worse. Seen by neurologist and ID doc, admitted. No past med/surg. Type 1 diabetes in aunt, father migraines, no autoimmune diseases. Had received chickenpox vaccine! Social: lives with parents and younger brother, much travel, Holland, Hawaii, most recent, pet lizard. In Hawaii, salad that she ate but no one else. Physical: febrile, heart rate >110, bp ok. Does not want to move because of pain. Neurological: extremity movement is slow. Rash irregular on chest, neck, back, abdomen. Labs: white normal, not much shift. Sed: 24, slightly increased. Lumbar puncture: increased white cells 280, 32% eosinophils. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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: Monthly case studies (CDC) The Parasite on the Playground (NYTimes) Introduced rats and raccoon roundworm (J Parasitol) Parasite Hero: Theodor Bilharz Letters read on TWiP 147 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 [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Reticulocyte receptor for Plasmodium vivax (Science) Image credit: Parasitic Diseases, 6th Ed. Parasite Heroine: Marietta Voge Letters read on TWiP 146 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Excretory and secretory products of Giardia intestinalis (PLoS NTD) Image credit Letters read on TWiP 145 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Malaria plasmepsins involved in invasion and egress (Science) Image credit Letters read on TWiP 144 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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: Malaria plasmepsins involved in invasion and egress (Science) Letters read on TWiP 143 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 [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: APOLs kill all African trypanosomes (Nat Micro) Trypanocidal properties of APOL1 on TWiP 85: Channeling tryps Letters read on TWiP 142 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

The TWiP Wataalamu solve the case of the One Year Old From Kenya With Moving Skin Lesions, and describe how to make mosquitoes refractory to Plasmodium with engineered symbiotic bacteria. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Engineered Serratia make mosquitoes refractory to Plasmodium (Science) Operation Sea Spray (Wikipedia) Photo credit Letters read on TWiP 141 Case Study for TWiP 141 A 59 yo Spanish speaking female on Long Island originally from Guatemala. Goes to ER after returning from 10 day trip to visit friends and relatives in Guatemala and El Salvador with fever, cough, diffuse muscle aches, fatigue, chills. Respiratory pathogen panel done, positive for rhinovirus. Told that it's just a virus, go home. 5 days later returns with fever and chills, pain in upper belly, feels constipated. Admitted. No past med/surg, no allergies, no significant family history, no meds. Works cleaning houses. Travel: spends most time in and around big cities, lots of exposure to animals, ate all local fare; conch ceviche, fresh eggs, flattened chicken dish. Elevated white count left shifted, neutrophils increased, eosinophils cleared; cultured Salmonella from blood. IV antibiotics given, gets better, about to go out the hospital door, when results of stool O&P comes back from initial admission. Observed: Entamoeba coli; Endolimax nana; Blastocystis hominis. Released to home, 2 weeks later feels fine. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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: Genome diversity of Blastocystis (PLoS Biol) Photo credit Letters read on TWiP 140 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 [email protected] Music by Ronald Jenkees

The TWiPwalas solve the case of the Woman with a Worm in Her Eye, and discuss the role of nitric oxide in the resistance of rats to Schistosoma japonicum. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Nitric oxide blocks schistosome development (PNAS) Photo credit: Dave the Sheep Shearer Letters read on TWiP 139 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 139 Seen at Columbia Medical Center, a crossover. Woman in 30s returns to US after 2 years in Peace Corp, Cameroon and Gabon. On medical exam 2 years earlier: eosiniphilia noted, no diagnosis reached. Now comes to NYC 2 years later to attend grad school, again eosinophilia noted. Asymptomatic. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Tr (Cell Host Microbe) Letters read on TWiP 138 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Transmissible dysbiotic skin microbiome in cutaneous leishmaniasis (Cell Host Microbe) Letters read on TWiP 137 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? Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Inflammatory monocytes and skin Leishmania (PLoS Path) Dracunculiasis (TWiP 37) Photo: Daniel using a LifeStraw Letters read on TWiP 136 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: ASM Grant Writing Online Course Single-sex Schistosoma infection (PLoS NTD) Asterix the Gaul Letters read on TWiP 135 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? Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Links for this episode: ASM Grant Writing Online Course Is Toxoplasma infection related to brain and behavior impairments? (PLoS One) Toxoplasma infection and sexual attraction (Evol Psychol) TWiP 21 - The giant intestinal worm, Ascaris lumbricoides Candiru (Wikipedia) Image credit Letters read on TWiP 134 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Become a patron of TWiP. Links for this episode: Journal of Microbiology and Biology Education SciComm Issue (link) TWiP 19: Enterobius vermicularis, the pinworm Multiple roles of Toxoplasma gondii clathrin adaptor AP1 protein (PLoS Path) Image credit Letters read on TWiP 133 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. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Inhibitors of protein import into trypanosome glycosomes (Science) Hookworm (TWiP #22) Photo by Nita Letters read on TWiP 132 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 [email protected] Music by Ronald Jenkees

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 Racaniello, Dickson Despommier, and Daniel Griffin Guest: Jonathan Larson Become a patron of TWiP. Links for this episode: Jonathan Larson (Twitter, Google Plus) Arthro-Pod podcast Warm hemolytic anemia after babesiosis (NEJM) Tickborne diseases of the US (CDC) Image credit Letters read on TWiP 131 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 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 [email protected] Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson 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. Become a patron of TWiP. Links for this episode: T. brucei exosomes and social motility (PLoS Path) Image credit Parasites Without Borders Letters read on TWiP 130 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 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! Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees