This Week in Parasitism

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP Masters solve the case of the Australian Wildlife Carer, and review evidence that nodding syndrome may be caused by an autoimmune reaction to the parasitic worm that causes river blindness. Become a patron of TWiP. Links for this episode: Nodding syndrome an autoimmune disease? (Sci Transl Med) Nodding syndrome: Preventable and treatable (Sci Transl Med) River Blindness lyrics (Google Play) Image credit Letters read on TWiP 129 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 129 Young male in 30s, presents to ER with male partner, NY area, chief complaint over 1 month significant diarrhea, watery, non bloody. Abdominal cramping. Feels poorly, low energy, fever. Some vomiting, lost noticeable amount of weight, can't stay hydrated. Past: AIDS positive, not on meds, last CD4 Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPerati solve the case of the Man Who Sat in Feces, and discuss a study on how Dickson's favorite parasite induces the formation of a collagen capsule. Become a patron of TWiP. Links for this episode: Induction of collagen synthesis by Trichinella (Vet Parasitol) Letters read on TWiP 128 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 128 Daniel doesn't expect anyone to get this. From Australia, 80 yo retired teacher from Atherton, northheast Australia, presents to clinic with generalized weakness, concern of chronic lyme or Q fever. Seen by neurologist, concern about motor neuron disease. 18 months of illness, insidious onset of limb (arms and legs) weakness. No issues with speaking, swallowing or breathing; no weight loss; no fever, sweat, chill. History of osteoarthritis, joint replacements; myocarditis; vertigo; allergic to pen and dox. Father, rhematoid arthritis, brother colon cancer. On a number of medications. Does extensive travel, when not traveling, is a volunteer carer in Australia (abandoned wildlife), over the past three years. Lives with husband. Marsupials, hand feeds puggles and juvenile spiny anteaters, has pet cockatoo. No history of polio, HIV negative. Neuro exam: diffuse non tender muscle with no rash. Normal upper and lower limb tone, strength is symmetrically reduced proximally. Reflexes good at knees, normal sensation to all modalities. Normal cranial nerve exam. Test results: has eosinophilia, elevated muscle enzymes, EMG shows myopathic changes, nerve conduction normal. Stop statin therapy, no change. This is a rare parasite. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPsters solve the case of the Peace Corps Volunteer with a Liver Lesion, and discuss the dependence of Leishmania survival on the gut microbiome of the sandfly. Become a patron of TWiP. Links for this episode: Leishmania depends on sandfly gut microbiome (mBio) Kava (Wikipedia) Letters read on TWiP 127 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 127 The last of our trio for the Peace Corp, an eosinophilia case. 29 yo pc volunteer in Rwanda, male, 3 weeks of feeling poorly. Starts with rash on lower back and upper legs, maculopapular rash. Fatigue later, cough, then diarrhea, 51% eosinophils (9000). No significant exposure to fresh water. Stool sent for oandp. Said sat down and got something on behind, realized later was feces, this was where rash developed. OandP seeing larva in stool. HIV neg, no med issue, no surgeries, no Kava. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP Trinity solve the case of the Peace Corps volunteer with diarrhea, and reveal how immunizing against a virus ameliorates exacerbated leishmaniasis. Become a patron of TWiP. Links for this episode: Viral vaccine prevents exacerbated leishmaniasis (PLoS NTD) For whom the trich tolls (TWiP 47) A virus in a parasite in a human (virology blog) Virologists in the mist (TWiV 128) Letters read on TWiP 126 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 FREE SHIPPING - by going to blueapron.com/twip. Case Study for TWiP 126 Another Peace Corps volunteer in Fiji. 24 yo male, several days of fever, headache, dry cough, rash. Feels poorly, starts diarrhea. No blood or mucus, no vomiting but abdominal discomfort. Heart rate over 100. At private nearby hospital for evaluation: no prior med probs or surgeries. Social history: MSM, not always protected, drinks every weekend. Home blown away by cyclone. Alcohol: drinks beer, a lot. White rice, split peas, bread diet. Fan of cava, also drank unfiltered water. He is admitted, continues to feel poorly. Continued fevers, localized abdominal pain RUQ. On exam he has tender palpable liver, elevated WBC 17.8, eosinopenia, 0 cells. AST/ALT slightly above normal. Dengue, chick, lepto, blood all negative. Ultrasound of liver: shows 8x8 cm mixed echogenic lesion in right lobe. HIV negative. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPonderers solve the case of the Timber Worker with Severe Shaking Chills, and describe an experimental malaria vaccine comprising attenuated sporozoites produced by genetic engineering. Become a patron of TWiP. Links for this episode: Genetically engineered P. falciparum sporozoite vaccine (Sci Transl Med) Parasitology Superhero: Francesco Redi Image credit: Betsy Weissbrod Letters read on TWiP 125 This episode of TWiP 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 FREE SHIPPING - by going to blueapron.com/twip. Case Study for TWiP 125 Thanks to the Peace Corps - 24 yo female serving in Cameroon, teaching English and science at local school. Been in country 5 months, first 3 lived with host family, now in own home in community with electricity, 12 hr from Yaounde, capital. Reports intermittent diarrhea, loose stools, abdominal discomfort. No prior problems, no problems in family. No meds. No drinking or smoking. Lots of animals present, roam into class. Eating all local fare, cooks some, or buy locally. Eats fish, vegetables, no fish. Sleeps in house with mosquito nets. Not sexually active, AIDS negative. Young kids at school 6-12 yo, 20 in room. Does not eat at school. Not clear if water is treated. Not on antimalarials. Going on for a few a few weeks. No fever, no rash. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The prolific podcast-shedding Hosts solve the case of the Global Health Intern with a snakelike lesion on her foot, and reveal the role of a single-stranded DNA binding protein in differentiation of trypanosomes. Become a patron of TWiP. Links for this episode: RPA protein and differentiation of T. cruzi (PLoS NTD) Image credit Letters read on TWiP 124 Case Study for TWiP 124 28 yo male from referral hospital near thai-burma border. Fever and chills 2 days, feels poorly, small amount of dark urine. Severe shaking chills, 1x per day, no rash. No diarrhea, difficulty breathing. Seen by local health care volunteer, went to hospital then tertiary hospital in Bangkok. Exposure history to pigs, dogs, insects, etc. Involved in timber industry and farming, sleeping out at night with no cover, clothes and sandals. No meds. Not married, family lives with him. Family is fine. Sleep in dwelling but no screens. No toxic habits, HIV negative, sexually active but not brothels. High fever, low bp, rapid heart rate, breathing rapidly, scleral icterus, dry mucus membranes, neck supple, lungs clear. 2/6 systolic murmur. Abdomen soft but tender, enlarged liver and spleen. Many cuts, bruises, bug bites. Labs: low platelets, low hematocrit, low glucose. Blood smear: abnormal, 5-10% infected RBCs with multiple band forms. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPanorama solve the case of the Dutch Woman with Wormy Objects in Her Stool, dissect a study on cytoadhesion of malaria infected red blood cells, and introduce Parasitology Superheroes. Become a patron of TWiP. Links for this episode: Myiasis (Wikipedia) Cytoadhesion of Plasmodium in severe malaria (PLoS Path) Image credit Letters read on TWiP 123 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. Case Study for TWiP 123 Nurse in early 20s, recent grad, decides to spend year in global health internship in western DR/Haitian border. On her foot has skin issue: told is fungal infection, using antifungal cream, is getting worse. Several days, only on one foot. Healthy, no past med/surg/allergies, no meds, no HIV, lives with local family. Daughter, wife, husband, cat. No toxic habits. Originally from US, swims, walks barefoot to and from, shoes off in house. Easts local food, exposure to dogs, cats, sister. Very itchy, but not open; rash area is raised. Blistery in certain areas, involves different areas in different days, snakelike. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPniks docs solve the case of the Female from Peru with Epistaxis, and discuss the effect of community deworming on immunosuppression. Become a patron of TWiP. Links for this episode: Community deworming and immune hyporesponsiveness (PNAS) Paul C. Beaver (one, two) Photo by Oscar Adam Oscarson Letters read on TWiP 122 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. This show is sponsored by Drobo, a family of safe, expandable , yet simple to use storage arrays. Drobos are designed to protect your important data forever. This Holiday season give someone a Drobo to keep all their files and memories safe forever. TWiV listeners can save 20% or more off of their purchase of a Drobo 5D, Drobo 5Dt, Drobo 5N, or any 8-drive or 12-drive system at www.drobostore.com by December 31, 2016 using discount code MICROBE20. Case Study for TWiP 122 First of a series of cases with a theme, a 23 yo female international aid worker, chief complaint of diarrhea. Dutch descent, born in US, been in rural area of western DR, close to Haitian border. It's been raining, houses have tin roofs, other flat concrete, rainwater pours off. Child comes by with mangoes, she buys one, washes it in rain water from the roof. Bites open mango, peels it, eats mango. The same night she is not feeling well, loose stools, abdominal discomfort. Next day, goes with group to border town; then has full fledged diarrhea. Looks into toilet, sees white objects 1 cm in length on stool, and they are moving. Uniform width, thinner than long, wormy looking. Has been participating in other activities in this area, swims in local river, walks barefoot, eating lot of local foods. Lunch: rice, beans, cooked meat, avocado. Dinner, yucca, fried salami, etc. Healthy before, no family history, not on meds, living with one of local families, no toxic habits. Dogs, cats, pigs, chickens around. One month earlier, cat in family home had kittens, she played with them. Very excited about that. Local physician contacted, he treats her. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPanosome docs solve the case of the Mali Man with Profuse Diarrhea, and review the presence of Trypanosoma cruzi in vectors, canids, and humans along the Texas-Mexico border. Become a patron of TWiP. Links for this episode: T. cruzi in vectors, canids, humans at Mexican border (PLoS NTD) Tetracapsuloides bryosalmonae (Wikipedia) T. cruzi in US (Clin Micro Rev) Image credit Letters read on TWiP 121 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. Case Study for TWiP 121 Back to Peru. 55 yo female from highland central valley area near Cuzco. Works in farming, no prior skin lesions but has multiple hypopigmented scars on exposed extremities (trauma during working), now reports many years of bloody nasal discharge. Seen in Lima by Daniel in outpatient clinic. No other medical problems, no surgeries, no allergies, everyone in family fine, husband and kids. Still working. No travel except to see doctor. Exam in right nare: ulcerated lesion inside nose, muco-cutaneous lesion. Simple test will decide. No anemia, no fever. Not eosinophilic, labs normal, HIV negative. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP triumvirate solve the case of the Thai Woman with Facial Swelling, and explain how Th17 T cells protect against the intracellular parasite Trypanosoma cruzi. Become a patron of TWiP. Links for this episode: Th17 cells protect against Trypanosoma cruzi (PLoS Path) Plasticity of helper CD4+ cells (Science) Image credit Letters read on TWiP 120 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. Case Study for TWiP 120 A 48 yo man from Mali comes to hospital ER in Washington Heights in NY with profuse watery diarrhea. Born in Mali, came to US at 18, working in US as long haul truck driver for 30 y, frequently visits Mali, recently to attend his father's funeral. Got symptoms one week after return (was there for 3 weeks). 3 liters diarrhea/day. No past med/surg history, not seen doctor in long time. No allergies. Unknown what father died of, Mother in Mali is ok. No medications. Some alcohol, marijuana use. Does report that has exposure to professional female sex workers, no condoms. Temp of 39 C, bp down 80/40, heart over 110, rapid breathing high 20s, cachectic. Wasted. Fungating lesion perianally. Undergoes HIV testing, clade B. T cells Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello and Daniel Griffin Vincent and Daniel solve the case of the Family with Eosinophilia, and discuss HIV-1 infection and genome integration in the blood fluke Schistosoma mansoni. Become a patron of TWiP. Links for this episode: Family cluster of eosinophilia (Clin Inf Dis) Dientamoeba fragilis (Wikipedia) Parasites without borders HIV integrates into Schistosoma genome (PLoS Path) Image credit Letters read on TWiP 119 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more. Case Study for TWiP 119 This one will be kinder and gentler case. Back in Thailand but could be in several places. 25 yo Thai woman from Bangkok, to hospital, chief complaint facial swelling. Eats typical Thai diet (see previous episodes!) Som tum, etc fish that is not cooked. Migratory - moves around face. Not tender, but mild itchiness. For about a week, no pain. Healthy, no past med/surg history, family all fine. HIV negative, no drugs, no travel. On examination, has swelling on right side, 3-4 cm raised, little redness, firm, does not feel like fluid filled. No fever, no GI problems, no bloods. WBC up, eosinophils up. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPinella solve the case of the Woman from Guinea, and describe the use of CRISPR/Cas9 to identify essential apicomplexan genes. Links for this episode: Malarias in Guinea (CDC) Genome-wide CRISPR screen in Toxoplasma (Cell) Plasmodium parasitemia associated with increased Ebola survival (Clin Inf Dis) Image credit Letters read on TWiP 118 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more. Become a patron of TWiP. Case Study for TWiP 118 Little bit of a twist - a human family with eosinophilia. Conveyed by good friend/colleague ID physician. Australia, NSW, 45 yo Dad, having problem with mild abdominal distention. Seen by doc in Sydney, CBC shows eosinophil count of 10,500. Wife of same age reports feeling fine, but gets CBC and also shows eosinophils of 5,200. Two daughters, 17 and 19, no symptoms, bloods: 900 and normal eosinophils. One week prior to dads symptoms, sister in law came (also in NSW) and stayed, developed severe diarrhea, discomfort, bloating, weight loss, eosinohils 4,700. Eat raw fish (not known if fresh or salt) purchased at local markets. No overseas travel or out of urban environment. No pets, no home grown foods. Went back to previous labs and found normal eosinophil levels. Full workup for strongyloides, all negative. No HIV. No toxic habits, no remarkable medical history. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The parasite prophets solve the case of the Thai Man with Abdominal Distention, and discuss the finding that metastatic leishmaniasis dependent on a virus can be prevented by blocking IL-17A. Links for this episode: TWiP 27: Trematodes Leishmaniavirus and IL-17A dependent leishmaniasis (PLoS Path) Image credit Letters read on TWiP 117 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more. Become a patron of TWiP. Case Study for TWiP 117 Woman 66 yo born in Guinea, grew up the moved to US past 10 years, just retired. Lives in Washington Heights. Mother having issues in Guinea, so went back for 3 months in 2016. Just came back a week ago, reporting headache, fever, feeling poorly. Staying in big city, with Mom (80s). Has own private toilet in nice home. No screens or bednets. Married for 40 years, recently divorces. Has had 10 children. Not sexually active. Starts with high fever, breaks, then 2 days later another for several hours, goes to ER. Given Ebola screening questions, negative, do some blood work, send her back out. 2-3 days later high fever, double vision, headache, comes to Columbia ER. No diarrhea, no urination discomfort. Has backache, feels that mouth is dry. Was admitted. Past med history: high bp, cholesterol, diabetes; not overweight; appendix out; has unknown reaction to novocaine. No smoking, drinking. Physical: 39.4 temp, 14-16 breath rate, heart rate over 100, rapid heartbeat, 2/6 systolic murmur with radiation to left carotid (flow murmur). No jugular venous distention. Abdomen right upper quadrant: slight enlargement of liver, not tender, can palpate spleen tip in left upper quadrant, slightly enlarged spleen. Normal bowel sounds, no rash. Blood: elevated white count, bands 9%. 0.1 eosinophils, platelets 79, hemoglobin 11. Bilirubin 1.5, bicarb 20, chest xray clear. Red cells: small, 79.4 mcv. Animals: don't like animals! In middle of rainy season. Likes to walk outside in rain during day. No cats to keep out rodents. Food: all food is prepared in home. Eats all favorite foods: rice. No sick contacts, no exposure to health care setting, no bug bites. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPtoids solve the case of the Thai Fisherman with Chronic Diarrhea, and reveal a potential new drug for treatment of leishmaniasis, Chagas diseases, and sleeping sickness. Links for this episode: Capillaria philippensis (Wikipedia) Proteasome inhibitor for three parasitic diseases (Nature) Image credit Letters read on TWiP 116 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more. Become a patron of TWiP. Case Study for TWiP 116 This week's case involves no math. 36 year old Thai man from the northeast part of the country. Comes in with abdominal distention. Eats a normal Thai diet - Som Tam, Koi Pla, lots of rice. Feels well, came in because he is getting yellowing of skin and whites of eyes - jaundiced. Previously healthy, no prior med prob or surgery. No diseases running in family. Fisherman in the northeast (freshwater). Wife and many children, monogamous, HIV negative. Lives in jungle area, near river, many dogs, chickens, monkeys, goats, cows, pigs. Bathroom is outside. No fever, thin. Distention going on for months. Getting bigger. Exam: jaundiced, has large palpable non-tender mass below liver on his right side. No enlarged liver or spleen. No travel. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPlets solve the sad case of the Boy Who Went Swimming, and explain why the tomato is resistant to the plant parasite Cuscuta. Links for this episode: Detection of plant parasite by a tomato receptor (Science) Dodder (Wikipedia) Mixed messages (TWiP 77) Image credit Letters read on TWiP 115 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more. Become a patron of TWiP. Case Study for TWiP 115 This week's case is more challenging, but with a better outcome than last time. Thailand: 32 year old Thai man from southern coastal part of country, comes to ID hospital in Bangkok with two months of watery diarrhea. Rapid onset. Looks emaciated, protuberant belly. Ten times per day, has trouble flushing feces in toilet, floats. Eats normal fare, boat noodles, fish, rice, vegetables. Som tam - fish sauce from raw fish. Also with salted crab, not well cooked. No unusual past med history, healthy fisherman, no medication. Married with kids, everyone healthy. No bad habits. Monogamous. HIV negative. Liver, spleen not enlarged. Abdominal xray with contrast: loss of villi. Good appetite. No abdominal pain. Too weak to work. No vomiting. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP troika solve the case of the Female from the Bronx, and reveal how feeding on different plants affects mosquito capacity to transmit malaria. Links for this episode: Plant mediated effects on malaria transmission (PLoS Path) Image credit Letters read on TWiP 114 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more. Become a patron of TWiP. Case Study for TWiP 114 12 year old boy brought to hospital ER by parents with severe headache, stiff neck, fever, decreased alertness. No rashes. Has been healthy with no prior medical problems. No one else in family is ill. In summer, boy has been engaged in usual summertime activities: soccer, swimming in warm freshwater, playing outside. Undergoes lumbar puncture for CSF: start on meningitis treatment. No surgeries, no allergies. Not on any meds. Lives with Mom, Dad, few brothers. No substance abuse. Not a geographically limited illness. Has had bug bites - lots of mosquito bites. Dogs around as well. Symptoms began a day or two before hospital visit. Eats whatever family eats, food is cooked. Exam: 39.4C, bp low, heart rate up, resp up, decreased responsiveness, stiff neck, looks ill. WBC elevated, neutrophil predominant, eosinopenia. CSF glucose low, cells increased, no bacteria, fungi, acid fast bacilli on stain. CT scan, diffuse swelling of brain. Doing poorly, not a good outcome. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Jason Zucker The TWiP ternion solve the case of the Man from Mexico, and discuss a transgenic toxoplasma vaccine for chickens using Eimeria tenella. Links for this episode: Transgenic Eimeria as a toxoplasma vaccine (Sci Rep) Image shows cysticercus of T. solium in brain (Parasitic Diseases, 5th Ed) Letters read on TWiP 113 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. Become a patron of TWiP. Case Study for TWiP 113 22 yo female comes to clinic in Bronx, reports one week of vaginal discharge and itching. Looks bad, yellowish. Sexually active with boyfriend. He has no symptoms. Some discomfort on urination. Healthy, no prior surgeries, no allergies. Mother with diabetes, father has high bp. Takes oral contraceptive pills. Not employed, lives with mother and sisters. Substance abuse: some on occasion, marijuana and alcohol, no i.v. No pets. Diet: lot of fast food. Physical exam: slightly heavy, normal but vaginal exam: discharge, thick, slight yellow light green color, no strong odor, some redness to vaginal walls, no changes to cervix. 2 weeks from last menstrual period. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP trio solve the case of the Woman from Washington Heights, and reveal how helminth infection protects mice deficient in the Crohn's disease gene NOD2 from intestinal disease by inhibiting colonization with an inflammatory bacterial species. Subscribe to TWiP (free) in iTunes, by the RSS feed or by email Links for this episode: Helminth infection promotes colonization resistance (Science) NOD2 (Wikipedia) Image credit Letters read on TWiP 112 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. Become a patron of TWiP. Case Study for TWiP 112 A case here at CUMC, 59 yo male, past medical history of childhood polio, presents with worsening lower extremity weakness, bowel and urinary incontinence. 2 year before worsening back pain, weakness, could not work. Cannot walk up one flight of stairs since 1 month; 1 week prior to admission had fever, no headaches, diarrhea, cough, or any other symptoms. Splits time between Washington Heights and Mexico. Construction worker. Rural town in southern Mexico, 10 months of the year. Worked in the corn growing area. Has been exposed to bugs. Stopped working in cornfields 20 years ago. Has son and daughter, visits them. Lives with wife, stays in Mexico, she is fine. HIV negative. Eats home prepared foods, no dietary restrictions. Physical exam: not febrile, vital signs all good, neurological: upper strength good, weakness in hip flexors, ⅗; quadriceps, but ⅕ in lower extremities ⅖ in right. Sensory has decreased as well. Possibly spinal lesion. Labs: elevated glucose, ESR 33, CRP 2.2, whites 8, 30.6 hematocrit, guaiac negative. Imaging: MRI of spine shows normal vertebrae, T9/10 inflammation of spinal cord, mass lesion, compromise of canal. Brain MRI: hydrocephalus. Problem with recirculation of CSF. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP trio solve the case of the bug bites all in a row, and talk about a secreted Toxoplasma protein that is central to the parasite's manipulation of host cells. Subscribe to TWiP (free) in iTunes, Google Play Music, by the RSS feed or by email Links for this episode: Pigeon mites feed on humans at night (EPA) Secreted Toxoplasma protein (mBio) Image credit Letters read on TWiP 111 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. Case Study for TWiP 111 82 yo woman living in Washington Heights NYC 10 days of watery diarrhea, not smelly, does not float. Wakes her up at night. No fever, sweats at night. Losing some weight, appetite. No recent travel. Born in DR early 1930s, moved to US age 30. Sometimes goes back but not for several years. Springtime. Lives with extended family, only one sick. Eats whole assortment of cooked foods, rice, beans, fresh fruits. Drinks tap water. Not working. No pets. Stays mostly inside. History of reflux, high blood pressure, cognitive decline, diagnosed with temporal giant cell arteritis. Put on prednisone, doing better. Has had gall bladder removed. HIV negative. Extended family works in city, no taxi drivers. Belly uncomfortable for >week. Temp 38.1, BP 116/78, HR 105, breathing 12/min. Exam: looks ill, has diffusely tender abdomen, decreased bowel sounds. Liver, spleen not enlarged. Oriented. Has rash on abdomen: odd patchy distribution, looks like multiple thumbprints, front of belly, extending from umbilicus. White count 8, 78 polys, 14 lymphs, 4 mono, 1 eosinophil. Sodium 129, BUN 15, Creat 0.6. Urine histoplasma negative, TB test negative. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Paul Calle The TWiP trio visit the Bronx Zoo where Paul solves the case of the Four Year Old with Pulmonary Edema, and talks about his career as the Chief Veterinarian and Director of the Zoological Health program for the Wildlife Conservation Society. Links for this episode: Bronx Zoo Avian malaria (Wikipedia) Letters read on TWiP 110 Video of this episode at YouTube This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE. Case Study for TWiP 110 This week's case involves humans. Young woman, 40s, concerned about bug bites. Several weeks ago her 13 year old daughter woke up in morning, reported bug bites. Several small, red, raised itchy areas, 3-4 in a line, just above belt line. They go on vacation in Europe, no problems. Upon return, several weeks later the Mother woke up with a similar pattern. Then second daughter has the same problem. Family lives in NY metropolitan area, which is an epicenter for this problem. Always on trunk, not on arms or legs. No travel before the first daughter's bug bites. Husband does not report any problems. Family spends a lot of time outdoors, live in suburban wooden area. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello and Daniel Griffin Guest: Paul Daniel and Vincent solve the case of the Truck Driver from India, discuss why parasites resistant to an antimalarial drug are not transmitted by mosquitoes, and introduce Paul who presents a new case study. Links for this episode: Atovaquone resistant parasites not transmitted by mosquitoes (Science) Image credit Letters read on TWiP 109 This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/m​icrobe ​and use the promo code MICROBE​. Send your case diagnosis, questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The case of the Man from Assam is solved, and phagocytosis of Leishmania by B-1 cells is brought to you by the Three Twipeteers on this episode of TWiP. Subscribe to TWiP (free) in iTunes, Google Play Music, by the RSS feed or by email Links for this episode: Kalazar detect (pdf) Phagocytosis of Leishmania promastigotes by B-1 cells (Parasite Immunol) Image credit Letters read on TWiP 108 This episode is sponsored by ASM Agar Art Contest and ASM Microbe 2016 Case study for TWiP 108 Todays case is a 26 yo male longhaul truck driver from northern tiger country of India. Comes into hospital at end of rainy season with 6 days of fever, chills, muscle aches, small loose stools, vomiting, trouble breathing, cough, decreased urine output. Lives in mud hut with coconut leaf roof. No one else in family is sick (wife, two children). Significant animal and insect exposure (dogs, cows, monkeys). Got sick after coming home from a trip up north. No significant medical probs, no surgery. Really sick. Pain everywhere. Occasionally drinks palm wine. Some yellowing of eyes. Has lost a little weight. Ketonic breath. Exam: 39 fever, bp 100/71, 126 heart rate, 24 resp rate. Looks distressed, not fully sharp. Nothing focal on lung exam. Belly tender, esp upper right, spleen enlarged. Liver is tender but not enlarged. Some labs: bun elevated 102, creatinine elevated, Hg decreased 11, platelets 9000 (down), white count 10.3 no eosinophils. LDH 8000 AST/ALT normal, bilirubin 21. Never been this sick. Send your diagnosis to [email protected] Send your questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPtastic trio solves the case of the Surfer from Switzerland, and reveal how taste-chemosensory tuft cells in the gut regulate immune responses to parasites. Links for this episode: Taste-chemosensory cells and parasite gut immunity (Science) Image credit Letters read on TWiP 107 This episode is sponsored by ASM Agar Art Contest and ASM Microbe 2016 Case study for TWiP 107 Todays case is a fun case about a 45 year old gentleman from Assam India, with sixteen years of fever, abdominal pain, darkening of skin, yellowing of eyes. Farmer, does not have much energy. Works barefoot in fields. Fever occurs every other day. Prior medical problems, nothing out of the ordinary. No surgeries, no meds, has never seen physician. Married, kids, no extramarital affairs, HIV negative, eats mostly cooked vegetables. Lives in concrete house, no screens, mosquito netting. Other people in area have similar problems. Water comes from pump, fill plastic jugs. Been in Assam sick his whole life, finally came to regional med center for evaluation. Underweight. No pets. Dogs around, avoids dogs. Cows, monkeys are around. Fair appetite. Exam: febrile, in face can see darkening which is increasing, also extremities. Whites of eyes are yellow (jaundiced). Striking is has a very large liver, spleen. Elevated bilirubin. Some increased liver enzymes. No physical scarring or lesions. Send your diagnosis to [email protected] Send your questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP triumvirate solves the case of the Missionary in Kenya, and review the finding of a soldier caste in flatworms that parasitize snails. Links for this episode: Social organization in parasitic flatworms (J Parasitol) Image credit Letters read on TWiP 106 This episode is sponsored by ASM Agar Art Contest Case study for TWiP 106 This week's case comes from an ophthalmologist colleague Florian in Switzerland. Swiss female, early 20s, returns after surfing vacation in northern Africa. Accommodations were rustic, lots of animal and insect exposure, right on the beach. No screens. Had loose stools there, now left eye is bothering her, eyelid swollen, eye red. This happened after return. Thinks she has seen things moving around in her eye. Opthalmologist gave eyedrops, now looking for second opinion. Healthy, no med/surg/allergies, no meds, student lives alone, occasional alcohol. No AIDS. Surfing in Morocco. Lots of insect bites. Little tiny things moving around in eye, on surface when she looks in mirror. All blood work was negative. Florian inspects her eye, surprised to see several tiny mobile objects, headed towards lacrymal ducts. Is able to grab one, about 1 mm long, plucks three off. Send your diagnosis to [email protected] Send your questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPanosomes solve the case of the Young Man from Anchorage, and discuss how cestode parasites increase the resistance of brine shrimp to arsenic toxicity. Links for this episode: Trichinella life cycle (pdf) When parasites are good for health (PLoS Path) The Origin of AIDS by Jacques Pepin Letters read on TWiP 105 Case study for TWiP 105 This week's case involves a 32 yo male with several concerns. Spent 6 weeks doing religious missionary work in Kenya, performed baptisms in Lake Victoria.Waist deep in water, no shoes. Took malaria drugs, ate lots of interesting foods: cichlids, ugali, corn based food, flavored with greens; stew with some sort of meat, beef and goat. Five weeks after return developed rash with fever, shortness of breath. Three of four friends who were with him in Kenya reported similar symptoms. The fourth who did not get sick did not go in water, nor did he eat very much. No medical/surgical history, no drugs. Had some sexual activity while there. Elevated white count, 70% eosinophils. Chest CT shows nodules in lungs. Doc told him, allergy, you will be fine. The water he went into is near a village, there are rodents nearby, and a runoff. Send your diagnosis to [email protected] Send your questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Michael Libman Michael returns to help the TWiP trio solve the case of the Delusional African Expatriate, and discuss the association of natural and induced antibodies in mice with differential susceptibility to secondary cystic echinococcosis. Links for this episode: T. brucei life cycle (pdf) Natural and induced antibodies in echinococcosis (Immunobiol) The collaborative cross Letters read on TWiP 104 Case study for TWiP 104 This week's case involves a young man in his thirties, admitted in hospital in Anchorage AK in early June. Chief complaint, severe muscle pain and tenderness. Usually healthy guy, 1 week ago had bad case of diarrhea with belly pain and vomiting, lasted a full week. Now has fever. Concerned because wife now is having diarrhea. Unremarkable history, unknown family history. HIV negative. All childhood vaccinations. Does not eat raw meat. No meds, does seasonal work, social drinker. Came back from successful hunt, got a black bear. Dressed in field, cooked at home really well. Wife also ate bear meat. Bear meat is in freezer. No vegetables. Also eats salmon which he caught the previous season, then frozen. Drinks water from the stream when he hunts. Physical exam: hot, 38.5, bp 115/75, pulse 105, breathing comfortably. Anxious, swelling around both eyes. Sclera not noted. Labs: WBC elevated 14,000, 30% eosinophils; chemistries fine; muscle enzymes LDH, CK elevated. Send your diagnosis to [email protected] Send your questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Michael Libman The TWiP-scholars solve the case of the Housewife from Kolkata, discuss mutations in the IL17 gene associated with cerebral malaria, and hear a case presentation from guest Michael Libman. Links for this episode: IL-17 mutations and risk of cerebral malaria (Inf and Imm) Echinococcosis (CDC) Echinococcus life cycle (pdf) Letters read on TWiP 103 Case study for TWiP 103 This week's case concerns a 42 yo male, refugee in Canada, from DRC, former Zaire, where there is unending civil war. Upper middle class, professor of French at university. Had been imprisoned, tortured, lived in jungle for a few years, reached refugee camp in Tanzania, moved to Canada. Came to health care system 15 months after arrived. Was sent to psych, unstable emotionally, delusions, hallucinations, depression, post traumatic issues. Was under psych care for ~1 yr, did not improve, became worse. Sent to hospital. History: talked about having minor injury, hurt lower back, pain there bothering him. Some anemia (normochromic), basic hem/chem/urine/liver nothing remarkable. Physical exam, nothing remarkable. HIV negative. Some evidence for chronic inflammatory condition: sed rate 60 (elevated), had diffuse increase in IgG, IgM. Developed some low level autoantibodies; anti-nuclear, p-anka, anti-neutrophil cytoplasmic antibodies. Slightly elevated fever for a few days, then few days or week with no fever. No eosinophilia. Radiology: on CT did have some mediastinal, aortic, axillae, lymphadenopathy. Prob screened in Africa for malaria and treated; prob also got ivermectin. Also got head MRI: not completely normal, classic nonspecific midbrain abnormality. Diffuse mild edema. Weight loss remarkable. No visual problems. Send your diagnosis to [email protected] Send your questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiPyzoites solve the case of the Uncommon Parasite, and discuss the role of eosinophils in promoting the growth of Trichinella in skeletal muscle. Links for this episode: Eosinophils and IL-4 support nematode growth (PLoS Path) Balantidiasis (CDC) Letters read on TWiP 102 Case study for TWiP 102 This week's case involves a 24 yo housewife, from a village outside of Calcutta. Comes into a tertiary care hosp, 6 months coughing up blood, fever, no weight loss. Drinks rainwater, milks her cow. Dogs everywhere, no livestock except cows. Eats meat, well cooked. No extramarital encounters. Husband well. 4 children. Cistern for drinking water is covered. No health issues. Reports salty, clear mucus. No blood in stool, no changes in stool. Exam: looks healthy, lungs clear. Lab tests: White count of 9000, 12% eosinophils (elevated). So she has eosinophilia. Chest X-ray and CT: lesion on left side in xray. CT: shows 4 cm cavity, with air pocket on left side, mid-lung. HIV negative. Dusty soil, birds. Send your diagnosis to [email protected] Send your questions and comments to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The doctors TWiP solve the case of the Woman with White Worms, and explain the role of a secreted growth factor from a carcinogenic parasite in wound healing and angiogenesis. Links for this episode: Wound healing growth factor from carcinogenic parasite (PLoS Path) Opisthorchis (CDC) Opisthorchis life cycle (CDC) Image credit Letters read on TWiP 101 Listener Pick Ramon - Ancient Rome was infested with parasites Case study for TWiP 101 This week's case involves an uncommon parasite. Young girl, Send your diagnosis to [email protected] Send your questions and comments (email or mp3 file) to [email protected]

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP trifecta solves the case of the Woman from Bolivia with Belly Pain, and discuss a method for population modification of malaria mosquitoes using a Cas9-mediated driver gene. Links for this episode: Cas9-mediated drive for population modification of malaria mosquito (PNAS) FAQ: Gene drives (pdf) Image credit Letters read on TWiP 100 Case study for TWiP 100 This week's case is a 27 yo female, native NY, referred to outpatient at CU after seeing OBGYN, told had seen worms in stool and underwear. Inch or two in length, pale white, round, moving, 2-3 weeks of constant abdominal bloating. Sexually active. No particular diet. Travel: works for NGO, refugee camp in Ethiopian-Sudan border, southern Sudan. Last visit month ago. Noticed worms when she got back from last trip. Eats what local people eat. Raw food popular there: kitfo, raw steak tartare, with melted butter. Made from local beef. Did not take malaria prophylaxis, did not avoid local water, does wear sandals. College graduate. Nothing remarkable in family. CBC, liver, metabolic: all normal. Stool not normal: loose, no mucus or blood. Send your diagnosis to [email protected] Send your questions and comments (email or mp3 file) to [email protected]

The TWiP trifecta solves the case of the Professor Who Went to Brazil, and discuss an amazing case of a tapeworm that turned into a tumor in an AIDS patient. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Do young doctors need more sleep? (Slate) H. nana tumor in AIDS patient (NEJM) Hymenolepiasis (CDC) H. nana lifecycle (CDC/Wikipedia) Image credit Letters read on TWiP 99 Case study for TWiP 99 This week's case is a 53 yo woman visiting family in US, comes in with intense belly pain, right upper part of belly. Has become strict vegetarian after having breast cancer, on raw vegetable diet (carrots, collect plants in local markets). From Bolivia. Lives in agricultural area, avoids sheep, fearful of dogs. Housekeeper. Married, lives with husband. Noticed pain when came to US. Breast cancer: localized, removed lesion, no therapy, months ago. No allergies, family healthy. No insect bites, lives in concrete house. Physical exam: not febrile, right upper quadrant is very tender, some liver enlargement. CBC: 10,000 white count, mostly eosinophils, liver function: AST, ALT, AlkPhos all normal. Neuro exam: normal. Five months before this diet, she did have normal diet. Some meat, drank milk. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email TWiP is a MicrobeTV production

The TWiP-lets reveal Balamuthia infection in the Children from Peru, and discuss resistance to pyrethroids revealed by RNA sequencing of Anopheles mosquitoes. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Balamuthia (CDC) Pyrethroid resistance in Anopheles (Parasit Vectors) Voltage-gated sodium channels Pyrethroid (Wikipedia) Image credit Letters read on TWiP 98 Case study for TWiP 98 This week's case is a Professor clinician, teacher, researcher. In his 50s, he presents with lesion on big toe, anterior portion, tip, nodular. No surrounding redness, area is itchy. Has a small central black area the size of pencil tip, concerned because feels is getting larger over last week. Spooky. Travels, last in Brasil, had been for a few weeks, noticed toe issue a week after returned. Spent time on beach, but wore flip flops. Different types of beaches, crowded and not crowded. Went with wife. Healthy man, no prior medical problems. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

The paratenic hosts reveal a case of scabies in the Traveling Salesman, and discuss a role for natural antibody in protection from infection with Plasmodium. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Parasite Nobel Prizes 2015 Ivermectin story (Nat Rev Micro) Ivermectin target (Brain Res) Gut microbiota and Plasmodium protection (Cell) Natural antibody (virology blog) Image credit Letters read on TWiP 97 Case study for TWiP 97 Daniel has two cases this week. Two people with similar presentations. A 12 yo girl in Peru presented for care with painless dark brown area on right knee. Has brothers and sisters, often play together. No trauma, but area is expanding. Months later develops cognitive changes. Second case is a 5 yo boy from the coastal region of Peru brought in by Mother, has red swollen area on face. Mom says while playing scratched nose, swelling right cheek, eye, nasal obstruction, no response to antibiotics. MRI of both show infiltrating process. Girl, left side of brain, middle cerebral artery territory. Boy in frontal region, midline area. Thus both skin lesions associated with infiltrating process in brain. Came into clinic months after lesions started, and lesions still present. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

The TWiPanosomes solve the case about the Young Woman who Went to Belize, and relate how sandfly saliva skews the immune response and increases risk of cutaneous leishmaniasis. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Sandfly exposure and risk of cutaneous leishmaniasis (J Inf Dis) TWiP 14: Leishmania Image is L. longipalpis (credit) Letters read on TWiP 96 Case study for TWiP 96 Daniel's patient for this week is male patient referred for consultation by OB-GYN: his wife is pregnant, has been admitted and is about the give birth. It is her first pregnancy. There are concerns about the husband's skin problem and whether it is a threat to his pregnant wife. No lesions on woman, husband recently developed itchy skin problem on his hands. Bilateral. Small papules on webs of fingers, brown lines, blood clots at ends, has clearly scratched the lesions. Skin between fingers is involved. Travels, often stays in cheap hotels. Beds not clean. Last trip 1 month before symptoms. Midwest travel. Family history of heart disease. Sales occupation. No animal exposure. Travels to medium to large cities. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel solve the case about the 33 year old Chinese male with watery diarrhea, and discuss whether arsenic in drinking water might lead to treatment failures for Leishmania infections. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: TWiP 17: Entamoeba histolytica Arsenic exposure and Leishmania treatment outcomes (PLoS NTD) TWiP 14: Leishmania Letters read on TWiP 95 This episode is sponsored by ASMGAP. Case study for TWiP 95 Daniel's patient for this week is a 28 yo single female, returns from beach vacation with new boyfriend. Two weeks in Central America (Belize). Often found secluded beaches. Good health, noticed upon her return had small nodules/papules on front of thighs. Thought were insect bites, became very itchy. Noticed serpiginous red lines forming, radiating out from bumps. Felt things moving in her skin. Benadryl did not help. Daniel say something similar occurs in Lima. Healthy, no allergies, surgeries, no relevant family history, using barrier contraception, sexually active. Only drinks alcohol socially. Boyfriend did not report symptoms. She did lie on sand, used thin fabric. Stayed in hotel. There were wild dogs on beach. During her stay she ate ceviche. No intestinal symptoms. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel solve the case about the man from El Salvador, discuss the use of tyrosine kinase inhibitors to treat onchocerciasis and filariasis. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Targeting filarial tyrosine kinases (J Inf Dis) Onchocerciasis on TWiP 24 Filariasis on TWiP TWiP 25 Image shows c-abl kinase bound to imatinib (red) Image credit What good are ticks? Letters read on TWiP 94 Case study for TWiP 94 Daniel's patient was seen in the clinic. He is a 33 yo chinese male, from Chinatown NYC, for several months on and off has had watery diarrhea, headaches. Tried reflexology, chiropractic therapy, with no results. Has traveled quite a bit, been in Chile (was there a few months before). Came to US when young. Grew up in the US. In Chile, has had many sexual partners, >50, of both sexes, also has done many drugs. Two years ago was diagnosed with chronic HIV, CD4 count 685, on ARVs triple therapy, virus loads are well controlled. Has had syphilis, nose job, no medication allergies. Lives with family. On exam, afebrile, looks well. Symptom onset a few months after last Chile visit. Is an addventurous eater. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel solve their fishy tale, and present a new case study for your consumption. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Freezing and the quality of sushi (Clin Inf Dis) Anisakis biology (CDC) Image credit Letters read on TWiP 93 Case study for TWiP 92 April 2015 a 177 lb 5ft10in 39 yo man seen as outpatient in ID clinic, reports 2 y ago had issues with constipation on and off; throat hurts; feels closing when lies down. For several years has had skin irritation on upper chest and arms. Tried to donate blood, was rejected, told to see doctor. Emigrated to US from El Salvador 2002, married, reports no extramarital sex, smokes 2-3 cigs/day, now quit; had drinking issue in past, no more; was agricultural worker in rural part of El Salvador; has history of asthma, on a number of medicines, including steriod nasal spray, inhaler, no visual problems, healthy appearing, not allergic to medicines. Family history: mother heart attack and diabetes; father peptic ulcer disease. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel discuss how fluctuation in the price of guinea pig food could help transmission of the agent of Chagas disease, and present a new case study for your consumption. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Ascaris on TWiP 21 Ascaris lumbricoides life cycle (jpg) Child with distended abdomen due to Ascaris (jpg) Bottlenecks and Chagas disease (Proc Biol Soc) Letters read on TWiP 92 Case study for TWiP 92 A 20 yo Japanese female student went to the emergency room with severe abdominal pain. nausea, had vomited. Had just enjoyed homemade sushi an hour or two previuosly. She prepared the sushi: rice, salmon, tuna rolls. Salmon was local, caught by boyfriend. Tuna from store, sushi grade. No past medical history, mother with anemia. Takes oral contraceptives. No toxic habits. No travel. Monogamous. Temp 100.2, bp 140/90, hr high 90s, breathing upper teens. Physical exam normal except appears distressed in pain, belly extended, tender in left upper quadrant. Friends ate sushi but no one else got sick. All guests ate both types of fish. Send your diagnosis to [email protected] Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel review how Viagra might be used to block transmission of Plasmodium falciparum, and introduce a new case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Malaria life cycle (jpg) cAMP regulates gametocyte infected erythrocyte deformability (PLoS Path) P. falciparum in bone marrow (Blood) Image credit Letters read on TWiP 91 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel discuss identification of an erythrocyte protein essential for invasion of Plasmodium falciparum, and introduce a new case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Dermatobia hominis (Wikipedia) Plasmodium falciparum erythrocyte invasion (Science) Plasmodium life cycle (TWiP #10) Letters read on TWiP 90 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel reveal last week's case study and introduce a new one concerning a patient who traveled to Belize. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Neurocysticercosis (TWiP 6) Cysticercosis (CDC) Sarah Lane's neurocysticercosis Letters read on TWiP 89 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel discuss how a secreted protein from the protozoan parasite Theileria transforms its host cells via a cellular proto-oncogene. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Leishmania (TWiP #14) Transformation by a prolyl isomerase (Nature) Theileria.org Prolyl isomerase (Wikipedia) Image from Transformation & Oncogenesis Letters read on TWiP 88 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel review new insight into antigenic variation in trypanosomes, reveal the difficult solution to the last case study, and present another mystery for your solving. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Pinworm (CDC) Pinworm on TWiP #19 Dynamics of antigenic variation in T. brucei (Science) Image credit Letters read on TWiP 87 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel discuss how filarial infection modulates the immune response to mycobacterial infection, and reveal a new case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Filarial infection modulate immune response (J Immunol) Memory T cells (Wikipedia) Image: Loa loa microfilaria Letters read on TWiP 86 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel explain how trypanolytic factor forms membrane channels to lyse trypanosomes, and present a new case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Human trypanolytic factor forms channels (PNAS) Human paragonimiasis (MMWR) Don't eat raw crawfish Daniel and Dickson in studio (jpg) Image credit Letters read on TWiP 85 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel consider the delivery of anti-trypanosome nanobodies to the tsetse fly via a bacterial symbiont, and present a new case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Delivery of a functional nanobody to tsetse flies (Microb Cell Fact) Nanobodies (Wikipedia) V.B. Wigglesworth (Wikipedia) VB Nimble, VB Quick Knott test Mazzotti reaction Image credit Letters read on TWiP 84 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel present a new case study, and discuss the effect of chronic malaria infection on wild warbler life span and telomere degradation. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Effect of chronic malaria infection on wild warblers (Science) Image credit Letters read on TWiP 83 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel solve last week's case study, present a new one, and reveal how secreted proteins from a helminth prevent diabetes in mice. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Babesiosis (CDC) Babesiosis blood smear with Maltese cross (NEJM) Helminth proteins prevent diabetes in mice (PLoS One) Letters read on TWiP 82 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel provide the solution to last week's case study, present a new one, and discuss how immune suppression by nematodes increases tuberculosis fatality in African buffalo. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Consequences of living in a wormy world (Am Nat) Opposite effects of antihelminthic treatment on microbial infection (Science) Send your case study solutions to [email protected] Daniel's cufflinks (jpg) Daniel's TB bowtie (jpg) Image credit Letters read on TWiP 81 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent and Dickson welcome new TWiP host Daniel to discuss the association of a new Mycoplasma with Trichomoniasis, and to introduce a new feature to the show, a case study. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Links for this episode: Association of Mycoplasma with trichomoniasis (PLoS One) Biggest DNA genomes (Wikipedia) Send your case study solutions to [email protected] Letters read on TWiP 80 Contact Send your questions and comments (email or mp3 file) to [email protected] Subscribe Subscribe to TWiP (free) in iTunes, by the RSS feed or by email