Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Hero: Bailey K. Ashford
• Letters read on TWiP 276
• TWiP study – information and survey

New Case

Male in his 20s from Hokkaido, Japan, developed fatigue and rash, followed by fever and myalgia 6 days later. He was a group of five individuals on a hunting trip prior to this and reports that 3 friends are just fine but one other individual developed similar symptoms.  He reports that they had been hunting the Ussuri brown bear, which is larger and more aggressive than the Asian black bear. They had been successful and all five of them had consumed well cooked bear meat. He does share that he is aware of infectious risk from eating bear and thus the meat was well cooked. He and the one fellow hunter who did get sick were unique in that they each ate one of the eye balls raw. This is a tradition that is felt to give the consumer the great vision that these animals are purported to have.

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Spatial emanators for malaria control (Lancet Inf Dis)
• Dengue suppression with Wolbachia-infected mosquitoes (NEJM)
• Singapore Environmental Health Institute (TWiV 630)
• TWiP study – information and survey

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Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Hero: Glenn L. Hoffmann
• Fish and seafood consumption (Our World in Data)
• Wild fish vs aquaculture (Our World in Data)
• TWiP study – information and survey

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Intestinal parasites in dogs (Vet Parasitol)
• Zoonotic protozoal diseases of companion animals (Clin Micr Rev)
• Canine visceral leishmaniasis in stray and owned dogs in Brazil (Acta tropica)
• Zoonotic protozoal diseases of companion animals (Clin Micr Rev)
• Canine visceral leishmaniasis (Leish Vet, pdf)
• Immune Responses in leishmaniasis (Trop Med Inf Dis)
• Canine leishmaniasis in the US (Today's Vet Prac)
• TWiP study - information and survey

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Music by Ronald Jenkees

TWiP solves the case about the man with positive Strongyloides serology who is waiting for a kidney transplant.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Chronic strongyloidiasis (Australian Family Physician)
• Hero:  Gwendoleen Rees (Wikipedia)
• TWiP study – information and survey
• Letters read on TWiP 272

New Case

40 year old man travels to India, is only there for a week before he develops problems. Bloating, diarrhea. Weathers the storm. Returns to US. Stool sent for testing. Some interesting results. Comes back positive for Hymenolepis nana, Blastocystis hominis, Giardia intestinalis. Recommended he take four tablets. Flatulence. HIV negative. He ate food that were prepared in the home but also out. Delhi area. 

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Music by Ronald Jenkees

Dear TWiP listeners,

Have you ever wondered how TWiP shapes your understanding of science? We have! To find out more, Christina and the team are running a survey based study to learn more about how TWiP contributes to your scientific literacy and trust in science. Listen to the segment in this episode (TWiP 267) where Christina discusses the study’s aims and scope.  

Anyone who listens to TWiP can participate. The survey is anonymous and we do not collect personal data that could identify you. There are no potential disadvantages or harms in taking part, other than using a few minutes of your time. You will receive no direct benefit from taking part in this study. However, the information that is collected during this study will give us a better understanding of who our listeners are, and why they choose to listen to TWiP. We can use this understanding to make TWiP even better!

This is an academic study and we aim to disseminate our findings to the wider public, including you. For example, we’ll have a conversation about the findings on a future episode of TWiP, we plan conference presentations and publication in a relevant academic journal

The project has been reviewed and approved by the University of Glasgow College of Medical, Veterinary & Life Sciences Ethics Committee. Application 200250013

You can find the study, detailed participant information, and consent information here: 

TWiP study – information and survey 

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Female genital schistosomiasis in Malawi (Parasitology)
• Mainstreaming female genital schistosomiasis (Parasitology)
• Female genital schistosomiasis (WHO)
• TWiP study – information and survey

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• TWiP study – information and survey
• Letters read on TWiP 270

New Case

A man in his 20s is admitted to the hospital with some electrolyte issues related to his end-stage renal disease. Infectious disease is consulted as he has a report of a recent positive strongyloides serology test that was done as part of his pre-transplant evaluation. He reports no international travel, no interesting exposures.

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Music by Ronald Jenkees

Dear TWiP listeners,

Have you ever wondered how TWiP shapes your understanding of science? We have! To find out more, Christina and the team are running a survey based study to learn more about how TWiP contributes to your scientific literacy and trust in science. Listen to the segment in this episode (TWiP 267) where Christina discusses the study’s aims and scope.  

Anyone who listens to TWiP can participate. The survey is anonymous and we do not collect personal data that could identify you. There are no potential disadvantages or harms in taking part, other than using a few minutes of your time. You will receive no direct benefit from taking part in this study. However, the information that is collected during this study will give us a better understanding of who our listeners are, and why they choose to listen to TWiP. We can use this understanding to make TWiP even better!

This is an academic study and we aim to disseminate our findings to the wider public, including you. For example, we’ll have a conversation about the findings on a future episode of TWiP, we plan conference presentations and publication in a relevant academic journal

The project has been reviewed and approved by the University of Glasgow College of Medical, Veterinary & Life Sciences Ethics Committee. Application 200250013

You can find the study, detailed participant information, and consent information here: 

TWiP study – information and survey

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Martin Grobusch

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• Join the MicrobeTV Discord server
• Primaquine for blocking malaria transmission (Lancet Inf Dis)
• Pulmonary tuberculosis, Sierra Leone (New Microb New Inf)
• TWiP study – information and survey

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Music by Ronald Jenkees

TWiP discusses a 41-year long human infection with Schistosoma mansoni, and CRISPR screens that reveal genes essential for Cryptosporidium survival in the host intestine.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• 41 year old Schistosoma infection (J Travel Med)
• Genes essential for Cryptosporidium survival in host intestine (Nat Comm)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Eyal Leshem

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• Join the MicrobeTV Discord server
• Life cycle of Dermatobia hominis (CDC)
• Letters read on TWiP 267
• TWiP study - information and survey 

New Case

Man in his 40s, married with 2 children, on Eliquis for a prior DVT, diet-controlled diabetes, who is admitted for evaluation of an abnormal brain MRI. He left AMA but then developed vomiting and returned.

CT- Large peripherally enhancing mass lesion in the deep left cerebral hemisphere is associated with considerable vasogenic edema/infiltrative nonenhancing tumor. Mass effect results in left-to-right subfalcine herniation and entrapment of the right lateral ventricle. Findings are typical for glioblastoma. Intracranial abscess tumefactive multiple sclerosis and brain metastasis may mimic this appearance. Recommend supplemental imaging evaluation including gadolinium-enhanced MR brain.

MRI- Dominant heterogeneously enhancing mass in the left basal ganglia/peri-insular region measuring 3.1 cm AP by 2.8 cm TR by 2.9 cm cc, with surrounding vasogenic edema resulting in mass effect and midline shift, as detailed above, concerning for high grade glial neoplasm versus metastasis. Additional leptomeningeal nodule in the right postcentral sulcus. Additional smaller peripherally enhancing lesion in the right lateral temporal region with suggestion of leptomeningeal component and measures approximately 0.8 x 0.8 cm, with mild surrounding vasogenic edema.

They do a biopsy and pathology comes back as: – Brain tissue with extensive necrosis acute chronic inflammation, and rare microorganisms (on permanent section)

-Brain, designated “left brain lesion”, excision:

– Brain tissue with extensive necrosis acute and chronic inflammation, reactive gliosis and occasional microorganisms

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TWiP explains research showing that treatment of baby wraps with an insect repellent, and oral dosing with ivermectin, are both effective measures to prevent malaria.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Treated baby wraps prevent malaria (NEJM)
• Oral ivermectin prevents malaria (NEJM)

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Music by Ronald Jenkees

TWiP solves the case about the parasite check in summer camp, and presents a new case about a woman who traveled to Brazil and developed furuncles on the back of her head.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Hero: Francesco Redi
  • Wikipedia: https://en.wikipedia.org/wiki/Francesco_Redi
  • Linda Hall Library, Kansas: https://www.lindahall.org/about/news/scientist-of-the-day/francesco-redi/
  • Habermehl, G., (1994). Francesco Redi—Life and work, Toxicon 32 (4) https://doi.org/10.1016/0041-0101(94)90292-5.
• Letters read on TWiP 265

New Case

From Eyal Leshem, a returning case “provider”

43 years old female who travelled to Brazil on May 2025 for a two week dance class. The dance school is located in a farm two hour drive West of Rio de Janeiro. 

Upon return to Israel she started feeling pricking and “movements” and under her scalp on the back of her head. She noted three non-healing furuncles on the back of her head A month after she returned movement and pricking in the back of her scalp increased, the furuncles enlarged and produced serous discharge. Several days before her ED visit she thinks an “object” dropped from the back of her scalp, but being outdoors, she could not locate the object. 

On physical examination she is afebrile and her vitals are normal, and on the back of her head two indurated   were detected under the hair on the back of her head. Serous discharge was produced by pushing the furuncles. A non-surgical office procedure led to immediate recovery and confirmed the diagnosis. 

What was the parasite? What was the procedure?

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Music by Ronald Jenkees

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• T. gondii infection of neurons (PLoS Path)

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Music by Ronald Jenkees

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• Hero: Dr Laurence Tetley
• Letters read on TWiP 263

New Case

It is the first day of summer camp and the children are lined up for a parasite check. Some of the children have certificates that allow them to bypass the screening. Some of the parents are upset about this process commenting that this is not required by the state and report this could not be a problem for their children. One by one the children have their scalps examined and 2 of the children are asked to step to the side. The parents of these two children are contacted and told that they must address the identified concern before they can attend the camp. They are treated with a topical therapy on their hair with repeat in 1 week. The upset parents have several questions that hopefully our listeners can address.

-what is this all about?
-is anyone suggesting this is a hygiene issue?
-what is the most sensitive way to look for this problem?
-how do we know it is cured?
-feel free to talk about the life cycle

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Music by Ronald Jenkees

Guest: Chuck Knirsch

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• Does schistosome infection affect behavior? (PLoS NTD)
• Hero: Harold Brown (NY Times)

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Music by Ronald Jenkees

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• Hero: Dame Bridget Ogilvie (Interview and Wiki)
• Letters read on TWiP 261

New Case

I feel like the back section of our book has been a bit neglected. The new PD 8th Edition is posted on our website so please download a copy and extra points to anyone who can tell us what that is on the cover.

Three individuals are involved here with a rather impressive travel history. We have a mom, a daughter and a son who reach out for guidance. Initially one of them found something small dark and about the size of a poppy seed embedded in their skin. This led to a more involved investigation where they found that all three had similar findings but some of these were larger, some a bit larger, one was actually described as mobile. They all feel fine and report no skin rashes. They have a number of concerns about what these are, if they might carry disease, what to do about removing them and should there be testing or treatment. The interesting travel and exposure history. They report that just prior to this they spent a week on a remote island off the coast of Scotland with extensive hiking in tall grass and boggy areas with deer, rabbits, and lots of sheep. An Island called Harris and Lewis and then just that Saturday hiking in wooded areas around Loch Ness and in the Cairngorns. Sunday out hiking and running on Long Island and then Wednesday when these mystery objects were found they had just been hiking and going for a run in Cape Cod. They report on Cape Cod the trail they followed had a fallen tree and they had to crawl underneath it prompting this skin inspection.

-lots of questions here… 

What might these be and how do we identify them?
Is the travel history relevant?
Are there any timing issues that impact what we do?
Should we try to remove these and if so how?
Any testing or treatment indicated?

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Music by Ronald Jenkees

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• Clocks mediate malaria transmission (Nat Micro)
• Hero: Dame Bridget Ogilvie (Wiki)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 259

New Case

Another case from Northern Tanzania, up by the border of Kenya. 32 yo pregnant woman admitted to the hospital, dehydrated, reporting 3+ weeks of diarrhea. Second trimester, second pregnancy, reports stools are sticky and it is hard to get herself clean. She also noticed blood mixed in the stool. No fever, no chills, but she feels weak. While many in the area get their water from boreholes, rivers and rainfall she reports getting hers from a nearby river. She lives with her husband and one child who is 2 years old. She is HIV negative and reports she had been in good health otherwise. She looked tired and worn down when she arrived in the hospital but is already feeling better. Her blood work is notable for a low hemoglobin and elevated creatinine. Stool studies are sent and Ockam would be confused but Dr Hickam would know what to do.

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Music by Ronald Jenkees

TWiP describes how a gut commensal protozoan influences respiratory disease outcomes by shaping pulmonary immunity, and body shape variation in lice that parasitize diving hosts.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Gut commensal shapes pulmonary immunity (Cell)
• The deeper the rounder (Sci Rep)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 257

New Case

We are still in Kuching, Malaysia in the northern part of the Island of Borneo. This is the Sarawak portion of Malaysia. A man in his late 30s is admitted to the hospital in December with daily fevers that last for several hours and shaking chills. He had previously been healthy with no medical problems. He lives in the city and works in an office, however, in the few weeks prior to getting admitted he was visiting the jungle. Apparently not too far outside of Kuching, one can go up into the jungle and see Orangutans. He had gone into the jungle but this was 2 weeks prior to the onset of symptoms. Since then he reports no unusual exposures. He lives with his wife and children and they are all healthy. A few days prior to admission he noted fever, chills, and a headache. He is a little nauseated but no vomiting.

On exam he has a fast heart rate and appears ill. His respiratory rate is increased and he is not febrile on admission but later does have fever.  No enlargement of the liver or spleen on exam. Otherwise unremarkable.

His labs are notable for low white blood cells, anemia, and a platelet count of less than 50k per microL. His coagulation studies are abnormal, serum creatinine is elevated, and there is elevation of his serum aminotransferases.

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Naegleria fowleri acquired at splash pad (MMWR)
• Determinants of P. falciparum drug resistance (Science)
• Paleoparasitological analysis of 5th–16th c. CE latrine (Parasitol)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Michelle Labrunda

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• Letters read on TWiP 255

New Case

A man who is on eculizumab, a recombinant humanized monoclonal antibody that targets complement protein C5 which serves as a terminal complement inhibitor, comes in with left arm swelling. He lives in a city in the north part of the island of Borneo. He is being managed by a doctor in the Malaysian City of Kuching. Now the doctor caring for this man is married to an Infectious Disease expert and she raises concerns that this might be due to a parasitic disease. She is told by the husband that the disease of which she is thinking is not present in the region. She is not swayed and admits him for nightly blood smears which are negative. She then does a rapid immunochromatographic dipstick test that is positive. He lives in a community outside the city and they go to that village and find others with limb swelling issues who are also positive on antigen testing. He is treated with an antibiotic, not antiparasitic for 4 weeks and the arm improves.  Hint: this is not Wuchereria Bancrofti.

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Music by Ronald Jenkees

TWiP explains a study which finds that tissue spaces are reservoirs of antigenic diversity for Trypanosoma brucei, then remembers our departed colleague Dickson Despommier.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Click arrow to play
Download TWiP #254 (88 MB .mp3, 61 minutes)

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• Tissue spaces are reservoirs of antigenic diversity for T. brucei (Nature)
• Understanding trypanosome antigenic variation (Emerg Top Life Sci)
• Tissue resident T. brucei (PLoS Path)
• Hero – Dickson Despommier
• Despommier Photo Art
• Parasitology Course (YouTube)

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Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 253

New Case

26-year-old female with no past medical history.  Patient is from Georgia in the US and is volunteering in Hérico, Guinea (town in the Lélouma Prefecture in the Labé Region of northern-central Guinea). She arrived in Guinea in December  2023.  She was taking doxycycline for malaria prophylaxis and says that she has not missed any doses

On October  2024 she presented with fever and dry cough.  Lab work was done and follow up planned for the following day.  The patient slept poorly, was febrile to 104 and had ongoing cough.  The next day she went to the hospital and was evaluated in the ER for acute febrile illness of unclear etiology.  

In the hospital, VS were 97.9F, BP 105/70, P 94 Oxy sat 98%, normal physical exam.

She was started on Augmentin and Coartem.

Pause here to think about the differential at this point and maybe some more history and what testing you might want

WBC 14, Hb 13, HCT 40, PLT 285, Neut abs 8, Eos Abso0.80; BUN/creat  normal, AST normal; ALT 44, GGT 125

Stool parasite screen + for some sort of eggs, malaria smear negative, CXR with b/l infiltrates

She was given a medication (vomited 30 min after dose received).  She then received a second dose of medication 5 hours after the first) and was discharged. The following day the patient returned to the ER, stating that she felt worse.  Her temperature had climbed to 104 overnight, and she developed watery diarrhea and nausea.  There were no additional episodes of vomiting.  She was given an additional dose of a medication, ibuprofen, and started on ceftriaxone 1 gm IV Q12 hrs.  During the day she continued to have low grade fevers and developed abdominal pain.  That night she was again febrile to 104 F.   

She remained admitted for 5 days with ongoing symptoms of diarrhea, nighttime fevers and diffuse abdominal discomfort.  Three more malaria tests were negative (rapid test and slide review)

Blood cultures collected – no growth

She continued to have mild elevation of WBC and slight elevation of AST and ALT.

The patient was transferred to a different hospital. They give her a different medication, and within 24 hours symptoms resolve. 

What is the diagnosis and what happened here with management?

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Live attenuated malaria vaccine (NEJM)
• Plasmodium metabolism during hepatic development (Cell)
• Heroes – Jimmy and Rosallyn Carter, and the Carter Center
• The Carter Center Guinea Worm Eradication Programme
• Guinea Worm data visualisations (Our World in Data)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 251

New Case

Recent case, Arusha hospital, 1800 m, 28 yo comes in, has been visiting game parks. Developing fevers, malaise, bad headaches, body aches, somnolent. Blood smears negative, no malaria. Repeat blood smear, see something extra-erythrocytic. This gives them the diagnosis. HIV neg, no toxic habits, no history. Symptom onset about a week ago. Rest of family is ok. 

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Gut bacteria and Trichinella suppression of colitis (PLoS NTD)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 249

New Case

Woman in 30s or 40s goes to Belize and after returning notices a lesion on her face. She goes to see several physicians and despite a number of topical creams the ulcer on her face does not heal. She is then referred to our office where a certain parasitic infection is considered and we involve our friends at Columbia to help us with the diagnosis..

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Music by Ronald Jenkees

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

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• Toxoplasma reduces amyloid in brain (J Inf Dis)
• Hero: Theodor Hiepe (Parasitol Res)

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Music by Ronald Jenkees

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

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• Hero: Charles Louis Alphonse Laveran
• Letters read on TWiP 247

New Case

A middle-aged male is referred to evaluation because of eosinophilia. This man is married, living here in the NY tristate area, and this was picked up on ‘routine blood work’ by his primary care doctor. This man had been in the military, serving as a marine, with time spent in Okinawa, Japan. This individual does report sexual activity with paid sex workers while in Okinawa  but has been monogamous with his current wife for many years. A number of investigations are done with a test coming back showing serological evidence of a prior parasitic infection and he was treated with an antiparasitic medicine with resolution of the eosinophilia. The eosinophilia returned and he was referred to us. Blood work is now down showing evidence of a viral infection that might explain why the eosinophilia returned after treatment. Pt is HIV negative. This was prior to the COVID-19 pandemic. He is on no medications and in general feels fine.

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Music by Ronald Jenkees

TWiP taps into Dickson’s knowledge of Trichinella to discuss an outbreak in humans who consumed rare bear meat, and the impact of globalization and climate change on the epidemiology of the species.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Join the MicrobeTV Discord server
• Outbreak of human trichinellosis (CCDR)
• Impact of climate change on Trichinella (Food Waterborne Parasit)
• Letters read on TWiP 246

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Ben LaBrot

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• Join the MicrobeTV Discord server
• Floating Doctors
• Letters read on TWiP 245

New Case

A man in his early 20s comes in reporting pain when he urinates or ejaculates. He reports that he is sexually active. He does confide that he has been in a relationship with a woman but he had a sexual encounter outside this relationship about 2 weeks ago when they were on a break and he did not wear protection. He feels like he needs to urinate more often and describes thin white discharge from the penis. He reports that he has no history of any sexually transmitted infections and had no medical issues prior to this.

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Christina Naula

Guest: Lilach Sheiner

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• Join the MicrobeTV Discord server
• Engineering T. gondii for protein secretion (Nat Micro)

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Music by Ronald Jenkees

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

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• Join the MicrobeTV Discord server
• Enterobius, the pinworm (TWiP 19)
• Hero: Mary Pritchard

New Case

This case comes from Panama mid summer 2024. A provider for Floating Doctors working in the coastal region in northeastern Panama. This case involves a one year old, so the history is a bit difficult, but there may have initially been a scratch or some sort of break in the skin. Otherwise healthy but over a period of time this area expands and becomes a deep necrotic wound on the leg. Several other nearby wounds develop and become deep and infected. By the time this one year old is seen by the provider much of the leg appears eaten away. This is just the tip of the iceberg as a number of others develop similar wounds in the area. No prior medical history.

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin and Christina Naula

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• Join the MicrobeTV Discord server
• Worms impair COVID vaccines (Sci Trans Med)
• Heligmosomoides image (Wiki Commons)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier and Christina Naula

Guest: Sean Murphy

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• Join the MicrobeTV Discord server
• Daily natural history of Plasmodium infections (Lancet Microbe)

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Music by Ronald Jenkees

Hosts: Vincent Racaniello and Daniel Griffin

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• Join the MicrobeTV Discord server
• Cryptosporidium (TWiP 18)
• Letters read on TWiP 239

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New Case

Man in his 70s originally from Mainland China, then Hong Kong who has been living in the US for decades is admitted to the hospital with fever for 6 days. He reports that he saw his primary care physician in Queens and was referred to the hospital after blood work revealed a sodium level of 123 and an increased monocyte count. Pt reports drenching sweats, lots of outdoor activity walking in local parks in Queens. He reports he does not feel particularly sick.
PMH-HTN, BPH
PSH-neg
Social-retired, no wife, has one son, no pets, no exotic exposures or recent travel
VS febrile to 39.5, tachycardia, meets sepsis criteria
PE -unremarkable
Labs, nl wbc, eos-0, elevated neutrophils and monocytes, Na-123, elevated AST, elevated ALT, low platelets, low Hct, CT Chest A/P unremarkable

Send your guesses to twip@microbe.tv with TWiP 239 in the subject line

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Music by Ronald Jenkees

Hosts: Daniel Griffin, Dickson Despommier and Christina Naula

Guest: Michael Barrett

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• Join the MicrobeTV Discord server
• Elimination of human African trypanosomiasis (PLoS NTD)
• Hero: David Livingstone

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Send your guesses to twip@microbe.tv with TWiP 237 in the subject line

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Music by Ronald Jenkees

Hosts: Daniel Griffin, Dickson Despommier and Christina Naula

Guest: Marilyn Fabbri

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• Join the MicrobeTV Discord server
• Toxoplasma gondii (TWiP 12)
• Parasitic Diseases Lectures #15: Toxoplasmosis
• Letters read on TWiP 237

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New Case

Man in his 60s with HIV/AIDS CD4 count less than 50, CD4% less than 5% and elevated viral load (VL) with report of prior CNS toxoplasmosis requiring a craniotomy, disseminated Mycobacterium avium complex (MAC), comes in with fever and very watery diarrhea x 4 days. He reports that he lives in Georgia but comes up to NY for his HIV care and stays in NYC.

Send your guesses to twip@microbe.tv with TWiP 237 in the subject line

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Music by Ronald Jenkees

Hosts: Dickson Despommier and Christina Naula

Guest: Marion Avril

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• repRNA-based CSP malaria vaccine (NPJ vaccines)
• Hero: Mwelecele Ntuli Malecela

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

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Music by Ronald Jenkees

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

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• The giant intestinal worm, Ascaris lumbricoides (TWiP 21)
• Parasitic Diseases Lectures #24: Giant Intestinal Worm (YouTube)
• Letters read on TWiP 235
• Hero: Ernst A. H. Friedheim

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New Case:

I first learned about this case from a colleague at work who tells me that their friend has just gotten really sick. The friend is described as having had multiple illnesses over time but that he has never been as sick as he recently got. He reports that the illness began as a diffuse myalgia with fever, there was some sore throat, noted swelling in the neck, and overwhelming fatigue. He tells some of his friends that he is feeling really terrible and it turns out that some of his friends also feel poorly. It turns out that about a week prior to the onset of his symptoms he and a number of friends attended a large dinner where venison and boar was served. 

This individual is then seen in our office. Some testing is done. He feels really terrible and despite being reassured that he should get better without treatment he is given therapy.

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

Send your questions and comments to twip@microbe.tv

Hosts: Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Hookworm vaccines in school-aged children in Gabon (Lancet Inf Dis)
• Step forward towards hookworm vaccines (Lancet Inf Dis)
• Hookworm vaccine protects dogs (FASEB J)
• Hero: Muriel Robertson

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Music by Ronald Jenkees

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

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Hero: Keith Vickerman
• Letters read on TWiP 233

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New Case study:

I was recently asked about this case while I was off visiting Denmark. A man in his 50s has been reporting months of abdominal discomfort and decides to go discuss this situation with a local pharmacist. He describes this discomfort, some nausea, and some bloating of the abdomen. The pharmacist recommends that he take mebendazole. He takes the mebendazole and some time afterwards he vomits a worm into the sink. The worm does not have any obvious segmentation and appears completely nonsegmented and is moving around. One end is very pointy and the other little less so. 

 Send your questions and comments to twip@microbe.tv

Music by Ronald Jenkees

Hosts: Dickson Despommier, Daniel Griffin, and Christina Naula

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Cellular lives of Wolbachia (Nat Rev Micro)
• Hero: Patricia F. Walker

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Music by Ronald Jenkees

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

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• Join the MicrobeTV Discord server
• Please support our work at microbe.tv/contribute
• Hero: Ann Bishop

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New Case study:

A physician with no significant PMH who is currently doing their fellowship training develops diarrhea. The diarrhea is significant enough that they are beginning to feel weak, lightheaded, and end up going to the local ER. The physician lives in NYC, works most of the time but did just get back from a week-long vacation in Florida with their long-term partner where they got a chance to swim in the pool and get some sun. They returned feeling well and then noted the onset of the diarrhea. The diarrhea was watery, with some abdominal cramping but no noted blood or actual fever. The stool did not have a strong smell and no floating stools were reported. The physician was given IVF and returned home feeling better but now gets a call that there is a parasite on the stool testing and is recommended to take a medicine they have never heard of 3x per day for 3 days. 

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Music by Ronald Jenkees

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

Guest: Maria Adelaida Gomez

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Links for this episode

• CIDEIM
• Healing in cutaneous leishmaniasis (J Immunol)

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Music by Ronald Jenkees

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

Guest: Eyal Leshem

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Case Study for TWiP 229

Woman in her 40s is referred to me to be seen in the office from one of my colleagues. She reports that she has been having recurrent issues with worms exiting her anus and vagina since 2018. She reports that she lives with her husband and 4 children and they have never reported any issues. She reports that initially she took something over the counter and things resolved. She then a couple years later has this problem again and this time discussed the problem with her housekeeper from El Salvador who gave her an antiparasitic tablet from her home country. This problem has now recurred and she was referred to a GI doctor who she explains laughed at her and suggested she see a psychiatrist. She come in now very upset and tearful. She relates that she has this itching that wakes her up at night and was able to take pictures of something she found on the anus. She has photos as well as a video of a thin white 1 cm motile thing with on end coming to a point. 

She reports a normal nonrestrictive diet. She reports no travel outside the US or even outside the local area. No PMH, no PSH, family history of different cancers. She does not work outside the home. She reports no pets. She has an unremarkable exam and labs only notable for low vitamin D. 

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Music by Ronald Jenkees

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

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• Extreme lifespan extension in tapeworm-infected ant workers (Roy Soc Open Sci)
• Candidate antibody drug for prevention of malaria
• Ceilidh goes viral (YouTube)

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Send your questions and comments to twip@microbe.tv

Music by Ronald Jenkees

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

Guest: Jim Small

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• Parasites and childhood stunting (Trends Parasitol)
• Letters read on TWiP 227

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Send your questions and comments to twip@microbe.tv

Music by Ronald Jenkees

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

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Links for this episode

• Second malaria vaccine (Nature)
• Malaria report 2023 (WHO)
• Malaria and climate change (WHO)
• Parasites and childhood stunting (Trends Parasitol)
• Sea creature spotted off Japan identified (Science)

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Send your questions and comments to twip@microbe.tv

Music by Ronald Jenkees

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

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Links for this episode

• Vaccine against cow parasite (Vert Farm Daily)
• Protective vaccine against bovine parasitic nematode Ostertagia ostertagi
• Hero: Dr. Katy Ewer
• Letters read on TWiP 225

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Case Study for TWiP 225

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

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

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

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

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

Hosts: Vincent Racaniello, Dickson Despommier, and Chuck Knirsch

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Links for this episode

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

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Send your questions and comments to twip@microbe.tv

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

Click arrow to play
Download TWiP #223 (63 MB .mp3, 88 minutes)

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Links for this episode

• Malaria (Lancet)
• Chagas disease (AJTMH)
• Hero: Joe Cook
• Letters read on TWiP 223

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Case Study for TWiP 223

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

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

Music by Ronald Jenkees

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

Guest: Natasha Spottiswoode

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Links for this episode

• Treatment of Balamuthia encephalitis with nitroxoline (Emerg Inf Dis)
• Letters read on TWiP 222

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Case Study for TWiP 222

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

MHx:

HIV 

Shx:

Lives in haiti

Remarried, Last sexual encounter 2 years ago.

Denies illicit drug use. Drinks alcohol 

Allergies: No Active Allergies

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

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

Music by Ronald Jenkees

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

Guests: Michelle Naegeli and Alexander Grieb

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Links for this episode

• cAMP-dependent invasion by Trypanosoma cruzi (PLoS NTDS)
• Letters read on TWiP 220

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Case Study for TWiP 221

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

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

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

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

Music by Ronald Jenkees

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

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Links for this episode

• Malaria transmission-blocking vaccine (Lancet Inf Dis)
• mRNA vaccine against malaria (Nat Immunol)
• Letters read on TWiP 220

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Case Study for TWiP 220

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

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

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

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

Michelle and Alexander from the First Vienna Parasitology Passion Club

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

Music by Ronald Jenkees

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

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Links for this episode

• Insecticide resistance in mosquitoes promotes Plasmodium infection (PLoS Path)
• Letters read on TWiP 219

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Case Study for TWiP 220

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

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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Links for this episode

• Malaria parasite evades mosquito immunity (Proc Natl Acad Sci USA)
• Letters read on TWiP 218

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Case Study for TWiP 218

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

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

Directed testing reveals canine coccidia and giardia in the stool.

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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Links for this episode

• Post-partum clearance of P. falciparum (J Inf Dis)
• Letters read on TWiP 217

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Case Study for TWiP 217

We have two cases today!

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

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

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

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

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

Music by Ronald Jenkees

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

Guest: Eyal Leshem

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Links for this episode

• Letters read on TWiP 216

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Case Study for TWiP 216

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

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

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

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Music by Ronald Jenkees

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

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

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Case Study for TWiP 215

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

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

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

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

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

Music by Ronald Jenkees

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

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

Guest: Kay Schaefer

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• Join MicrobeTV Discord server
• TROPMEDEX
• Letters read on TWiP 214

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Case Study for TWiP 214

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Jessie Stone

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•Soft Power Health
•Letters read on TWiP 213

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Case Study for TWiP 213

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

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

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

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

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

Music by Ronald Jenkees

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

Guest: Shauna Gunaratne

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

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• Letters read on TWiP 212

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Case Study for TWiP 212

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

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Music by Ronald Jenkees

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

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• Monoclonal antibody against malaria trial (NEJM)
• Hero: Stephen Hoffman
• Letters read on TWiP 211

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Case Study for TWiP 211

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

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

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

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

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

He ends up getting a biopsy that reveals:

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

Additional testing is ordered that leads to the diagnosis.

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Aisha Khatib

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• Aisha delivers baby on airplane (The Varsity)
• Helminth infections during pregnancy (J Travel Med)
• SARS-CoV-2 transmission during air travel (Curr Op Inf Dis)
• Letters read on TWiP 210

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Case Study for TWiP 210

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

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

         9.3  

8.97  )———–( 210    

           28.4 

Absolute eosinophil count is >1000

134  |  97  |  51

—————————-<  184

3.8   |  25  |  5.10

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Music by Ronald Jenkees

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

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• Malaria intensity modifies vaccine effectiveness (J Inf Dis)
• Letters read on TWiP 208

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Case Study for TWiP 208

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

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

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

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Music by Ronald Jenkees

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

Guest: Claire Panosian

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• Claire’s website
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• Letters read on TWiP 207

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Case Study for TWiP 207

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

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Music by Ronald Jenkees

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

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Links for this episode

• Bacteria protect mosquitoes from parasite infection (Nat Microbiol)
• Letters read on TWiP 206

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Case Study for TWiP 206

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

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Music by Ronald Jenkees

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

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

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• Emodepside for onchocerciasis (PlOS NTD)
• Hero: Dr. Mwelecele Ntuli Malecela
• Letters read on TWiP 205

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Case Study for TWiP 205

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

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Music by Ronald Jenkees

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

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

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• Oral fexinidazole for African trypanosomiasis (Lancet)
• Hero: Madeline Albright
• Letters read on TWiP 204

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Case Study for TWiP 204

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

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Music by Ronald Jenkees

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

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• Mosquito net use in Tanzania (NEJM)
• Michiaki Takahashi (Wikipedia)
• Letters read on TWiP 203

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Case Study for TWiP 203

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

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Music by Ronald Jenkees

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

Guest: Sara Deng

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

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• Febrile podcast
• Hero: Eloise Blaine Cramm
• Support MicrobeTV at Parasites Without Borders
• Letters read on TWiP 202

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Case Study for TWiP 202

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

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Music by Ronald Jenkees

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

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• Reservoirs for Leishmania (Transboundary Emerg Dis)
• Support MicrobeTV at Parasites Without Borders
• Letters read on TWiP 201

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Case Study for TWiP 201

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

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Music by Ronald Jenkees

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

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

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• Accidental parasitoid introduction (Mol Ecol)
• Hero: Gerald Keusch
• Support MicrobeTV at Parasites Without Borders
• Letters read on TWiP 200

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Case Study for TWiP 200

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

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Music by Ronald Jenkees

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

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• PWB on Facebook, Instagram, Twitter
• Historic malaria vaccine (Nature)
• Efficacy and safety of RTS,S/AS01 (Lancet)
• Letters read on TWiP 199

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Case Study for TWiP 199

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

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Music by Ronald Jenkees

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

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• PWB on Facebook, Instagram, Twitter
• Malaria parasite resists fever due to heat shock response (Nat Micro)
• Malaria beats the heat (Nat Micro)
• Letters read on TWiP 198

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Case Study for TWiP 198

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

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Music by Ronald Jenkees

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

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

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• PWB on Facebook, Instagram, Twitter
• Experimental T. vivax vaccine (Nature)
• Letters read on TWiP 197

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Case Study for TWiP 197

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello and Daniel Griffin

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

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• PWB on Facebook, Instagram, Twitter
• Entomophagy (TWiP 131)
• Malaria mRNA vaccine (NPJ vaccines)
• Letters read on TWiP 196

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Case Study for TWiP 196

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

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Music by Ronald Jenkees

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Christina Naula

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

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• PWB on Facebook, Instagram, Twitter
• VLP-based malaria vaccine (Cell)
• Promise of a malaria vaccine (Ann Rev Micro)
• Hero: Maria Mota
• Letters read on TWiP 195

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Case Study for TWiP 195

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Christina Naula

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• PWB on Facebook, Instagram, Twitter
• Helminth infection enhances West Nile viruses pathogenesis (Cell)
• Hero: Franz Von Lichtenberg
• Letters read on TWiP 194

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Case Study for TWiP 194

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Audun Lier

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

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• PWB on Facebook, Instagram, Twitter
• Blastocystis interactions with gut microbiota and immune system (PLoS Path)
• Hero: Lucy Engel Graves Taliaferro
• Letters read on TWiP 193

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Case Study for TWiP 193

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Audun Lier

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• PWB on Facebook, Instagram, Twitter
• Hero: George B. Craig
• Letters read on TWiP 192

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Case Study for TWiP 192

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• PWB on Facebook, Instagram, Twitter
• RNAseq atlas of S. mansoni (Science)
• Hero: Kathleen Hussey
• Letters read on TWiP 191

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Case Study for TWiP 191

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Christina Naula

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

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• PWB on Facebook, Instagram, Twitter
• COVID-19 effects on malaria in Africa (Lancet)
• Hero: Clark Read
• Letters read on TWiP 190

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Case Study for TWiP 190

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

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Music by Ronald Jenkees

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

Guest: Christina Naula

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• PWB on Facebook, Instagram, Twitter
• Support MicrobeTV through Parasites Without Borders
• Hero: Tony Fauci
• Tony Fauci on TWiV 219 and 641
• Letters read on TWiP 189

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Case Study for TWiP 189

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• PWB on Facebook, Instagram, Twitter
• Letters read on TWiP 188

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Case Study for TWiP 188

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• Heme oxygenase-1 in protozoan infections (PLoS Path)
• Support Floating Doctors at PWB
• Letters read on TWiP 187

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Case Study for TWiP 187

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• Three-dimensional structure of malaria parasite (PLoS Path)
• Support Floating Doctors at PWB
• Letters read on TWiP 186

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Case Study for TWiP 186

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• Intrinsic oscillator in malaria parasite (Science)
• Malaria parasite has intrinsic clock (Science)
• Letters read on TWiP 185

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Case Study for TWiP 185

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

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Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• Contribute to Parasites Without Borders
• Microsporidian impairs Plasmodium transmission (Nat Comm)
• Hero: Eugene T. Lyons (obituary)
• Image credit: Josh
• Letters read on TWiP 184

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Case Study for TWiP 184

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

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

Music by Ronald Jenkees

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• Structure of roundworm digestive complex (PLoS Path)
• Hero: Dr. Anthony Fauci
• Fauci Pharmacy (TWiV 219)
• Letters read on TWiP 183

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Case Study for TWiP 183

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• PWB social media: Facebook, Instagram, Twitter
• Daniel on TWiV
• HIV-1 integration into Schistosome genome (PLoS Path)
• Image from John Southall's Treatise of Buggs, 1730.
• Letters read on TWiP 182

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Case Study for TWiP 182

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• PWB social media: Facebook, Instagram, Twitter
• Daniel on TWiV Special
• Engineered symbionts limit honeybee pathogens (Science)
• Letters read on TWiP 181

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Case Study for TWiP 181

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• PWB social media: Facebook, Instagram, Twitter
• Endocytosis pathway mediates artemisinin resistance in malaria parasites (Science)
• Letters read on TWiP 180

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Case Study for TWiP 180

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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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

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Case Study for TWiP 179

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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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

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Case Study for TWiP 178

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dand Daniel Griffin

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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

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Case Study for TWiP 177

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Links for this episode

• Effect of schistosome soluble egg antigen on HIV-1 infection (PLoS P)
• Hero: Lawson Soulsby
• Letters read on TWiP 176

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Case Study for TWiP 176

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

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

Music by Ronald Jenkees

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

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Case Study for TWiP 175

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

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Music by Ronald Jenkees

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

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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

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Case Study for TWiP 174

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

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Music by Ronald Jenkees

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

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Links for this episode:

• Matryoshka RNA virus of Plasmodium (bioRxiv)
• Hero: Rose Gana Fomban Leke
• Letters read on TWiP 173

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Case Study for TWiP 173

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

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Music by Ronald Jenkees

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

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• Transgenic Metarhizium kills mosquitoes (Science)
• Hero: Veena Tandon
• Letters read on TWiP 172

Links for this episode:

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Case Study for TWiP 172

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

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

Music by Ronald Jenkees

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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

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

Music by Ronald Jenkees