This Week In Parasitism

The TWiP team solves the case of the Shopkeeper with Thirst, Rash, and low Blood Oxygen, then review a study on the effect on survival to adulthood in Tanzania of mosquito net use in early childhood. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Mosquito net use in Tanzania (NEJM) Michiaki Takahashi (Wikipedia) Letters read on TWiP 203 Become a patron of TWiP Case Study for TWiP 203 Two individuals, same issue. Small village in Ghana, near fast flowing river. Teenaged boy, father farmer. Boy develops severe itchy rash on right leg. Light and dark areas. They live nearby, father farms near river. After school they swim in river then travel. Father in 70s, has 2-3 cm nodule on left knee, second on in groin area, no other problems. Has some visual issues. Nodules are firm, fixed to the skin.Both have positive diagnostic skin snip. Send your case diagnosis, questions and comments to twip@mi

Sara from the Febrile Podcast joins the TWiP team at The Incubator to solve the case of the Man With an Egg Laden Colonic Mass, and Daniel presents a new puzzle for us to solve. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Sara Deng Click arrow to play Download TWiP #201 (72 MB .mp3, 60 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Febrile podcast Hero: Eloise Blaine Cramm Support MicrobeTV at Parasites Without Borders Letters read on TWiP 202 Become a patron of TWiP Case Study for TWiP 202 Man 60 yo shopkeeper in Rohingya Camp displaced Myanmar natives. 3 months getting up at night, urinating, thirsty, losing weight. Develops rash on elbows, abdomen, very itchy. Rest of family has rash as well. Starts headache, fever, cough, trouble breathing, seeks medical care. O2 sat is in 80s. Past med/surg healthy individual, heavy smoker, HIV negative. Living in dwelling with tin roofs, dirt floors, many people crowded. Elevated WBC

The TWiP team solves the case of the Man with a Cat and Ring Enhancing Lesions, and discuss domestic mammals as reservoirs for Leishmania donovani on the Indian subcontinent. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Reservoirs for Leishmania (Transboundary Emerg Dis) Support MicrobeTV at Parasites Without Borders Letters read on TWiP 201 Become a patron of TWiP Case Study for TWiP 201 Older male, >65, abdominal pain over last several months, getting worse, otherwise feels well. No change in weight. Past medical, surgical unremarkable. Social: grew up in rural inland China. As adult lived in large city. Always active and healthy, eating fish and leafy vegetables. Move to US 10 years before illness. No pets. No toxic habits. HIV negative. Unremarkable exam. Labs: elevated white count, platelets low, not anemic. Differential on white count: neutrophils predominant. Gets belly CT: reveals mass

The TWiP team solves the case of the Gentleman from New York with Intestinal Issues, and review a 20 year study of butterflies, their associated parasitoid wasp and Wolbachia introduced into an island community. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Download TWiP #200 (41 MB .mp3, 68 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Accidental parasitoid introduction (Mol Ecol) Hero: Gerald Keusch Support MicrobeTV at Parasites Without Borders Letters read on TWiP 200 Become a patron of TWiP Case Study for TWiP 200 Man in 30s with HIV-AIDS, presents with lower extremity weakness, headache, fever, ends up in hospital. Lives with wife and her cat, doesn’t take his medications. CD4 less than 100. Told to take medicine every day, one 3x week, one weekly. Does not drink alcohol, only eats well cooked meat. Born and raised in San Juan. Has had multiple sexual exposures with multiple women over years. Thin coating on tongue, lungs bo

The TWiP team solves the case of the Traveler to Tanzania with a Purple Lesion, and discuss Mosquirix, the first vaccine approved for Plasmodium parasites. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Historic malaria vaccine (Nature) Efficacy and safety of RTS,S/AS01 (Lancet) Letters read on TWiP 199 Become a patron of TWiP Case Study for TWiP 199 Gentleman in 40s, repeated intestinal issues, diagnosed with Giardia and treated, a year later again, again not feeling well. Stool testing shows Blastocystis and Endolimax nana. Lives in NYC area, single, active socially with different partners, no other medical problems, does take PREP for AIDS. Exam and labs normal except for stools. HIV negative. Treated with metronidazole, no impact on symptoms. Coincides with successful encounters.   Send your case diagnosis, questions and comments to twip@microbe.tv Music

The TWiP quadfecta solves the case of the Traveler With Watery Diarrhea, and reveals that a heat-shock response regulated by a transcription factor protects human malaria parasites from the high temperatures of fever. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Malaria parasite resists fever due to heat shock response (Nat Micro) Malaria beats the heat (Nat Micro) Letters read on TWiP 198 Become a patron of TWiP Case Study for TWiP 198 31 yo woman, previously healthy, traveled to Tanzania, went on 11 day long safari. One week later, at home, developed fever and severe headache, went into hospital. Thick blood smears negative, physical exam normal, small purple lesion near buttocks. Started on treatment for African tick bite fever. Did not get better, lesion grew in size. Biopsy of lesion, nothing remarkable on microscopy. Improved, sent home, 10 days anothe

TWiP solves the case of the Adventurous Eater with Areas of Swelling, and discusses an experimental Trypanosoma vivax vaccine comprising an invariant flagellum antigen. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Download TWiP #197 (39 MB .mp3, 64 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Experimental T. vivax vaccine (Nature) Letters read on TWiP 197 Become a patron of TWiP Case Study for TWiP 197 Gentleman in late 20s, has for weeks had watery diarrhea that is not getting better. Recently took trip to Oaxaca, Mexico. Stayed at nice hotel, all fruits, vegetables, salads well cleaned. Always ate at hotel. Developed diarrhea there. Went with three others, stayed at same place. No prior surgeries, no family history, no medications, no toxic habits. Daniel recommends one test and that gives diagnosis and therapy and he resolves.   Send your case diagnosis, questions and comments to twip@micro

TWiP solves the case of the Homeless Man With Skin Issues, and discusses an experimental mRNA based malaria vaccine. Hosts: Vincent Racaniello and Daniel Griffin Download TWiP #196 (49 MB .mp3, 81 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Entomophagy (TWiP 131) Malaria mRNA vaccine (NPJ vaccines) Letters read on TWiP 196 Become a patron of TWiP Case Study for TWiP 196 30 yo woman having areas of swelling in different parts of body, blood work shows elevated eosinophils. History: prior had been travelling around SE Asia. Had some loose stools on return, some tingling in fingers, otherwise fine. Adventurous eater, fish, pickled fish, salads. Previously in good health, no surgeries, all in family healthy. No meds. Lives alone. Went to Indonesia and Thailand. Toxic habits: no smoking, drinks periodically, HIV negative. On exam: swollen area on arm, biopsy is done. Pathologist report: cross section has what appears to be larval nema

Christina returns to the TWiP trifecta to solve the case of the Beachgoer with Red Lines on Her foot, and an experimental malaria vaccine based on the junctional region of the circumsporozoite protein displayed on a virus-like particle. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Christina Naula Download TWiP #195 (46 MB .mp3, 76 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter VLP-based malaria vaccine (Cell) Promise of a malaria vaccine (Ann Rev Micro) Hero: Maria Mota Letters read on TWiP 195 Become a patron of TWiP Case Study for TWiP 195 Gentleman in 60s, does not have permanent home, comes in with skin issues. Pruritis all over. Wearing heavy coat, unwashed polyester shirt. 1 cm diameter patches, erythematous, areas where open from scratching. Cover much of torso. Solve case by examining his clothes.   Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP solves the case of the Long Island Man with Unilateral Eye Pain, followed by a discussion of how enteric helminth coinfection enhances host susceptibility to West Nile virus by a tuft cell-IL-4 receptor signaling axis. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Helminth infection enhances West Nile viruses pathogenesis (Cell) Hero: Franz Von Lichtenberg Letters read on TWiP 194 Become a patron of TWiP Case Study for TWiP 194 Woman in 40s, on return from Puerto Rico where she often went. Went to local beaches, brought their dogs. Noticed problem on foot, raised red serpiginous lines, slowly moving all over the foot. Bloodwork showed elevated eosinophils.  Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

Audun returns to help solve the case of the Ecuadorean Gentleman Treated for COVID-19, followed by a discussion of the interaction of Blastocystis with the intestinal microbiota and the immune system, and of course a new clinical case from Daniel. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Audun Lier Download TWiP #192 (46 MB .mp3, 76 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Blastocystis interactions with gut microbiota and immune system (PLoS Path) Hero: Lucy Engel Graves Taliaferro Letters read on TWiP 193 Become a patron of TWiP Case Study for TWiP 193 Male, 50s, seen by physician for unilateral eye pain, blurred vision, watery drainage. Soft contact lens wearer. Given eye drops, oral medication, sent for another opinion when does not resolve. Has hypertension, hyperlipidemia, no surgeries, no allergies, is on hypertension/statin med. Works in store. No toxic substance use. HIV negative. Lives

The TWiPers solve the case of the Teenager in Malawi with Red Urine, then Audun joins to present our clinical case for this episode. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Audun Lier Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Hero: George B. Craig Letters read on TWiP 192 Become a patron of TWiP Case Study for TWiP 192 Older gentlemen with chills, muscle aches, headaches, shortness of breath, family members same symptoms. Hypertension, diabetes. From rural Ecuador, worked in timber industry, worked on farm. No pets. COVID positive. Treated with steroids, ab. Got worse over next two weeks. Developed bloodstream infection and pneumonia. Saw serpiginous trail on diagnostic agar plate of sputum sample. Started on treatment and recovered. No eosinophils on admission, later developed eosinophilia.  Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiPers solve the case of the Rural Man from North Carolina with Blurred Vision, and discuss the results of single-cell RNA sequencing of Schistosoma mansoni. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter RNAseq atlas of S. mansoni (Science) Hero: Kathleen Hussey Letters read on TWiP 191 Become a patron of TWiP Case Study for TWiP 191 Visit in Malawi, capital, teenage son of USAID worker urine has started to turn red. New to Malawi. On weekends go 2.5 hr east to lake and place to swim, Lake Malawi. Given pills, taken morning and night, clears up. Rest of family has been swimming in Lake Malawi. All in family are healthy.  Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

Christina from Glasgow returns to help the TWiPlets solve the case of the Ghanian Woman with Abdominal Mass, followed by discussion of the impact of COVID-19 on malaria morbidity and mortality in Africa. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Christina Naula Download TWiP #190 (57 MB .mp3, 94 minutes) Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter COVID-19 effects on malaria in Africa (Lancet) Hero: Clark Read Letters read on TWiP 190 Become a patron of TWiP Case Study for TWiP 190 Male, 50 yo, rural NC, suddenly notices blurred vision right eye. Went away 1 hr later, normal vision. Returned next night, same eye, then corrected. Went to local doctor, sent to larger med center, went to Presbyterian Hospital NYC. Had exposure to various animals, normal diet. Dickson and Dr. Brown went to see this gentleman. Examined by head of ophthalmology dept. Dickson looked through ophthalmoscope and saw cause of his blu

Christina from Glasgow joins the TWiPlets to solve the case of the Elderly Gentlemen with Full Body Rash, and to present a new clinical case for listeners to solve. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Christina Naula Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Support MicrobeTV through Parasites Without Borders Hero: Tony Fauci Tony Fauci on TWiV 219 and 641 Letters read on TWiP 189 Become a patron of TWiP Case Study for TWiP 189 At a clinic in Ghana, woman seen for hernia, large swelling in right upper abdomen that grew steadily in previous year. Exam found to have mass, too high for inguinal hernia. Thought to be in liver. Mother, subsistence farmer, 50s, not unwell, no jaundice, mobile, overweight. Lump was firm, did not appear to be fluid filled, did not reduce under pressure, smooth, over 20 cm. Concern was liver cancer. Due to remoteness of clinic not possible to order tests. One test was done

Dickson, Daniel and Vincent solve the case of the Baby with Hydrocephalus, and present a new clinical case for listeners to solve. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode PWB on Facebook, Instagram, Twitter Letters read on TWiP 188 Become a patron of TWiP Case Study for TWiP 188 Man in 90s, suffering for months, healthy, hypertension, diabetes, large man, over 6 ft, 200 lb, rash. Full body rash for months. Gone through allergy med, cream, prednisone, some helped but regressed. Tried ivermectin 3 pills, got better for a few weeks, then rash worsened. Primary care doc did thorough exam, found abnormal area between toes, did scraping, sent to lab. When came back, asked some questions. Wife is also suffering. Gave larger dose of ivermectin, repeated 2 weeks later, wife also treated, and then recover. Not COVID-19, no HIV-AIDS, no drinking or smoking. Started before COVID, first in wife. Had gone on trip, not

Dickson, Daniel and Vincent solve the case of the Middle Aged Woman with Loss of Vision in One Eye, and discuss the role of heme oxygenase in the various protozoan infections. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Heme oxygenase-1 in protozoan infections (PLoS Path) Support Floating Doctors at PWB Letters read on TWiP 187 Become a patron of TWiP Case Study for TWiP 187 Pregnant newly married, living North Shore, first pregnancy. Affluent family, measured successful lawyer who cooks. Organic eating. Boy born at 9 mo, has midwife, has delivery at home. Baby has enlarged head. OB diagnosed with hydrocephalus. Mother healthy. No meds. Works in retail store, lives with husband, not working for second half of pregnancy. Drank alcohol rarely. No significant travel. Patient reports having no pets but her brother owns small farm, and husband likes serving rare meats, all kinds, which she has eaten since she marr

Dickson, Daniel and Vincent solve the case of the Elder Gardener Feeling Poorly, and discuss the three-dimensional ultrastructure of Plasmodium falciparum during cytokinesis. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Three-dimensional structure of malaria parasite (PLoS Path) Support Floating Doctors at PWB Letters read on TWiP 186 Become a patron of TWiP Case Study for TWiP 186 Middle aged woman quite upset, referred to Daniel. Sheltering at home, one day looking at her children, noticed problem with vision. When covers right eye, notices area of loss of vision in left eye. No other associated symptoms. Admitted to hospital, blood tests, eye exam (lesion in back of eye had developed). Blood: WNV serology, another was done but he’s not saying. Comes back positive. No cat or dog exposure. Healthy, no prior medical problems, no surgeries, no toxic habits, HIV unknown, married.  Send your case diagnosis, quest

Dickson, Daniel and Vincent solve the case of the Wife of a Guy with Cyclospora Diarrhea, and discuss the discovery of an intrinsic oscillator that drives the bloodstream stage cycle of the malaria parasite. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Intrinsic oscillator in malaria parasite (Science) Malaria parasite has intrinsic clock (Science) Letters read on TWiP 185 Become a patron of TWiP Case Study for TWiP 185 Seeing this type of case 1/week for last several weeks. 75 yo female, admitted with fever, body aches, cough, loose stool for 2 week, sodium 118. Sheltering in place in Long Island, some gardening, no travel. Blood testing detected low sodium. COVID-19 negative, no other symptoms. Blood work: wbc 2000; hematocrit 24; platelets 40; sodium 120s. Unremarkable physical exam. Lyme test negative; other tick borne diseases negative. Send your case diagnosis, questions and comments to twip@microbe.tv M

Dickson, Daniel and Vincent solve the case of the Safari Goer With Watery Diarrhea, and explain how a microsporidian endosymbiont of Anopheles mosquitoes might impair the transmission of malaria. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Links for this episode Contribute to Parasites Without Borders Microsporidian impairs Plasmodium transmission (Nat Comm) Hero: Eugene T. Lyons (obituary) Image credit: Josh Letters read on TWiP 184 Become a patron of TWiP. Case Study for TWiP 184 69 yo female with several months of abdominal symptoms started in S. Africa, water shortage as described for her husband in the previous TWiP. Husband had C. cayetanensis. Her symptoms improved; her stool was positive for B. hominis and E. nana. Given many different treatments. Then comes to see Daniel. Some abdominal discomfort, mucosy stools. All past med/surg unremarkable, nothing in family, sent for repeat labs, stool O&P all normal including GI