This Week In Parasitism

The doctors of awesome solve the case of the Woman Who Visited Lebanon, and reveal that immunoglobulins protect the olfactory organ of trout against infection with the Ich parasite. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Mucosal Ig protect trout from Ich (PLoS Path) Hero: Sir Patrick Manson Letters read on TWiP 163 Case Study for TWiP 163 From here in US before leaving for Uganda: male has lesion affecting nose. Has been having problem with nose for 2 yr, in 40s, surfer, hit nose with board. Southern eastern Costa Rica. After that had blood and scabs from nose. Inside of nares, scab formed. Did not improve with time. Saw ENT doc on LI, said he hit nose and needs reconstructive surgery. Entire septum destroyed. 20+ years ago had non healing ulcer on left hand, saw physician in CR, was treated for 20 days. Send your case diagnosis, questions and comments to twip@microbe.tv Music b

The TWiP professors solve the case of the Baby With Pericardial Effusion, and discuss whether the flagellate without a flagella, Dientamoeba fragilis, causes human illness. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Patients with Dientamoeba fragilis infection (Am J Trop Med Hyg) Hero: Dr. Eloise B. Cram Image credit Letters read on TWiP 162 Case Study for TWiP 162 A fresh case. Woman in late 30s born in Palestine, moved to NY. Presented for care with sore throat, swollen lymph nodes. Married Lebanese man, he’s still there, travel back in forth. Had been in Lebanon for 3 weeks before illness. Ate special raw meat dish while in Lebanon. No other animal exposure. Small children at home, works in office. No medical/surgical history, no meds. On exam, has posterior cervical lymphadenopathy. Otherwise normal exam. HIV negative. Low grade fever. Send your case diagnosis, questions and com

The TWiPsters solve the case of the Brazilian Immigrant With Heart Problems, and describe how genome organization controls trypanosome antigenic variation. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Trypanosome genome organization and antigenic variation (Nature) Hero: Arthur Looss Letters read on TWiP 161 Case Study for TWiP 161 Daniel was asked to see 30 yo female from Bolivia, had to travel back during 3rd trimester. Was there for most of 3rd trimester. Child born in US, pericardial effusion, ascites, moderate PDA. Heart function is ok. Woman was healthy, no issues during pregnancy. Baby’s  white count elevated, diagnostic evaluation. It is a parasite. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiPlets solve the case of the Electrician from Tamil Nadu with a Liver Mass, and reveal that dogs and humans share a common Chadian Guinea worm. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Chadian Guinea worms in humans and dogs  (PLoS NTD) Hero: Karl George Friedrich Rudolf Leuckart Image credit Letters read on TWiP 160 Case Study for TWiP 160 Referred to Daniel for consult, 40 yo immigrant from Brazil, a farmer had worked there, family in US. While here 1 y ago sees physician for increased heart rate, arrythmia, premature ventricular contractions, A-fib and flutter, treated by cardiologist then gets implantable defibrillator. Diagnostics: EKG, right bundle branch block; Echo shows heart is dilated with apical aneurysm; thrombosis. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiP triptych solve the case of the 9/11 Survivor infested with parasites, and discuss the effect of community ivermectin treatment for onchocerciasis on Loa loa infections. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Ivermectin for onchocerciasis and loiasis (PLoS NTD) Hero: William Boog Leishman Thanks to Caitlin for the image Letters read on TWiP 159 Case Study for TWiP 159 Going back to India, gentleman in 20s seen during rainy season in south. Week of feely achy, fever, severe pain in right upper part of belly. Vomiting, no diarrhea. Married, no children, works indoors in trades - electrician. Drinks large amount of palm date liquor. Previously healthy, no allergies, no medical issues. No travel. On exam: right lung base decreased breath sounds; upper right area of belly can feel liver coming down. Area of intercostal tenderness. Elevated white count; left shift, eosinopenic

The TWiP hosts solve the case of the Thai Woman With Red Bumps, and reveal that a master manipulator contacts ant brain tissue to control its behavior. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Imaging parasites in ant brain (Nat Rep) Brain worm turns ants into zombies (Nat Hist Museum) Hero: Giovanni Battista Grassi Image credit Letters read on TWiP 158 Case Study for TWiP 158 Male in 50s comes to see Daniel, concerned that is infested with parasites. Retired firefighter, 9/11 survivor. Several years of skin issues not resolved. 2009 dating Haitian girl, goes to Haiti to assist with disaster relief efforts, there notices itchy rash, worse at night, elevated eosinophils.  Prior biopsy showed arthropods with compound eyes. Treated with oral ivermectin, topical permethrin. Ulcers form, preceded by small white objects that pop off skin and these can swim in water. Repeat cystoscopies triggered by hematuria. Multiple biopsies and skin scr

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

The TWiP crew solves the case of the Ecuadorian with Immunodeficiency and Chronic Diarrhea, and discuss oral transmission of Chagas disease in mice. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Imaging Chagas after oral transmission (Sci Rep) NJ invasive species strike team and app Red Mother Hero: Angelo Dubini Image credit Letters read on TWiP 156 Case Study for TWiP 156 While on ID consultant service on LI during July, asked to see woman in late 70s admitted for fever, confusion, diarrhea. 2-3 days of abdominal pain, nausea, vomiting. Week prior was a family party, drank two large glasses Scotch. Had watery, nonbloody diarrhea 4-5 times per day; vomiting 2-3 times/day. Developed 103F fever, headache, lost appetite, 4-5 days did not eat. Hospitalized. No one else in party became ill. 2005 had episode of turning yellow after visiting Nepal. No surgeries, no allergies, no diseases running in family. ITP on prednisone, other drugs listen t

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

Vincent and Daniel solve the case of the Man in the City with Groin Rash, catch up on the long backlog of email, and present a new case, possibly the most complex one yet on the show. Hosts: Vincent Racaniello and Daniel Griffin Become a patron of TWiP. Links for this episode: Bloodless malaria diagnostic (BBC) Image credit Letters read on TWiP 154 Case Study for TWiP 154 Daniel's colleague will solve this case, in two weeks. 79 year old man history of chronic lymphocytic leukemia that became B cell lymphoma, had chemotherapy a few weeks before coming. Was discharged with scrip for prednisone, but pharmacy made error gave him enough to take every day for over two weeks. Patient has fevers up to 100 degrees at home, headache, develops dry nonproductive cough. Brought to ER by family, there reports has lost weight. No nausea, no vomiting, no abdominal pain or diarrhea. Admitted to hospital. Has fever, chest x-ray suggests pneumonia, started on ab. Fever and symptoms continue, stop steroids. Chest CT shows mul

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

The TWiP peeps solve the case of the Panamanian Mother with Steatorrhea, and reveal new monoclonal antibodies that effectively block malarial infection. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Plasmodiumimmunity from injected sporozoites(Nature) New monoclonal prevents malaria infection(Nat Med) Parasite Hero: Carlos Chagas Image credit Letters read on TWiP 152 Case Study for TWiP 152 40 yo man in same Panamanian village, diarrhea for several weeks, notices blood mixed in with stool. Works in fields. No weight change, no fever, but tired. Drinking water from rooftop, lives in home with wooden slat floor, no electricity, many animals around, no one else sick in family. Lower belly tenderness, normal rectal exam. Farmer with 3 weeks of bloody diarrhea. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The Podfessors solve the case of the Itchy Child from Panama, and discuss competition for blood in human malaria-helminth co-infections. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Competingfor Blood (Ecol Letters) Parasite Hero: William C. Campbell Image credit Letters read on TWiP 151 Case Study for TWiP 151 Woman in 30s, mother of last two boys we saw, same locale. Concerned about abdominal pain for 3 years. Fullness, bloating of lower abdomen. No blood in stool, but occasionally loose stools, difficult to clean, stick/pasty/greasy stool. Had visited hospital, underwent test, told it is an ovarian cyst and needs surgery. Took omeprazole, allbendazole, azithromycin, none helped. On exam, diffuse abdominal tenderness. Portable ultrasound: small ovarian cyst 1.5 cm, not tender. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

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

Shivang joins the TWiP triumvirate to solve the case of the New Yorker With Rash and Pins and Needles, and reveal how agrochemicals increase risk of human schistosomiasis by causing high snail density. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Shivang Shah Become a patron of TWiP. Links for this episode: Even dinosaurs had parasites (Cosmos Mag) Why some people are wormier than others (RSTMH) Angiostrongylus species in badger lungs (thanks, Rachel!) Spread of rat lungworm (Hawaii News Now) Aussie teenager swallowed slug (news.com.au) Agrochemicals increase snail numbers (Nat Comm) Parasite Hero: Émile Brumpt Image credit Letters read on TWiP 149 Case Study for TWiP 149 31 yo man ulcer on let, 4 cm diameter. Raised borders, reddish and hard. Feels well, concerned not resolving. Started as bump, slowly enlarged, ulcerated, 1 month now. Healthy, no prior med, diabetes in mom. Works in field with machete, lives with family, social drinking, smoking. Lives in isolated villages on N

The TWiP-tologists solve the case of the South American Child With Belly Pain, and reveal how B1 cell IgE blocks parasite clearance by inhibiting mast cell activation by B2 cell IgE. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Do not eat raw earthworms! (Pediatrics) Would you let worms in your veins? (Science) Guinea Pig Doctors by Jon Franklin and John Sutherland Parasite Hero: David Bruce Letters read on TWiP 148 Case Study for TWiP 148 Will have a guest on next show to unveil! Female teenager living in NYC, previously in good health, rash for 2 week, abnormal feeling in legs. Initially had URT infection, no cough or fever. Rash is itchy, worse at night. But feeling of pins and needles, sharp stabbing in feet and legs. In ER told is zoster, started on gabapentin. Few days later fevers, pain getting worse. Seen by neurologist and ID doc, admitted. No past med/surg. Type 1 diabetes in aunt, father migraines, no autoimmune diseases. Had r

The three amigos of parasitology solve the case of the New York Lawyer With A Foot Ulcer, and discuss a survey of rodents for the raccoon roundworm in California. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Monthly case studies (CDC) The Parasite on the Playground (NYTimes) Introduced rats and raccoon roundworm (J Parasitol) Parasite Hero: Theodor Bilharz Letters read on TWiP 147 Case Study for TWiP 147 Three year old boy, in tropical S. America, brought in by mother, says has been sick about a month. Previously healthy, 4 healty siblings, vaccines up to date, now has abdominal pain. Belly pain increases throughout day, poor appetite, constipated, has goat stools, pellets. Has had fever, seems swollen, face pale, urine dark, belly distended. Occasionally coughs. Living conditions: home has dirt floor where he spends most of day. On exam is febrile, doesn’t look well, no teeth, sleepy, not responsive, distended belly, pale, weight 13 kg.

The TWIPniks solve the case of the Man With Diarrhea and 100 Micron Objects In Stool, and discuss the reticulocyte receptor for Plasmodium vivax. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Reticulocyte receptor for Plasmodium vivax (Science) Image credit: Parasitic Diseases, 6th Ed. Parasite Heroine: Marietta Voge Letters read on TWiP 146 Case Study for TWiP 146 27 yo male lawyer comes NY area to be seen, has 4 cm ulcer on right foot. Painless, has raised borders, minimal surrounding erythema. Going on for quite a while. Initially was papule, enlarged, ulcerated, this enlarged and has been more than 4 weeks. No past med probs, allergic to penicillin but just upset his stomach. No meds. Social habits: drinking. Own apt in NYC. Travel: 1 month before papule was whitewater rafting in Costa Rica, noticed when he got back. Wore sandals, got lots of insect bites. Afebrile, normal BP, fit athletic young man. Non tender lesion, base is red, whi

The Estimados Profesores of TWIP solve the case of the Man With Motile Objects, and reveal the secreted and excreted proteins of Giardia parasites. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Excretory and secretory products of Giardia intestinalis (PLoS NTD) Image credit Letters read on TWiP 145 Case Study for TWiP 145 Male 40s, visiting NYC on business. Lives in Thailand, seeks medical attention for diarrhea and abdominal pain. Diarrhea is continuous, even at night. Feels swollen. Stool cultures come back negative. CBC reveals eosinophilia. Clinician orders stool O&P. See something in stool: large elliptical objects, over 100 microns. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiPtomaniacs solve the case of the Boy With Visual Disturbances and Itching, and discuss identifying secreted and excreted proteins of Trichinella parasites. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Malaria plasmepsins involved in invasion and egress (Science) Image credit Letters read on TWiP 144 Case Study for TWiP 144 Individual in 30s, male, presented to physician with stomach upset, uncomfortable feeling in legs. Has motile objects in stools. From Vancouver BC, was eating salmon, reports was either dried/smoked or marinated. Not sure if this is relevant. Brought motile objects to physician. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees