This Week in Parasitism
TWiP is a podcast about the tiny creatures that live in and on us.

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

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Case Study for TWiP 156

While on ID consultant service on LI during July, asked to see woman in late 70s admitted for fever, confusion, diarrhea. 2-3 days of abdominal pain, nausea, vomiting. Week prior was a family party, drank two large glasses Scotch. Had watery, nonbloody diarrhea 4-5 times per day; vomiting 2-3 times/day. Developed 103F fever, headache, lost appetite, 4-5 days did not eat. Hospitalized. No one else in party became ill. 2005 had episode of turning yellow after visiting Nepal. No surgeries, no allergies, no diseases running in family. ITP on prednisone, other drugs listen to podcast as well as PMH. Social history: worked in retail shop in Kathmandu, retired. Born west Bengal India, moved to Kathmandu as teenager, lived until 50s in nice part of town. Moved to LI 25 years ago, returns periodically to Nepal, last in 2017 for 2 months. Earlier this month had done 3 day camping trip with family on LI in tents. Brought water to drink, no contact with animals. Belly: small liver on percussion, no enlarged spleen, fluid wave, belly distended, white count elevated 38,000, no eosinophils. CAT scan of belly: cirrhotic liver, some acidic fluid. Notice intracellular ring forms less than 4% on smear.

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

Music by Ronald Jenkees

Direct download: TWiP156.mp3
Category:Medicine -- posted at: 7:37am PDT

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

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Case Study for TWiP 155

Another challenging one. 60 yo man with poorly defined immunodeficiency: low Ig, low T cells, on chronic Ig therapy. Admitted with 1 yr chronic diarrhea. Had upper endoscopy, inflammation of duodenum, crypt hyperplasia, diffuse ulceration. Lower colonoscopy: granular appearance to cecal mucosa. Loss of haustral folds. Biopsies done and sent for culture. PMH: poorly understood interstitial lung disease. Unable to work, no toxic habits. Born Ecuador, moved to US in early 40s, living in Staten Island. No fever, bp low, hr >100, resp high teens. Remarkable: looks frail but not terribly ill. Labs: normal WBC, shifted to left with increase in neutrophils and eosinophils. Albumin low; respiratory pathogen positive for rhinovirus. Serum CMV: >4000 (virus measurement). Started on ivermectin, WBC rises, broad spectrum Ab.

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

Music by Ronald Jenkees

Direct download: TWiP155.mp3
Category:Medicine -- posted at: 7:55pm PDT

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

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Case Study for TWiP 154

Daniel's colleague will solve this case, in two weeks. 79 year old man history of chronic lymphocytic leukemia that became B cell lymphoma, had chemotherapy a few weeks before coming. Was discharged with scrip for prednisone, but pharmacy made error gave him enough to take every day for over two weeks. Patient has fevers up to 100 degrees at home, headache, develops dry nonproductive cough. Brought to ER by family, there reports has lost weight. No nausea, no vomiting, no abdominal pain or diarrhea. Admitted to hospital. Has fever, chest x-ray suggests pneumonia, started on ab. Fever and symptoms continue, stop steroids. Chest CT shows multifocal ground glass opacifications and nodules. Increase ab to broader spectrum, ID is consulted. Positive test for latent TB. History hypertension, coronary artery disease, enlarged prostate. Gets bactrim, antifungal, antiviral. Born in DR, living in US since 70s. Visits occasionally had been a few months before. Lives with wife, no pets, no smoking, no toxic habits. Heart rate in 90s, looking fatigued, coughing, scattered crackles in lung, old systolic murmur, no rashes, confused, but family says he is always like that. TB test is negative. Negative for strongyloides. WBC count has increased, 30% eosinophils (over 7000). Stool ONP ordered but becomes constipated. CAT scan of belly shows thickening of colon.

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

Music by Ronald Jenkees

Direct download: TWiP154.mp3
Category:Medicine -- posted at: 6:33pm PDT

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

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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

Direct download: TWiP153.mp3
Category:Medicine -- posted at: 6:54pm PDT

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

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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

Direct download: TWiP152.mp3
Category:general -- posted at: 11:20am PDT

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

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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

Direct download: TWiP151.mp3
Category:Science -- posted at: 8:33am PDT

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

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Case Study for TWiP 150

Up to Costa Rican border, travel by boat 2.5 hr, up stream through mangroves. Mobile med clinic in village in small island in archipelago. Mother concerned about two children, have a very itchy rash on trunk and arms. Worse at night, needs medicine. Boy is 6 yo, has rash on buttocks, arms, genital area. Nothing out of ordinary in medical history. Living in same village as previous case, few hundred people, home has slat wood floors, toilet is over water. Dogs, pigs, chickens; no electricity; water comes off roof. On exam see rash, on dermoscopy see 1 cm long brown lines, clotted blood deltas at end. In this area many kids have this rash.

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

Music by Ronald Jenkees

Direct download: TWiP150.mp3
Category:Medicine -- posted at: 8:15am PDT

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

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Case Study for TWiP 149

31 yo man ulcer on let, 4 cm diameter. Raised borders, reddish and hard. Feels well, concerned not resolving. Started as bump, slowly enlarged, ulcerated, 1 month now. Healthy, no prior med, diabetes in mom. Works in field with machete, lives with family, social drinking, smoking. Lives in isolated villages on Northern Panama archepelago, many animals and insects. Homes are raised, slats on floor. No fever, normal bp hr, breathing low teens. Healthy athletic young man, otherwise good health except for ulcer on left leg. Non tender, no pain, base of ulcer red; no purulent material, borders raised but not undermined. Feels hard around edge, no scab. Did dermoscopic exam: erythema, small yellowish teardrops, small white starbursts.

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

Music by Ronald Jenkees

Direct download: TWiP149.mp3
Category:Science -- posted at: 3:00am PDT

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

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Case Study for TWiP 148

Will have a guest on next show to unveil! Female teenager living in NYC, previously in good health, rash for 2 week, abnormal feeling in legs. Initially had URT infection, no cough or fever. Rash is itchy, worse at night. But feeling of pins and needles, sharp stabbing in feet and legs. In ER told is zoster, started on gabapentin. Few days later fevers, pain getting worse. Seen by neurologist and ID doc, admitted. No past med/surg. Type 1 diabetes in aunt, father migraines, no autoimmune diseases. Had received chickenpox vaccine! Social: lives with parents and younger brother, much travel, Holland, Hawaii, most recent, pet lizard. In Hawaii, salad that she ate but no one else. Physical: febrile, heart rate >110, bp ok. Does not want to move because of pain. Neurological: extremity movement is slow. Rash irregular on chest, neck, back, abdomen. Labs: white normal, not much shift. Sed: 24, slightly increased. Lumbar puncture: increased white cells 280, 32% eosinophils.

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

Music by Ronald Jenkees

Direct download: TWiP148.mp3
Category:Medicine -- posted at: 1:31pm PDT

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

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Case Study for TWiP 147

Three year old boy, in tropical S. America, brought in by mother, says has been sick about a month. Previously healthy, 4 healty siblings, vaccines up to date, now has abdominal pain. Belly pain increases throughout day, poor appetite, constipated, has goat stools, pellets. Has had fever, seems swollen, face pale, urine dark, belly distended. Occasionally coughs. Living conditions: home has dirt floor where he spends most of day. On exam is febrile, doesn’t look well, no teeth, sleepy, not responsive, distended belly, pale, weight 13 kg. Diffuse scaly skin inflammation around perianal area, breakdown of skin around mouth. HIV, HTLV1 negative. Dogs, chickens, goats around, they come in house. Stool O&P sent out, contained something that gave diagnosis.

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

Music by Ronald Jenkees

Direct download: TWiP147.mp3
Category:general -- posted at: 12:39pm PDT