At the meeting of the American Society for Tropical Medicine and Hygeine in Chicago, Natasha joins TWiP to solve the case of the Man with a Generalized Seizure and Infectious Forms in the Brain.

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

Guest: Natasha Spottiswoode

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

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

Become a patron of TWiP

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

TWiP solves the case of the Hiker from Queens who Denies Bug Bites, and reveal two different malaria experimental vaccines that target different parts of the parasite life cycle.

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

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

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

Become a patron of TWiP

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

TWiP solves two cases this week, the Man with Issues after COVID-19, and the Man with Left Arm Weakness, then describe how the malaria parasite evades mosquito immunity by glutaminyl cyclase–mediated posttranslational protein modification.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

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

Become a patron of TWiP

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

Eyal joins TWiP to solve the case of the case of the Feverish Patient from Israel, and reveals his training and experience with travel medicine in Israel.

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

Guest: Eyal Leshem

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

• Letters read on TWiP 216

Become a patron of TWiP

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.

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

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

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

Become a patron of TWiP

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.

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

Music by Ronald Jenkees

Jessie Stone joins TWiP to solve the case of the Boy With a Swollen Belly, and discusses Soft Power Health, a clinic that she founded in Uganda to provide healthcare for people in need.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Jessie Stone

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

•Soft Power Health
•Letters read on TWiP 213

Become a patron of TWiP

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

Shauna Gunaratne joins TWiP to solve the case of the Man from Mali with Painless Skin Lesions, and discuss her plans for a tropical medicine institute in New York City.

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

Guest: Shauna Gunaratne

Click arrow to play
Download TWiP #212 (51 MB .mp3, 84 minutes)

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

• Letters read on TWiP 212

Become a patron of TWiP

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.

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

Music by Ronald Jenkees

TWiP solves the case of the Man from Hong Kong with Multiple Comorbidities, and discuss safety and efficacy of a monoclonal antibody against malaria in Mali.

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

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

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

Become a patron of TWiP

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.

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

Music by Ronald Jenkees

The TWiP team solves the case of the Woman From Hawaii With Allodynia and abdominal pain, bilateral hip and leg pain, dizziness, and diffuse hyperesthesia.

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

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

• Use coupon code MicrobeTV when purchasing a spike t-shirt from Vaccinated.us
• Accidental host (TWiP 207)
• Hero: Dan Colley
• Letters read on TWiP 209

Become a patron of TWiP

Case Study for TWiP 209

Man in his early 70s with PMH sig for HTN, DM-II, HLD, BPH is admitted to the hospital after coming from Guatemala to visit his son. He feels faint with standing and is noted to have a HR in the 40s and does not feel well when he stands. He is also noted to have diarrhea, but this has been going for an unclear period of time. On EKG he is noted to have a RBBB.

PMH  HTN, DM-II, HLD, BPH PSH neg

Allergies NKADR

Social -no toxic habits reported, reports living in Guatemala City but grew up in the rural areas. Enjoys fruit juice

FH-noncontrib

Exam: slow heart rate, orthostatic

A number of blood and stool tests are collected and he is referred to a tertiary care center for implantation of a cardiac pacemaker. At the tertiary care center the patient is seen by an Infectious Disease Specialist and a number of tests are ordered by the Infectious Disease Consultant but they are canceled by Cardiologist who writes in their note “no concern for an infectious process”. Now one of the tests collected at the first hospital returns with an interesting result that is later confirmed by a second test.

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

The TWiP team solves the case of the Woman Who Vomited Up a Worm, and discuss how malaria transmission intensity can modify the effectiveness of the RTS, S/AS01 vaccine in Africa.

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

Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email

Links for this episode

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

Become a patron of TWiP

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).

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

Music by Ronald Jenkees