Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPanorama solve the case of the Dutch Woman with Wormy Objects in Her Stool, dissect a study on cytoadhesion of malaria infected red blood cells, and introduce Parasitology Superheroes.

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Links for this episode:

• Myiasis (Wikipedia)
• Cytoadhesion of Plasmodium in severe malaria (PLoS Path)
• Image credit
• Letters read on TWiP 123

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

Case Study for TWiP 123

Nurse in early 20s, recent grad, decides to spend year in global health internship in western DR/Haitian border. On her foot has skin issue: told is fungal infection, using antifungal cream, is getting worse. Several days, only on one foot. Healthy, no past med/surg/allergies, no meds, no HIV, lives with local family. Daughter, wife, husband, cat. No toxic habits. Originally from US, swims, walks barefoot to and from, shoes off in house. Easts local food, exposure to dogs, cats, sister. Very itchy, but not open; rash area is raised. Blistery in certain areas, involves different areas in different days, snakelike. 

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPniks docs solve the case of the Female from Peru with Epistaxis, and discuss the effect of community deworming on immunosuppression.

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Links for this episode:

• Community deworming and immune hyporesponsiveness (PNAS)
• Paul C. Beaver (one, two)
• Photo by Oscar Adam Oscarson
• Letters read on TWiP 122

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

This show is sponsored by Drobo, a family of safe, expandable , yet simple to use storage arrays. Drobos are designed to protect your important data forever. This Holiday season give someone a Drobo to keep all their files and memories safe forever. TWiV listeners can save 20% or more off of their purchase of a Drobo 5D, Drobo 5Dt, Drobo 5N, or any 8-drive or 12-drive system at www.drobostore.com by December 31, 2016 using discount code MICROBE20.

Case Study for TWiP 122
First of a series of cases with a theme, a 23 yo female international aid worker, chief complaint of diarrhea. Dutch descent, born in US, been in rural area of western DR, close to Haitian border. It’s been raining, houses have tin roofs, other flat concrete, rainwater pours off. Child comes by with mangoes, she buys one, washes it in rain water from the roof. Bites open mango, peels it, eats mango. The same night she is not feeling well, loose stools, abdominal discomfort. Next day, goes with group to border town; then has full fledged diarrhea. Looks into toilet, sees white objects 1 cm in length on stool, and they are moving. Uniform width, thinner than long, wormy looking. Has been participating in other activities in this area, swims in local river, walks barefoot, eating lot of local foods. Lunch: rice, beans, cooked meat, avocado. Dinner, yucca, fried salami, etc. Healthy before, no family history, not on meds, living with one of local families, no toxic habits. Dogs, cats, pigs, chickens around. One month earlier, cat in family home had kittens, she played with them. Very excited about that. Local physician contacted, he treats her. 

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPanosome docs solve the case of the Mali Man with Profuse Diarrhea, and review the presence of Trypanosoma cruzi in vectors, canids, and humans along the Texas-Mexico border.

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Links for this episode:

• T. cruzi in vectors, canids, humans at Mexican border (PLoS NTD)
• Tetracapsuloides bryosalmonae (Wikipedia)
• T. cruzi in US (Clin Micro Rev)
• Image credit
• Letters read on TWiP 121

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

Case Study for TWiP 121

Back to Peru. 55 yo female from highland central valley area near Cuzco. Works in farming, no prior skin lesions but has multiple hypopigmented scars on exposed extremities (trauma during working), now reports many years of bloody nasal discharge. Seen in Lima by Daniel in outpatient clinic. No other medical problems, no surgeries, no allergies, everyone in family fine, husband and kids. Still working. No travel except to see doctor. Exam in right nare: ulcerated lesion inside nose, muco-cutaneous lesion. Simple test will decide. No anemia, no fever. Not eosinophilic, labs normal, HIV negative.

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiP triumvirate solve the case of the Thai Woman with Facial Swelling, and explain how Th17 T cells protect against the intracellular parasite Trypanosoma cruzi.

Become a patron of TWiP.

Links for this episode:

• Th17 cells protect against Trypanosoma cruzi (PLoS Path)
• Plasticity of helper CD4+ cells (Science)
• Image credit
• Letters read on TWiP 120

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

Case Study for TWiP 120

A 48 yo man from Mali comes to hospital ER in Washington Heights in NY with profuse watery diarrhea. Born in Mali, came to US at 18, working in US as long haul truck driver for 30 y, frequently visits Mali, recently to attend his father’s funeral. Got symptoms one week after return (was there for 3 weeks). 3 liters diarrhea/day. No past med/surg history, not seen doctor in long time. No allergies. Unknown what father died of, Mother in Mali is ok. No medications. Some alcohol, marijuana use. Does report that has exposure to professional female sex workers, no condoms. Temp of 39 C, bp down 80/40, heart over 110, rapid breathing high 20s, cachectic. Wasted. Fungating lesion perianally. Undergoes HIV testing, clade B. T cells <100. 

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

Hosts: Vincent Racaniello and Daniel Griffin

Vincent and Daniel solve the case of the Family with Eosinophilia, and discuss HIV-1 infection and genome integration in the blood fluke Schistosoma mansoni.

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Links for this episode:

• Family cluster of eosinophilia (Clin Inf Dis)
• Dientamoeba fragilis (Wikipedia)
• Parasites without borders
• HIV integrates into Schistosoma genome (PLoS Path)
• Image credit
• Letters read on TWiP 119

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more.

Case Study for TWiP 119

This one will be kinder and gentler case. Back in Thailand but could be in several places. 25 yo Thai woman from Bangkok, to hospital, chief complaint facial swelling. Eats typical Thai diet (see previous episodes!) Som tum, etc fish that is not cooked. Migratory - moves around face. Not tender, but mild itchiness. For about a week, no pain. Healthy, no past med/surg history, family all fine. HIV negative, no drugs, no travel. On examination, has swelling on right side, 3-4 cm raised, little redness, firm, does not feel like fluid filled. No fever, no GI problems, no bloods. WBC up, eosinophils up. 

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPinella solve the case of the Woman from Guinea, and describe the use of CRISPR/Cas9 to identify essential apicomplexan genes.

Links for this episode:

• Malarias in Guinea (CDC)
• Genome-wide CRISPR screen in Toxoplasma (Cell)
• Plasmodium parasitemia associated with increased Ebola survival (Clin Inf Dis)
• Image credit
• Letters read on TWiP 118

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more.

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Case Study for TWiP 118

Little bit of a twist - a human family with eosinophilia. Conveyed by good friend/colleague ID physician. Australia, NSW, 45 yo Dad, having problem with mild abdominal distention. Seen by doc in Sydney, CBC shows eosinophil count of 10,500. Wife of same age reports feeling fine, but gets CBC and also shows eosinophils of 5,200. Two daughters, 17 and 19, no symptoms, bloods: 900 and normal eosinophils. One week prior to dads symptoms, sister in law came (also in NSW) and stayed, developed severe diarrhea, discomfort, bloating, weight loss, eosinohils 4,700. Eat raw fish (not known if fresh or salt) purchased at local markets. No overseas travel or out of urban environment. No pets, no home grown foods. Went back to previous labs and found normal eosinophil levels. Full workup for strongyloides, all negative. No HIV. No toxic habits, no remarkable medical history.

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The parasite prophets solve the case of the Thai Man with Abdominal Distention, and discuss the finding that metastatic leishmaniasis dependent on a virus can be prevented by blocking IL-17A.

Links for this episode:

• TWiP 27: Trematodes
• Leishmaniavirus and IL-17A dependent leishmaniasis (PLoS Path)
• Image credit
• Letters read on TWiP 117

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more.

Become a patron of TWiP.

Case Study for TWiP 117

Woman 66 yo born in Guinea, grew up the moved to US past 10 years, just retired. Lives in Washington Heights. Mother having issues in Guinea, so went back for 3 months in 2016. Just came back a week ago, reporting headache, fever, feeling poorly. Staying in big city, with Mom (80s). Has own private toilet in nice home. No screens or bednets. Married for 40 years, recently divorces. Has had 10 children. Not sexually active. Starts with high fever, breaks, then 2 days later another for several hours, goes to ER. Given Ebola screening questions, negative, do some blood work, send her back out. 2-3 days later high fever, double vision, headache, comes to Columbia ER. No diarrhea, no urination discomfort. Has backache, feels that mouth is dry. Was admitted. Past med history: high bp, cholesterol, diabetes; not overweight; appendix out; has unknown reaction to novocaine. No smoking, drinking. Physical: 39.4 temp, 14-16 breath rate, heart rate over 100, rapid heartbeat, 2/6 systolic murmur with radiation to left carotid (flow murmur). No jugular venous distention. Abdomen right upper quadrant: slight enlargement of liver, not tender, can palpate spleen tip in left upper quadrant, slightly enlarged spleen. Normal bowel sounds, no rash. Blood: elevated white count, bands 9%. 0.1 eosinophils, platelets 79, hemoglobin 11. Bilirubin 1.5, bicarb 20, chest xray clear. Red cells: small, 79.4 mcv. Animals: don’t like animals! In middle of rainy season. Likes to walk outside in rain during day. No cats to keep out rodents. Food: all food is prepared in home. Eats all favorite foods: rice. No sick contacts, no exposure to health care setting, no bug bites. 

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPtoids solve the case of the Thai Fisherman with Chronic Diarrhea, and reveal a potential new drug for treatment of leishmaniasis, Chagas diseases, and sleeping sickness.

Links for this episode:

• Capillaria philippensis (Wikipedia)
• Proteasome inhibitor for three parasitic diseases (Nature)
• Image credit
• Letters read on TWiP 116

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more.

Become a patron of TWiP.

Case Study for TWiP 116

This week's case involves no math. 36 year old Thai man from the northeast part of the country. Comes in with abdominal distention. Eats a normal Thai diet - Som Tam, Koi Pla, lots of rice. Feels well, came in because he is getting yellowing of skin and whites of eyes - jaundiced. Previously healthy, no prior med prob or surgery. No diseases running in family. Fisherman in the northeast (freshwater). Wife and many children, monogamous, HIV negative. Lives in jungle area, near river, many dogs, chickens, monkeys, goats, cows, pigs. Bathroom is outside. No fever, thin. Distention going on for months. Getting bigger. Exam: jaundiced, has large palpable non-tender mass below liver on his right side. No enlarged liver or spleen. No travel. 

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPlets solve the sad case of the Boy Who Went Swimming, and explain why the tomato is resistant to the plant parasite Cuscuta.

Links for this episode:

• Detection of plant parasite by a tomato receptor (Science)
• Dodder (Wikipedia)
• Mixed messages (TWiP 77)
• Image credit
• Letters read on TWiP 115

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more.

Become a patron of TWiP.

Case Study for TWiP 115

This week's case is more challenging, but with a better outcome than last time. Thailand: 32 year old Thai man from southern coastal part of country, comes to ID hospital in Bangkok with two months of watery diarrhea. Rapid onset. Looks emaciated, protuberant belly. Ten times per day, has trouble flushing feces in toilet, floats. Eats normal fare, boat noodles, fish, rice, vegetables. Som tam - fish sauce from raw fish. Also with salted crab, not well cooked. No unusual past med history, healthy fisherman, no medication. Married with kids, everyone healthy. No bad habits. Monogamous. HIV negative. Liver, spleen not enlarged. Abdominal xray with contrast: loss of villi. Good appetite. No abdominal pain. Too weak to work. No vomiting.

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

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiP troika solve the case of the Female from the Bronx, and reveal how feeding on different plants affects mosquito capacity to transmit malaria.

Links for this episode:

• Plant mediated effects on malaria transmission (PLoS Path)
• Image credit
• Letters read on TWiP 114

This episode is sponsored by CuriosityStream, a subscription streaming service that offers over 1,400 documentaries and non­fiction series from the world's best filmmakers. Get unlimited access starting at just $2.99 a month, and for our audience, the first two months are completely free if you sign up at curiositystream.com/microbe and use the promo code MICROBE.

This episode is also sponsored by Drobo, a family of safe, expandable, yet simple to use storage arrays. Drobos are designed to protect your important data forever. Visit www.drobo.com to learn more.

Become a patron of TWiP.

Case Study for TWiP 114

12 year old boy brought to hospital ER by parents with severe headache, stiff neck, fever, decreased alertness. No rashes. Has been healthy with no prior medical problems. No one else in family is ill. In summer, boy has been engaged in usual summertime activities: soccer, swimming in warm freshwater, playing outside. Undergoes lumbar puncture for CSF: start on meningitis treatment. No surgeries, no allergies. Not on any meds. Lives with Mom, Dad, few brothers. No substance abuse. Not a geographically limited illness. Has had bug bites - lots of mosquito bites. Dogs around as well. Symptoms began a day or two before hospital visit. Eats whatever family eats, food is cooked. Exam: 39.4C, bp low, heart rate up, resp up, decreased responsiveness, stiff neck, looks ill. WBC elevated, neutrophil predominant, eosinopenia. CSF glucose low, cells increased, no bacteria, fungi, acid fast bacilli on stain. CT scan, diffuse swelling of brain. Doing poorly, not a good outcome.

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