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

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Links for this episode

• Mosquito net use in Tanzania (NEJM)
• Michiaki Takahashi (Wikipedia)
• Letters read on TWiP 203

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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.

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Music by Ronald Jenkees

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

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Download TWiP #201 (72 MB .mp3, 60 minutes)

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Links for this episode

• Febrile podcast
• Hero: Eloise Blaine Cramm
• Support MicrobeTV at Parasites Without Borders
• Letters read on TWiP 202

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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 count; elevated glucose.

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Music by Ronald Jenkees

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

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Links for this episode

• Reservoirs for Leishmania (Transboundary Emerg Dis)
• Support MicrobeTV at Parasites Without Borders
• Letters read on TWiP 201

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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 in colon. Colonoscopy done, mass resected. Pathology: shows adenocarcinoma, but also eggs in sample. Slightly ovoid, 80 microns.

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Music by Ronald Jenkees

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)

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Links for this episode

• Accidental parasitoid introduction (Mol Ecol)
• Hero: Gerald Keusch
• Support MicrobeTV at Parasites Without Borders
• Letters read on TWiP 200

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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 bowel normal. Has weakness in lower extremities. Skin unremarkable. Labs: CT shows multiple ring enhancing lesions with surrounding edema, also on MRI.  

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Music by Ronald Jenkees

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

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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

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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.  

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Music by Ronald Jenkees

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

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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

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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 another bout of fever that went down in 2 days. Lesion healed. PCR for plasmodium, Borrelia negative, but seroconverted for Rickettsia. Went home, a week later another 3 day bout of fever.   

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Music by Ronald Jenkees

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)

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Links for this episode

• PWB on Facebook, Instagram, Twitter
• Experimental T. vivax vaccine (Nature)
• Letters read on TWiP 197

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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@microbe.tv

Music by Ronald Jenkees

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)

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Links for this episode

• PWB on Facebook, Instagram, Twitter
• Entomophagy (TWiP 131)
• Malaria mRNA vaccine (NPJ vaccines)
• Letters read on TWiP 196

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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 nematode.  

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

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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

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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