TWiP 61: Some creep crept into the crypt and crapped

Maria Adelaida Gomez joins TWiP to discuss her career and the work of her laboratory on understanding the healing process during cutaneous leishmaniasis.

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

Guest: Maria Adelaida Gomez

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Links for this episode

• CIDEIM
• Healing in cutaneous leishmaniasis (J Immunol)

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Music by Ronald Jenkees

Eyal joins TWiP to solve the case of the Female Traveler with Intermittent Fever and Ring Enhancements in the Liver.

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

Guest: Eyal Leshem

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Case Study for TWiP 229

Woman in her 40s is referred to me to be seen in the office from one of my colleagues. She reports that she has been having recurrent issues with worms exiting her anus and vagina since 2018. She reports that she lives with her husband and 4 children and they have never reported any issues. She reports that initially she took something over the counter and things resolved. She then a couple years later has this problem again and this time discussed the problem with her housekeeper from El Salvador who gave her an antiparasitic tablet from her home country. This problem has now recurred and she was referred to a GI doctor who she explains laughed at her and suggested she see a psychiatrist. She come in now very upset and tearful. She relates that she has this itching that wakes her up at night and was able to take pictures of something she found on the anus. She has photos as well as a video of a thin white 1 cm motile thing with on end coming to a point. 

She reports a normal nonrestrictive diet. She reports no travel outside the US or even outside the local area. No PMH, no PSH, family history of different cancers. She does not work outside the home. She reports no pets. She has an unremarkable exam and labs only notable for low vitamin D. 

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Music by Ronald Jenkees

TWiP discusses a tapeworm that causes extreme lifespan extension in infected ant workers, and a candidate antibody drug for prevention of malaria.

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

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Links for this episode

• Extreme lifespan extension in tapeworm-infected ant workers (Roy Soc Open Sci)
• Candidate antibody drug for prevention of malaria
• Ceilidh goes viral (YouTube)

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Music by Ronald Jenkees

Jim Small joins TWiP to solve the case of the 41 year old Man with sudden GI distress and itchy hives, followed by a discussion of parasites and childhood stunting.

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

Guest: Jim Small

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Links for this episode

• Parasites and childhood stunting (Trends Parasitol)
• Letters read on TWiP 227

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Music by Ronald Jenkees

TWiP reviews some parasite stories of 2023, including progress in the control of malaria and polio, and review a connection between parasites and childhood stunting.

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

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Links for this episode

• Second malaria vaccine (Nature)
• Malaria report 2023 (WHO)
• Malaria and climate change (WHO)
• Parasites and childhood stunting (Trends Parasitol)
• Sea creature spotted off Japan identified (Science)

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Music by Ronald Jenkees

Lee Gottesdiener joins TWiP to help solve the case of the 46 Year Old Man with Ongoing Upper Extremity Swelling, and review plant‑based production of a protective vaccine antigen against the bovine parasitic nematode Ostertagia ostertagi.

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

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Links for this episode

• Vaccine against cow parasite (Vert Farm Daily)
• Protective vaccine against bovine parasitic nematode Ostertagia ostertagi
• Hero: Dr. Katy Ewer
• Letters read on TWiP 225

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Case Study for TWiP 225

41-year-old male mechanical engineer, former Army Ranger trainee, moved from Denver, CO to Chattanooga, TN. He was in his usual state of vigorous health, hiking, doing Spartan races, working on his semi-rural property,  and commuting to his place of work daily when about three months previous to his diagnosis, he began having episodes of sudden GI distress with diarrhea, followed by itchy hives in axilla and groin. He treated these episodes with Benadryl and got relief. At 10 PM one evening, he had another such episode, again took Benadryl, but began to experience gradual onset but relentlessly increasing shortness of breath and wheezing. He was taken at high speed to the Emergency Room by his wife. He reported that relaxation with a repetitive, meditative prayer seemed to control the symptoms but said it was like his throat was closing.

Past history includes variable exercise and cold-induced asthma treated with an inhaler as a child, with only rare episodes in adulthood related to high exposure to allergens like cat dander. Family history is not contributory. Diet was omnivorous. They had one dog, a labradoodle named Raphael, which they chose because he was “hypoallergenic.”

In the Emergency Department, he was treated with bronchodilators, intramuscular epinephrine, and antihistamines, and the symptoms abated.

The experienced ED physician ordered a diagnostic test, having seen other similar cases in the region. A lifestyle intervention was successful.

Chuck Knirsch returns to TWiP to discuss the Neglected Tropical Diseases Roadmap published by WHO, which sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups.

Chuck Knirsch returns to TWiP to discuss the Neglected Tropical Diseases Roadmap published by WHO, which sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups.

Hosts: Vincent Racaniello, Dickson Despommier, and Chuck Knirsch

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Links for this episode

• Neglected Tropical Diseases Roadmap (WHO)
• World malaria report 2023 (WHO)

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TWiP solves the case of the Haitian female with AIDS and voluminous diarrhea, and review the pathogenesis, epidemiology, prevention and treatment of malaria and Chagas disease.

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

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Download TWiP #223 (63 MB .mp3, 88 minutes)

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Links for this episode

• Malaria (Lancet)
• Chagas disease (AJTMH)
• Hero: Joe Cook
• Letters read on TWiP 223

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Case Study for TWiP 223

46 yo man with minimal pmh, elevated cholesterol, ongoing right upper extremity swelling, 5-10 years intermittently. Goose egg swelling on hand, foot. Lasts for hours, every few months. Go to ER, right upper extremity. Lives in NYS suburbs, Is vet and epidemiologist. Has done extensive travel, Liberia, Ghana, DRC, Uganda, Rwanda, 2 week duration. Doing work, fair amount of animal contact with bats, rodents, birds. PE unremarkable except for swelling of right arm. Blood work unremarkable. 2.5 yr later notice prickling irritation under right eyelid, think they see undulation under skin. 

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Music by Ronald Jenkees

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

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Links for this episode

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

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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%

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Music by Ronald Jenkees

Michelle and Alexander join TWiP to solve their case of the 36 Year Old Male with shortness of breath, stinging pain in the extremities, fatigue, abdominal cramps, and bowel irregularities, and discuss host cell invasion by Trypanosoma cruzi.

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

Guests: Michelle Naegeli and Alexander Grieb

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Links for this episode

• cAMP-dependent invasion by Trypanosoma cruzi (PLoS NTDS)
• Letters read on TWiP 220

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Case Study for TWiP 221

This is the case of a  man in his 50s, with no remarkable prior medical history, who received care at a hospital in northern California, USA, after experiencing a generalized seizure. Magnetic resonance imaging (MRI) demonstrated a solitary left temporal lobe T2 hyperintensity with gadolinium rim enhancement and surrounding edema. After receiving treatment with dexamethasone and levetiracetam, he was transferred to an academic medical center.

Examination by neurology consultants noted disorientation, inattention, moderate aphasia (difficulty communicating), and mild right hemiparesis. Cerebrospinal fluid (CSF) testing revealed increased nucleated cells up to 80/UL (60% lymphocytes, 17% neutrophils, 23% monocytes), protein concentration 38 mg/dL, and glucose concentration 100 mg/dL. 

They proceed to do a brain biopsy from the left temporal lobe lesion with cultures from the brain biopsy sample that did not grow bacteria, fungi, or mycobacteria. They performed metagenomic next-generation sequencing (mNGS) on a CSF sample and sent brain biopsy samples for universal broad-range PCR amplicon sequencing (uPCR) for bacteria, fungi, Mycobacterium tuberculosis, and nontuberculous mycobacteria. which is preliminarily reported as showing well-formed granulomata with acute inflammation. Rereview of neuropathology raised concern for certain round infectious forms that are about 50um in size with some surrounding clearing and a dark area within these forms.

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Music by Ronald Jenkees