This Week in Parasitism

The Podfessors solve the case of the Teenager With Swollen Scrotum, and continue the story arc of Daniel's favorite cells, B-1 cells, and their association with protective immune responses in human Chagas disease. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: B1 cells and Chagas disease (Front Immunol) Daniel discovers B1 cells (J Exp Med) Hero: Bridget Ogilvie Image credit Letters read on TWiP 166 Case Study for TWiP 166 Recent consult from gastroenterologist. 61 yo woman on trip to Thailand, Cambodia for a few weeks. Developed diarrhea, took azithromycin, 3 days. Diarrhea continued, back in states now ongoing a few weeks. Left lower abdominal pain, bloated, gassy, loose stools, stick and foul smelling. Not sexually active, but is relevant. Not restrictive in what she ate. Drank bottled water. Did not eat raw items. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiP team solves the case of the Four Year Old with Fever, Headache, and Cough, and discuss the release of extracellular vesicles from Leishmania amazonensis that manipulate the host immune response. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Crackles (Wikipedia) Extracellular vesicles released by L. amazonensis (Front Microbiol) Hero: Marietta Voge Image credit Letters read on TWiP 165 Case Study for TWiP 165 Still in Uganda. Young boy came from a distance to see Daniel, teenager with large swelling in scrotum, left side, 4-6 cm diameter, superior to testicle. Not only young man in area with similar problem. Daniel asked, are there people with large swollen legs? He said yes, my brothers wife, left leg is large, swollen, irregularity. Nontender. Can be transilluminated, and it glows. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiP legends solve the case of Surfer Sans Septum, and discuss how two symbiotic bacteria in the tsetse fly allow colonization with Trypanosoma brucei. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: A Tale of Three Species (mBio) V.B. Wigglesworth (Wikipedia) VB Nimble, VB Quick Hero: James Paget Letters read on TWiP 164 Case Study for TWiP 164 Welcome to Uganda. Mother brings in 4 yo female child, end of rainy season, concerned that has one day of fever, headache, cough. On exam looks ill, unremarkable except rapid heart rate, localized crackles in right lower lung. Several children in family. Spends day swimming in local stream. Take care of animals. Help gather drinking water in morning. Live in dirt floor home, thatch roof, with animals around. Saw many others with same problem. What tests do you want to do? Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The doctors of awesome solve the case of the Woman Who Visited Lebanon, and reveal that immunoglobulins protect the olfactory organ of trout against infection with the Ich parasite. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Mucosal Ig protect trout from Ich (PLoS Path) Hero: Sir Patrick Manson Letters read on TWiP 163 Case Study for TWiP 163 From here in US before leaving for Uganda: male has lesion affecting nose. Has been having problem with nose for 2 yr, in 40s, surfer, hit nose with board. Southern eastern Costa Rica. After that had blood and scabs from nose. Inside of nares, scab formed. Did not improve with time. Saw ENT doc on LI, said he hit nose and needs reconstructive surgery. Entire septum destroyed. 20+ years ago had non healing ulcer on left hand, saw physician in CR, was treated for 20 days. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiP professors solve the case of the Baby With Pericardial Effusion, and discuss whether the flagellate without a flagella, Dientamoeba fragilis, causes human illness. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Patients with Dientamoeba fragilis infection (Am J Trop Med Hyg) Hero: Dr. Eloise B. Cram Image credit Letters read on TWiP 162 Case Study for TWiP 162 A fresh case. Woman in late 30s born in Palestine, moved to NY. Presented for care with sore throat, swollen lymph nodes. Married Lebanese man, he's still there, travel back in forth. Had been in Lebanon for 3 weeks before illness. Ate special raw meat dish while in Lebanon. No other animal exposure. Small children at home, works in office. No medical/surgical history, no meds. On exam, has posterior cervical lymphadenopathy. Otherwise normal exam. HIV negative. Low grade fever. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiPsters solve the case of the Brazilian Immigrant With Heart Problems, and describe how genome organization controls trypanosome antigenic variation. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Trypanosome genome organization and antigenic variation (Nature) Hero: Arthur Looss Letters read on TWiP 161 Case Study for TWiP 161 Daniel was asked to see 30 yo female from Bolivia, had to travel back during 3rd trimester. Was there for most of 3rd trimester. Child born in US, pericardial effusion, ascites, moderate PDA. Heart function is ok. Woman was healthy, no issues during pregnancy. Baby's white count elevated, diagnostic evaluation. It is a parasite. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiPlets solve the case of the Electrician from Tamil Nadu with a Liver Mass, and reveal that dogs and humans share a common Chadian Guinea worm. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Chadian Guinea worms in humans and dogs (PLoS NTD) Hero: Karl George Friedrich Rudolf Leuckart Image credit Letters read on TWiP 160 Case Study for TWiP 160 Referred to Daniel for consult, 40 yo immigrant from Brazil, a farmer had worked there, family in US. While here 1 y ago sees physician for increased heart rate, arrythmia, premature ventricular contractions, A-fib and flutter, treated by cardiologist then gets implantable defibrillator. Diagnostics: EKG, right bundle branch block; Echo shows heart is dilated with apical aneurysm; thrombosis. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiP triptych solve the case of the 9/11 Survivor infested with parasites, and discuss the effect of community ivermectin treatment for onchocerciasis on Loa loa infections. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Subscribe (free): iTunes, Google Podcasts, RSS, email Become a patron of TWiP. Links for this episode: Ivermectin for onchocerciasis and loiasis (PLoS NTD) Hero: William Boog Leishman Thanks to Caitlin for the image Letters read on TWiP 159 Case Study for TWiP 159 Going back to India, gentleman in 20s seen during rainy season in south. Week of feely achy, fever, severe pain in right upper part of belly. Vomiting, no diarrhea. Married, no children, works indoors in trades - electrician. Drinks large amount of palm date liquor. Previously healthy, no allergies, no medical issues. No travel. On exam: right lung base decreased breath sounds; upper right area of belly can feel liver coming down. Area of intercostal tenderness. Elevated white count; left shift, eosinopenic, alk phos up. Chest xray: shows effusion in right base. Ultrasound of liver: fluid filled single lesion. Lesion aspirated. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiP hosts solve the case of the Thai Woman With Red Bumps, and reveal that a master manipulator contacts ant brain tissue to control its behavior. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Imaging parasites in ant brain (Nat Rep) Brain worm turns ants into zombies (Nat Hist Museum) Hero: Giovanni Battista Grassi Image credit Letters read on TWiP 158 Case Study for TWiP 158 Male in 50s comes to see Daniel, concerned that is infested with parasites. Retired firefighter, 9/11 survivor. Several years of skin issues not resolved. 2009 dating Haitian girl, goes to Haiti to assist with disaster relief efforts, there notices itchy rash, worse at night, elevated eosinophils. Prior biopsy showed arthropods with compound eyes. Treated with oral ivermectin, topical permethrin. Ulcers form, preceded by small white objects that pop off skin and these can swim in water. Repeat cystoscopies triggered by hematuria. Multiple biopsies and skin scrapings, all unrevealing. Had episode with forked headed worms came out while on toilet. Became temporarily blind. Another physician suggested were drug related. Brings Daniel video of swimming, skin scrapings. Spent time in Egypt where he swam in fresh water. Has issues with substance abuse. Family history unremarkable. One exam, has ulcerated areas widely. CBC eosinophil 700. Calcification at bladder periphery. Many negative tests returned. Review of many biopsies, stool ONP, all unremarkable. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

The TWiP professors solve the case of the Woman With Intracellular Ring Forms, and explore the role of Coxiella and Rickettsia endosymbionts in acquisition of Babesia by ticks. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Endosymbionts and Babesia in ticks (Front Microbiol) Q fever with Robert Heintzen (TWiM Special) Hero: Percy Garnham Image credit Letters read on TWiP 157 Case Study for TWiP 157 Back to Thailand. Housewife, complaint has multiple red bumps on body, intense itching, worse at night. On head, legs, upper chest. Also does not feel well, feverish, muscle aches, difficulty breathing. Moved into abandoned residence, symptoms began a few days later. Many coconut husks around. Thatched roof. Husband and children developed similar symptoms. No med/surg history, no allergies. No meds. Unused mattresses, rat nests around. No toxic habits, no travel. No pets. On exam: not febrile, not toxic, increased heart, breathing comfortably. Has multiple red papules, central punctum. Labs unremarkable. Diff: unremarkable 6% eosinophils. Skin scraping from lesion on chest done. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees