TWiP 206: Bacteria protect mosquitoes from parasites

The TWiP team solves the case of the Ghanian Women With Leg Swelling, and relate how Anopheline mosquitoes are protected against parasite infection by tryptophan catabolism in gut microbiota.

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

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Case Study for TWiP 206

42 yo Spanish speaking male, originally from capital city of Honduras. Admitted to hospital after seizure. Grew up in Honduras, 20 year history of seizures. Now in NYC area. Treated with carbamazepine, 2x a day. Has not filled scrip for 3 months. Fast heartrate, o2 sat fine, no fever. No surgery, no toxic habits. Unremarkable physical exam. Undergoes blood work and head imaging. CBC normal, normal diff, slight elevation in blood glucose. Imaging of head reveals non-specific coarse calcification. Eats regularly.

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Music by Ronald Jenkees

TWiP 205: Two for the price of one

The TWiP team solves the case of the Pregnant Ghanian Living Near a River, and reveal emodepside, a drug for treatment of onchocerciasis.

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

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Case Study for TWiP 205

Two women, 80s and 50s. Former had 9 children, lives in Ghanian village with large lagoon, many mosquitoes. Concerned about chronic swelling of left leg, groin area for much of her life. Walks barefoot. 50 yo with 4 children, both legs started to swell, cold, mosquito bites. With time left leg becomes hard, swollen, disfigured. Has gone to hospital for ulceration. Common problem in her village, mostly women but some men. Problems getting access to medications. 

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Music by Ronald Jenkees

TWiP 204: Near a fast-flowing river

The TWiP team solves the case Two Ghanians Near A Fast-Flowing River, and discuss a promising new drug for treatment of African trypanosomiasis.

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

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Case Study for TWiP 204

Pregnant woman, 20 yo, living in eastern Ghana near Volta River delta. Often in river. In second trimester. Comes in with abdominal pain, bloody diarrhea. Ovoid forms seen in stool, 160 microns, have single lateral projections. Other ovoid forms 45×30 microns which contain polar bodies.

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Music by Ronald Jenkees

TWiP 203: True, true, and unrelated

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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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

TWiP 202: 80 microns and ovoid

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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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

TWiP 201: Tiny and hairy

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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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

TWiP 200: Parasites without borders

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

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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

TWiP 199: Chagas kisses Cruzi and Brucei bites

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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Download TWiP #199 (41 MB .mp3, 68 minutes)

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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

TWiP 198: Cyclospora in the dining room with the salad bar

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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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 197: An adventurous eater

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

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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

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