TWiP solves the case of the middle-aged man with eosinophilia and a history of sexual activity with paid sex workers in Okinawa, and presents a new case for you to solve.
Woman in 30s or 40s goes to Belize and after returning notices a lesion on her face. She goes to see several physicians and despite a number of topical creams the ulcer on her face does not heal. She is then referred to our office where a certain parasitic infection is considered and we involve our friends at Columbia to help us with the diagnosis..
A middle-aged male is referred to evaluation because of eosinophilia. This man is married, living here in the NY tristate area, and this was picked up on ‘routine blood work’ by his primary care doctor. This man had been in the military, serving as a marine, with time spent in Okinawa, Japan. This individual does report sexual activity with paid sex workers while in Okinawa but has been monogamous with his current wife for many years. A number of investigations are done with a test coming back showing serological evidence of a prior parasitic infection and he was treated with an antiparasitic medicine with resolution of the eosinophilia. The eosinophilia returned and he was referred to us. Blood work is now down showing evidence of a viral infection that might explain why the eosinophilia returned after treatment. Pt is HIV negative. This was prior to the COVID-19 pandemic. He is on no medications and in general feels fine.
TWiP taps into Dickson’s knowledge of Trichinella to discuss an outbreak in humans who consumed rare bear meat, and the impact of globalization and climate change on the epidemiology of the species.
Founder of Floating Doctors Ben LaBrot joins TWiP to solve the case of the 1 year old in northeastern Panama with a fatal leg infection, followed by a discussion of the history and mission of Floating Doctors.
A man in his early 20s comes in reporting pain when he urinates or ejaculates. He reports that he is sexually active. He does confide that he has been in a relationship with a woman but he had a sexual encounter outside this relationship about 2 weeks ago when they were on a break and he did not wear protection. He feels like he needs to urinate more often and describes thin white discharge from the penis. He reports that he has no history of any sexually transmitted infections and had no medical issues prior to this.
Lilach Sheiner joins TWiP to talk about her career and her work on engineering Toxoplasma gondii secretion systems for intracellular delivery of multiple large therapeutic proteins to neurons.
This case comes from Panama mid summer 2024. A provider for Floating Doctors working in the coastal region in northeastern Panama. This case involves a one year old, so the history is a bit difficult, but there may have initially been a scratch or some sort of break in the skin. Otherwise healthy but over a period of time this area expands and becomes a deep necrotic wound on the leg. Several other nearby wounds develop and become deep and infected. By the time this one year old is seen by the provider much of the leg appears eaten away. This is just the tip of the iceberg as a number of others develop similar wounds in the area. No prior medical history.
TWiP reviews a study showing that intestinal helminth infection impairs vaccine-induced T cell responses through an IL-10 pathway, which compromised protection against antigenically drifted SARS-CoV-2 variants.
A woman in her 20s who has been previously healthy comes in to an Urgent Care in the NY TriState area reporting and I quote “I’ve seen small white worms in my stool since yesterday.” The small round white worms are about 1 cm in length. She reports that she recently returned from a trip to Mexico where she stayed in a luxury resort. She reports never leaving the resort, only drinking bottled water, but does volunteer that she did eat from the salad bar/buffet at the resort. She reports some lower abdominal cramping but no actual pain. She reports no fever, no chills, no rash, no diarrhea, no rectal pain, and no anal itching. Her exam is unremarkable and she refuses a rectal exam. Blood work is unremarkable and stool O+P is sent that comes back negative.
