TWiP 176: Blood schmear

The TWiPpers of the bite fantastic solve the case of the Indian Man Who Hiked, and discuss the effects of schistosome soluble egg antigen on infection of lymphocytes with HIV-1.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 176

Recent case, woman in late 20s, schoolteacher. Outer boroughs of NYC. Wakes up on Saturday, completely rash-y, head to toe. Goes to urgent care center, say is allergic, give anti histamines and steroids. Persists after a few days, goes to allergist. Only allergen positive, dust mites. Few days later goes to GP, still itchy and rash-y. He does more thorough exam, notices she has small red lesions on fingers and between fingers. Several children in classes she is teaching has similar malady. Given therapeutic, rash goes away. Otherwise healthy, HIV negative. Partner not around at the time this develops.

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Music by Ronald Jenkees

TWiP 175: None alone pathognomonic

The TWiP’ers solve the case of the Sudanese Boy With Fever, and reveal antibodies that slow invasion of red blood cells potentiate other malaria-blocking antibodies.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 175

70 yo man born in India, came to US 1985. Has not gone back for 2-3 years. Admitted with acute onset of fever, cough, not eating well. Was fine until a week ago, had lost consciousness, fever 102F. Negative cultures for urine and blood. Some kidney stones, type II diabetes, elevated cholesterol, no surgeries. No family medical issues. Started on vancomycin on zosyn. Works in post office, lives with house in private home. No toxic habits. Has history of hiking trip 1-2 months prior, in Rhode Island, in June. No pets, animals. Exam unimpressive. Labs: crit 25, hemoglobin 9. Platelets 39. Bilirubin 5.3. Liver enzymes slightly elevated. Chest CT clear, blood smear: anisocytosis, microcytosis, polychromasia, 4.3% reticulocytes. Daniel orders one test, 90 minutes later starts treatment. HIV negative.

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Music by Ronald Jenkees

TWiP 174: Fat cat

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The TWiPloid organisms solve the case of the Doctor with Chronic Epigastric Pain, and reveal how levels of linoleic acid in the intestine enable the sexual cycle of Toxoplasma gondii in cats.

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Case Study for TWiP 174

12 yo male living in refugee camp after fleeing Sudan. Presents to doctor with history of fever for many months, every other day; chronic abdominal pain. Tried antimalarials, no effect. Broad spectrum antibiotics, no effect. Exam: fast heart, clear lung, enlarged liver, enlarged palpable spleen. Camp has limited resources, no more diagnostic tests. Tried intravenous amphotericin. Child improves.  

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Music by Ronald Jenkees

TWiP 173: Rose colored spots

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The podcastellani hosts solve the case of the Sailor With Dysentery, and reveal the first virus discovered in Plasmodium species.

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Case Study for TWiP 173

Successful individual in NY area with 9 months of epigastric pain. Did upper endoscopy, saw in stomach several small mobile white serpiginous moving objects. 2.8 mm. Seem to be trying to burrow into gastric mucosa. One grabbed and sent to lab. History: curious habit of curing his own protein sources. 

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Music by Ronald Jenkees

TWiP 172: A painless lesion

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The metacyclic TWiPomastigotes solve the case of the Child With a Painless Leg Lesion, and reveal how to kill mosquitoes with a genetically modified fungus.

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Case Study for TWiP 172

Retired US Navy physician, lives aboard his sailboat, just finished doing remote medical volunteer work in C. America. In DR when has sudden onset of dull prog worsening epigastric lower abdominal pain. Over next 12 hr intensifies, near tears, went to local medical center. Admitted, given IV, probiotics. Febrile, elevated WBC 20,000, platelets low, white counts left shift. Initially some constipation, then diarrhea with some blood. Discharged without diagnosis; still fever and chills; rash rose colored spots on torso. Daniel gets involved; 3 day course of azithromycin, symptoms continue; then metronidazole, feels better, fever, pain, symptoms resolve. Wife is ok. Three men working on his boat, one had bloody diarrhea before the patient did. Keeps a bowl of nuts around.

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Music by Ronald Jenkees

TWiP 171: Better than a sharp stick in the eye

Daniel Griffin and Dickson Despommier

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

The Leishmaniacs solve the case of the Child With Band Keratopathy, and reveal a eukaryotic parasite with functional mitochondria but without mitochondrial genomes.

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Case Study for TWiP 171

By boat to remote village, young boy (<10) brought in by Mother, concerned about painless ulcer on leg. Hard nodular border, 2-3 cm. Originally seen by floating doctors a few months before, now back as ulcer is not healing. Non-tender, there is an area of hard, different color skin that surrounds lesion. Some nodularity, clean lesion, no undermining.

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Music by Ronald Jenkees

TWiP 170: A worm’s eye view

The TWiPlicates solve the case of the Child With Retinal Granuloma, and discuss an association of the complement protein collectin-11 with the pathophysiology of Chagas disease.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 170

3 yo girl, same context: mobile clinic in Bocas del Toro archipelago. Small village on remote island. Initially had red eye, rubbing a lot, mother noticed she seemed to have vision loss. On exam ophthalmologist did fundoscopic exam, sees band keratopathy, calcium on the cornea, and outer retinal punctate lesions.

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Music by Ronald Jenkees

TWiP 169: What goes on in the snail

The TriTWiPomonads solve the case of the Child Who Passed a Worm, and reveal recombination between bovine and human schistosome species.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 169

9 yo boy brought into mobile clinic set up in small village Bocas del Toro archipelago. Initially had red painful eye a few months ago, lasted 1-2 weeks. Eye no longer red but has issues with vision in the eye. On eye exam, some peripheral vision, but no sharp clear vision. Notes retinal retraction, seems quiet granuloma over macula of affected eye.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

TWiP 168: Kleptoparasitism and the stercoraceous souvenir

nurse cell

The Giardians of the Galaxy solve the case of the Woman With a Colonic Stowaway from Hispaniola, and discuss activation of intestinal tuft cells by Trichinella spiralis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 168

18 month old child, on medical mission for previous year with older sibling and 2 parents. Back in US for 2-3 months, just as leaving remote location were given dose of allbendazole. Call comes to Mom, child is at child care and has passed something. It is serpiginous, 5-6 inches in length, moving a bit. Not flat, but round. Child otherwise fine.

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

TWiP 167: The constipated mathematician

The Tremendous Trio solve the case of the Woman With Steatorrhea, and reveal breakdown of the glycocalyx associated with severe and fatal malaria.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 167

Woman 30 yo, traveled to DR, went to tourist part. On return for yearly physical, asked about her chronic constipation. She said does not have it any more, has normal bowel habits. A few weeks after her return this occurred. Primary care doc was intrigued, sent off some tests. Found Entamoeba hartmanni. What might the doc have done? What were the consequences of infection?

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

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