TWiP 184: The hunter gets captured by the game

Dickson, Daniel and Vincent solve the case of the Safari Goer With Watery Diarrhea, and explain how a microsporidian endosymbiont of Anopheles mosquitoes might impair the transmission of malaria.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 184

69 yo female with several months of abdominal symptoms started in S. Africa, water shortage as described for her husband in the previous TWiP. Husband had C. cayetanensis. Her symptoms improved; her stool was positive for B. hominis and E. nana. Given many different treatments. Then comes to see Daniel. Some abdominal discomfort, mucosy stools. All past med/surg unremarkable, nothing in family, sent for repeat labs, stool O&P all normal including GI PCR

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

Music by Ronald Jenkees

TWiP 183: When they dry they die

Dickson, Daniel and Vincent solve the case of the Female with Itchy Anus, and reveal the structure of a roundworm membrane protein involved in digestion of nutrients.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 183

70 yo male. Returns with wife from safari in S. Africa. Reports suffering from 2 weeks watery diarrhea. Severe water shortage in S. Africa, limited washing water, hand sanitizers to clean hands so problem with hand hygiene.  5 days after arrival he and wife have water diarrhea, 12 per day, nauseated, abdominal cramping. Ab no effect. Stool culture, ONP, negative. Healthy, no past med/surg, no allergies, nothing runs in family. Stool sent off for ONP acid fast stain, also GI PCR panel. Prompts treatment for 7 days trimethoprim sulfamethoxazole, resolves.

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

Music by Ronald Jenkees

TWiP 182: Super spreaders of science

Dickson, Daniel and Vincent solve the case of the Ugandan Volunteer With Morning Bites and discuss integration of HIV-1 into the Schistosome genome, with a sprinkling of COVID-19 throughout.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 182

60 yo female comes in with husband, grew up in Lima Peru. Having issue had when child, would get itchiness around anus, mother would have her eat pumpkin seeds. Every 2-3 weeks wakes up with severe itching. Put in q-tip and extracted something, has video of it. ONP stool cultures negative. Referred to Daniel. Negative medical history, no allergies, no surgeries, no medications. Does travel, mainly to Uganda. HIV negative, no toxic habits. Husband reports no symptoms. Has children/grandchildren.

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Music by Ronald Jenkees

TWiP 181: Daniel’s drive-through

Dickson, Daniel and Vincent solve the case of the Two Volunteers With Watery Diarrhea, discuss diagnosis of SARS-CoV-2 in the New York area, and reveal an approach to preventing honeybee colony collapse by imbuing their gut bacteria with the ability to produce antiviral and antiparasite double-stranded RNAs.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 181

Risks of being helpful. Volunteer from previous case. Diarrhea is gone, now has second issue. Since coming to Uganda noticing on waking in AM often has series of 1 cm red raised lesions in a line, 3-4, on torso. Swollen and itchy. New ones in the AM. Manager says welcome to Uganda. They move out of room, leave bedding behind. Lesions stop. What is going on and when can they move back into room?

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

Music by Ronald Jenkees

TWiP 180: A spleen palaver

The TWiP professors solve the case of the Ugandan Child with Splenomegaly, and reveal that mutations in the P. falciparum genome that confer artemisinin resistance interfere with endocytic uptake of hemoglobin.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 180

Uganda with a twist. Meets two people with watery diarrhea, 12 episodes/day, loss of appetite. No fever, no blood in stool. Living for months at staff guest house. One week prior to onset went on weekend trip to area with waterfalls. Were served outdoor meal: meat, salad, fruit. Recommends empiric treatment trimethoprim/sulfamethoxzole for 7 days. Prompt resolution of diarrhea. A few days later, upon drinking coffee with milk gets severe cramps. 20s, long term female volunteers. 

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Music by Ronald Jenkees

TWiP 179: Verminous visitors

Ascaris skirt

The TWiP DVD solve the case of the Child Who Passed Worms, and discuss a non-human primate model for severe malarial anemia.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 179

From Uganda, eastern up in mountains, rainy season. 6 yo girl brought in by mother on Monday, reporting several days of feeling poorly, headache, fever, muscle aches. Negative malaria smear on Monday. Wednesday returns, feeling worse, fever higher, headache worse. Lungs clear, belly (pain on left side) has large spleen. Living in good conditions, well dressed, dirt floor house, concrete walls. Toilet is hole in back. Same dietary habits, high in carbs. No mosquito netting. Water from stream. No siblings. HIV negative.

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

Music by Ronald Jenkees

TWiP 178: The shadowlands of medicine

The Knights of the TWiP solve the case of the Man Who Lost Weight, and discuss a Plasmodium protein kinase that is a malarial drug target.

Dientamoeba fragilis
Dientamoeba fragilis

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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Case Study for TWiP 178

Eastern border of Uganda with Kenya, in mountains. Drinking water from nearby stream. Two young boys come to clinic, without parents. Sent in by grandmother because 1 yo brother has been passing worms. Long, white, flat. Shown photos in PD7, pinkish worm, 8 inches long, round. He points to those, what he has been seeing in brother’s stool. 1 year old seems small, protuberant abdomen; brother small for stated age, bit of protuberant belly. Diet: high carbohydrate, flour deep fried; yams; cabbage; some rice; soybeans; pumpkin; bananas.

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

Music by Ronald Jenkees

TWiP 177: A scabrous education

The TWiPsters solve the case of the Rashy Schoolteacher, and reveal a drug from rotifers that live on the snail intermediate host which paralyzes schistosome cercariae and prevents infection of mice.

Hosts: Vincent Racaniello, Dand Daniel Griffin

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Case Study for TWiP 177

49 yo man sent to Daniel for ID consultation. Reports in August visited Hawaii with family, then flies to CA. Family event there. Take him to Pakistani restaurant. One day later has gastrointestinal issues, nausea, diarrhea. Goes to urgent care, send stool for O&P. Look at stool, shows chilomastix mesnili. No medicines, will be ok. Over this period of 1 week he loses 15 pounds. Gains 5 back. End of October feels fine, no bloating or diarrhea. No symptoms but goes to gastroenterologist. Stool test returns with D. fragilis; and chilomastix mesnili. Now sees Daniel. Not on any meds. No allergies, no toxic habits, athletic. No illness in family. Normal exam. He ate salads in Hawaii.

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

Music by Ronald Jenkees

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.

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

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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Download TWiP #175 (66 MB .mp3, 108 minutes)
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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.

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

Music by Ronald Jenkees

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