TWiP 103 letters

Case guesses:

Dr. Wink writes:

Going for a Personal Record of two right guesses in a row, I have to go for paragonamiasis causing hemoptysis and a lung cavity. Thanks, as always, to Daniel for clinical acumen and content; Vincent for his insights that cover all of biology; and Dixon for his experience, perspective and graciousness.

Wink Weinberg, Atlanta

Carol writes:

Lungworms (Strongyloides)

Carol

Ruben writes:

Dear TWIP-scholars,

I am neither a biologist nor an MD, but here is my uneducated, or shall I say, twip-educated guess.

First, eosinophilia just tells us that it is a parasitic infection, so we need to rely on something else.

Second, with the coughing-up-blood (aka hemoptysis) manifestation persisting for a long time the young lady could have had one of the following.

Ascaris lumbricoides:

 Pros: (1) extremely common; (2) penumothorax/air pockets; fever;

 Cons: (1) the pulmonary effects disappear after a few weeks.

       (2) after 2-3 months eggs are present in the stool (i thought stool was clean).

Paragonimiasis,

 Pros: (1) common in East Asia, (2) infection may persist for years;

 Cons: not sure about the lung manifestation.

Hydatiosis caused by tapeworms of the Echinococcus type

 Pros: common ; leads to  a single of multiple lung cysts;

 Cons: (1) cystic form starts with liver  , – no symptoms;

       (2) alveolar echinococcosis is rarely diagnosed in humans.

       (3) usually no fever is reported

Dirofilariasis

 Pros:   dogs everywhere,

 Contra: coin lesions, not sure the coin lesion is an air pocket; (2) unlikely for India.

Even though I gravitate to the ascaris diagnosis based on Daniel’s ‘air pocket’ hint, and ignore his ‘dogs everywhere’, – I have to say that this judgement is beyond the resolution of my mental microscope.

Love your podcast above all other podcasts.

Best regards from La Jolla,

Ruben