Case guesses:

Iosif writes:

Dear Twip Team,

One thing that I want to mention is that we are taught in our medical school that we should always ask our patients what they think is causing their problem. I do ask my patients occasionally, but the most common answer I get is either “I don’t know” or “Isn’t that why you are here?”.I find this question to be really helpful for another reason; allaying a patient’s fears. I commonly get a response that they are concerned their malady is a cancer or another diagnosis with significant morbidity, and being able to calm a patient down with an explanation of what may be going on is an amazing way of promoting the doctor patient relationship.

For the case today,

My guess would be malaria. To be more specific I would say it’s probably Plasmodium Vivax since her fever seems to be occurring every other day . You should ask the patient if she could pose for a textbook since she fits the case so well. Splenomegaly, anemia, thrombocytopenia, headache and fever all point to malaria. I would assume that since she has had malaria before, she would be able to say if it feels similar to that event if she were to be asked. I would get a peripheral blood smear to confirm. I would not get an ova & parasites or an Original Video Animation 🙂

I would treat with chloroquine, but if the patient does not get better within 3 days (or I find out that the strain is resistant) then I would use artemesinin combination therapy.


Iosif Davidov

Wink writes:

I think our traveler to Africa with periodic fever is infected with Spirillum minus and has rat-bite, relapsing fever. This is based on clues Daniel hinted. On further reflection, this show is TWIP, not TWIM, so I’m going to say malaria. But Daniel likes to keep us guessing, so I’ll go back to the bacteria, S. minus. But maybe he’s throwing a curveball that’s still a parasite, so I’ll say P. malariae or P. ovale. After further thought, I’m finally settling on a forme fruste of ebola!

Wink Weinberg

Adam writes:

Dear TWIPinella,

I started listening a couple of months ago after a friend recommended TWIP and am now finally up-to-date. Firstly, I shall address the case study. My guess is malaria, either P. ovale or falciparum, given the time between fevers and their co-endemicity in Guinea. Perhaps the former species if the lady does not feel like she is dying.

Admittedly, diagnostics is not my strong point as I work more on the molecular side of parasitology. I became interested in parasites after learning about Guinea worm in secondary school (in Geography lessons surprisingly). After studying biochemistry at the University of York (with a stint at the University of Valencia) and learning more about NTDs, I am now working on my PhD at Queen’s University Belfast under the guidance of Mark Robinson (one of the co-authors of the NOD paper from TWIP 82). My research focuses on the extracellular vesicles of helminths and how they are made by the parasite, work that I am very much enjoying despite discovering the less glamourous side of parasitology during abattoir visits (that’s if a glamourous one exists). I wouldn’t want to blow my lab’s own trumpet and I am yet to publish myself, but there is currently a lot of interesting work going on around the extracellular vesicles of both helminths and protozoa. Perhaps I could recommend the following paper for discussion on TWIP on the extracellular vesicles of Trypanosoma brucei (entitled: Extracellular vesicles from Trypanosoma brucei mediate virulence factor transfer and cause host anaemia), if anything just because it has nice videos.

Extracellular Vesicles from Trypanosoma brucei Mediate …

Extracellular Vesicles from Trypanosoma brucei Mediate Virulence Factor Transfer and Cause Host Anemia

Also, I have a question. Among Dickson’s many repeated anecdotes and nougats of information, an association between helminth infections (possibly Ascaris lumbricoides) and Clostridium difficile has been mentioned at least twice. Would he be able to provide a source of information on this? It interests a friend who studies C. diff but we have been unable to find anything in the literature bar a mention in pigs. Additionally, Dickson mentioned the chiclero ulcer (leishmania) from rubber tappers in Latin America. I would like to add that I remember being told in lectures about shifts in society causing the chiclero ulcer to now also be associated with (human) drug mules who venture into the depths of the jungle to avoid detection whilst smuggling.

I really appreciate all the time the three of you have put in, primarily in combating polio and NTDs but also in producing TWIP.

Sometimes when looking out over a grey Belfast on a particularly miserable day whilst listening to your podcast, I think ‘at least I don’t have…’

Many thanks,

Adam Bennett

PhD Student

School of Biological Sciences

Medical Biology Centre

Queen’s University Belfast


Alex writes:

Hello Vincent, Dickson and Daniel,

I’m significantly behind on TWiP, so I can’t comment on any of the recent case studies, but I have a good excuse that you are all complicit in. Let me explain.

I majored in evolution and ecology in 2004 from UC Davis, which included a parasitology course that was one of my favorite classes. I rediscovered my love of parasites about three years ago, and shortly thereafter found TWiP. You three helped me relearn the life cycles and non-infectiously exposed me to new parasites. The podcast helped motivate me to apply for graduate school. To make a long story short, I’m now a new Ph.D. student in the new disease ecology program in the Odum School of Ecology, at the University of Georgia. I was extremely busy applying for grad school and now I’m extremely busy being a grad student, hence the falling behind, but it brings me joy that I’m in an environment where I can talk about parasites to people without any discomforting looks. I’m taking their new disease course, which has included fascinating lectures on placental malaria and resistance to anthelmintics. Of course, being a grad student has also been very stressful, but at the same time I’ve been happier. I’m hoping to do work on wildlife helminths in community ecology, but research topics are open right now, of course. I have many people to thank, but TWiP played no small role, so thank you.

I’ve attached a photo of the shelf above my grad school desk, which I’m sure Dickson will appreciate.

Alex Lee


Anthony writes:

Professor Despommier noted that the snail vectors of liver flukes are not native to the US.  Are any of these invasive species in Florida?  Are these Asian snails imported for aquariums or do they live on plants brought in for the pet trade?  If so, then the tropical snails — and their parasites — are very likely crawling about in Florida waters.  

Have manatees been checked for exotic parasites?


Star writes: 

Thank you for your podcast!

Although the info about not getting rid of them makes me sad!

I am a mother of three.  My infant son, my middle child and I all have them.  I’ve treated my 11 year old although she has never shown signs.

So there is nothing I can do to get rid of them????  How did the wife manage them?

Your a little quip or dismissive about having them… that is likely because you don’t!

The itching, sleep disruption and irritability drives you crazy!!

Any suggestions are welcomed!

Kind Regards,


Wink writes:

Dear TWIP Professors:

Here’s a weird one…If you have the time, I’d love to here if you have any hypotheses on the mechanism.

Plasmodium Parasitemia Associated With Increased Survival in Ebola Virus–Infected Patients

Clin Infect Dis. (2016) 63 (8): 1026-1033.

In a cohort of Ebola virus–infected patients from Monrovia, Liberia, we found that patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age.

Wink Weinberg

Leave a Reply

Your email address will not be published. Required fields are marked *

One comment on “TWiP 118 letters