Case guesses:

Wink writes:

Dear TWIP Professors,

I think the young Peace Corps worker in Fiji has amebiasis. He might have acquired it sexually or by ingestion. He might be diagnosed by EIA or PCR and should initially receive metronidazole. 8 cm is fairly large and aspiration should at least be considered.

By the way, thanks for answering my question on disseminated strongyloidiasis. If you don’t mind, I have one more part to that question. Would the filariform larvae in someone with the autoinfection cycle be immediately infectious if they found their way to the soil? I am wondering if this was a reproductive advantage to the worm, before coffins and embalming. Perhaps the superinfection syndrome has evolved because of that advantage.

Wink Weinberg


Dan writes:

Dear TWiPsters

I think that the Peace Corps volunteer in Fiji with fever, headache, diarrhea and RUQ pain has an amebic liver abscess. Differential diagnosis would include arboviral infection, biliary sepsis, pyogenic abscess, leptospirosis or acute viral hepatitis. The findings of tender hepatomegaly, raised WBCs, eosinopenia, a modest rise in liver enzymes and the scan appearance are all consistent with hepatic amebiasis. Diaphragmatic irritation can cause a cough.

Positive serology for E. histolytica would support the diagnosis. Cysts may be found in the stool. Treatment is with metronidazole or tinidazole, followed by a luminal amebicide to kill any intestinal cysts and prevent transmission. Aspiration of abscess fluid can confirm the diagnosis but isn’t always necessary.

Although he’s been drinking unfiltered water, he may have acquired this parasite sexually. MSM are a higher-risk group. Apparently Kava has an aphrodisiac dis-inhibitory effect.  

(The reference to kava confused me at first – I thought he was drinking the Spanish sparkling wine Cava)

Stay parasitic!


Dan writes:

Dear TWiPanosomes

After Dickson’s comments on TWiP 126, I’m looking forward to hearing his take on the parasitology superhero Sir Ronald Ross.

Many years ago I studied at the Liverpool School of Tropical Medicine, where Ross was celebrated as their first professor of tropical medicine, the first British Nobel laureate, and a talented polymath. When the University of Liverpool opened an institute of infection and global health in 2010, they named the building after him.  

It was only after reading Spielman and D’Antonio’s book Mosquito: The Story of Man’s Deadliest Foe and hearing Robert Gwadz on TWiP #28, that I realised that this fascinating character had more of a ‘mixed’ reputation globally.

Best regards


Caleb writes:

Greetings Doctors:

As always I would like to thank you for your wonderful array of podcasts! I look forward every week to listening to new and informative content.

I have two reasons behind my email today.

First off:

I am current the TA of our Medical and Veterinary Entomology course taught to undergraduates here at the University of California Riverside and have been given the privilege of giving two guest lectures to the undergraduate students. I wanted to thank you for the easy access to the pdf of 6th Edition of Parasitic Diseases which gave me a great starting point in developing my lecture on Chagas Disease. I made sure in my lecture to include a link to parasites without borders so any of my students could access your book at will!

Second off:

I heard on the latest episode of TWiV that your entomology contact backed out of producing a podcast on insects. I have a friend and collaborator at the University of Nebraska-Lincoln who is an extension entomologist, who already has an entomology podcast called Arthro-Pod. You might want to get in touch with him about collaborating on a new entomology podcast.

Attached is his contact information:

Johnathan Larson


Caleb Hubbard  

Ph.D. Student: Medical and Veterinary Entomology

University of California, Riverside

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