TWiP 149: Stranger in a strange land

March 22, 2018

Derivation of R0Shivang joins the TWiP triumvirate to solve the case of the New Yorker With Rash and Pins and Needles, and reveal how agrochemicals increase risk of human schistosomiasis by causing high snail density.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

Guest: Shivang Shah

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Download TWiP #149 (55 MB .mp3, 89 minutes)
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Case Study for TWiP 149

31 yo man ulcer on let, 4 cm diameter. Raised borders, reddish and hard. Feels well, concerned not resolving. Started as bump, slowly enlarged, ulcerated, 1 month now. Healthy, no prior med, diabetes in mom. Works in field with machete, lives with family, social drinking, smoking. Lives in isolated villages on Northern Panama archepelago, many animals and insects. Homes are raised, slats on floor. No fever, normal bp hr, breathing low teens. Healthy athletic young man, otherwise good health except for ulcer on left leg. Non tender, no pain, base of ulcer red; no purulent material, borders raised but not undermined. Feels hard around edge, no scab. Did dermoscopic exam: erythema, small yellowish teardrops, small white starbursts.

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Music by Ronald Jenkees

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One comment on “TWiP 149: Stranger in a strange land

  1. Jean Buckley Apr 1, 2018

    I am a Physician Assistant and graduate of the Bangkok school of tropical medicine. I used to practice on the small Hawaiian Island of Lana’i. I now live in “exotic Central Wisconsin” but am lucky enough to still have a place in Lana’i City. About 3 years ago I first started noticing the large African snails in my garden. I was aware that they were a vector of A. Cantonensis, as are many Hawaiian residents. I write because I have been advised by the locals to “just smash ’em”. I am concerned because this merely perpetuates the life cycle, when the rats eat the smashed snails. I have been dropping the snails in a bleach solution which I assume kills the worms. Please spread the word, “don’t smash ’em, bleach ’em”. Thanks, and “I’ll pass on the salad”.