James writes:

On the man was a tick from Nantucket, 
From his skin through its nose it could suck it, 
Babesia rings, 
Or Borrelia springs, 
He should have taken the time to pluck it! 

James M. Small, MD, PhD, FCAPAssociate Professor of Pathology and MicrobiologyClinical Career CounselorRocky Vista University

Case guesses:

Peter writes:

A chairde (uh KHAHR-dyuh) TWIP,

Listening to Daniels case study the Grateful Dead song “Fire on the Mountain” started playing in my mind. I believe the patient has Rocky Mountain Spotted Fever. The symptoms seem to align including low sodium. Although tick borne disease tests were negative, to quote columbia-lyme.org; “While a number of laboratory tests are available for Rocky Mountain spotted fever, none are both rapid and sensitive enough to provide useful diagnostic assistance to the examining physician”. I have won parasitic diseases 6th edition already.

On parasitc songs I know you are collecting evolutionary ones on TWEVO. I am not sure if mentioned on TWIP before but I love “Hookworm Blues” by Blind Blake that contains the line “hookworm in your body and your food don’t do you no good”, educating the masses on the link with anaemia since 1929.

Also it may be of interest to listeners to know that to celebrate his 90th Birthday Prof. William Campbell launched his new book “Catching the worm”. It is a fantastic memoir I would recommend to anyone interested in parasitology or to quote Prof. Campbell in “an inexhaustible garden of worms”. You can hear an interview to mark the launch here (https://youtu.be/Ia61RY5Ppuc). Lots of wisdom shared in the interview and I am sure the TWIP Professors will appreciate Prof. Campbell’s timely caution on preliminary studies of SARS-COV-2 and the need for controlled studies at around 17min.

Finally another of my parasitology heroes Prof. Celia Holland was interviewed in the journal tropical parasitology link here. Prof. Holland has not allowed the difficulty in securing funding for neglected diseases to prevent her pursuing a career that greatly advances our knowledge of Ascarididae. Instead her infectious passion for all things parasitology has meant she has constantly maintained a diverse active research group working on parasites of human, wild mammals, fish, livestock, invertebrates to name a few. To quote Prof. Campbell again “Prof. Holland also writes the books that help the rest of us to make sense of the oceans of information that these days engulf us”. I was lucky enough to be postdoc of Prof. Holland before taking up a lecturing position. 

Sláinte (slawn-che),

Peter Stuart

Institute of Technology, Tralee, Ireland

Schuyler writers:

Good morning TWiPsters,

It is a muggy 90F here in DC, which only makes social distancing easier if you ask me. Sorry I’ve missed the last two write-ins; I did listen to the podcasts but was preoccupied with moving into my parents’ house and then into my new apartment. I am now settled-in and eagerly awaiting my first year of medical school, which starts in August. Classes will be virtual for the first semester.

On to the case in episode 185.

I started with the New York Department of Health website. When Vincent mentioned that there’s a mosquito-borne infection going around I thought of EEE, but that’s a viral illness. The only other mosquito-borne outbreak in Long Island reported on the website is WNV, another virus. Was this comment by Vincent a red herring or just something not mentioned on the NY Dept of Health website? It did get me wondering though, what are the rarest cases you have personally diagnosed or treated? When shadowing doctors during college I saw a suspected case of acute sporadic CJD. It’s effects were devastating and left such an impression on me that I don’t think I’ll ever forget the patient. She had gone from walking and talking to wheelchair-bound and nearly mute over the course of a month.

Considering the sheltering in place, I limited my search to parasites endemic to Long Island. While Dr. Griffin mentions negative tests for erlichiosis, lyme, and anaplasmosis, he didn’t mention whether or not the patient was tested for babesiosis. Anemia + fever + Long Island + parasite makes me think babesiosis. I’m not sure if hyponatremia is common in cases of babesiosis but I’ll stick with my guess.

All the best,


Dan writes:

Hi TWiP,

I missed out on a guess last time, but I am back.

The symptoms, time of year and location seem to suggest that babesiosis is the most likely culprit. I’m not sure if it would have been included in the tick-borne diseases tested for. 

If I am right, and this actually is the case, treatment is with Atovaquone and Azithromycin. Interestingly enough, it seems that Atovaquone might inhibit SARS-CoV-2 in vitro and there is a clinical trial enrolling to use atovaquone/azithromycin in the treatment of Covid19. 

Happy summer! and if you’re outside in the Northeast US, be sure to check for ticks. 


James writes:

First as a pathologist I want to know, does this look like a consumption coagulopathy with schistocytes?

I looked around and found a few parasites associated with hemolytic anemia and/or hyponatremia.

Strongyloides is associated with SIADH, not so much with hemolysit. (SiADH seems to be what took my father away..)

Visceral Leishmaniasis can do this but unless global warming is REALLY advanced I doubt it in a New Yorker…travel history?

Babesia seems the most likely to me although I did not in a quick Google find Babesia with Hyponatremia.

And of course a drug reaction to her antibiotic!


James M. Small, MD, PhD, FCAPAssociate Professor of Pathology and MicrobiologyClinical Career CounselorRocky Vista University

Sophia writes:

Hello doctors!

hope you are enjoying your summer!

my guess for this case is : Babesiosis. First, because this is the time of year that Dr. Griffin presents such cases and second because I can’t think of anything else. 

I didn’t think that cough was a symptom but then I found a paper (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458703/) that did list this symptom, along with others to the point that it totally sounded like COVID-19 (” Complications include adult respiratory distress syndrome, pulmonary edema, disseminated intravascular coagulation…”). wow, I am glad this doctor didn’t just assume it’s another COVID case.  

Dr Griffin I have a lot of respect for you. The more I listen to you on twiv, the more it grows. I hope you do get to rest and vacation.

thank you for all you do. I’ve learned so much!

greetings from Greece


Wyatt writes:

Dear TWiPsters! 

My name is Wyatt, and I am writing today from sunny Wheaton, Illinois. We are sheltering in place, and I just downloaded your 7th edition Parasitic Diseases PDF, in preparation for beginning medical school with Loma Linda on July 29th. I was just leafing through it and getting excited for the upcoming year, and I thought, “Heck, why don’t I try for a hard copy?” I find myself drawn to infectious diseases, and wonder if that may be what I will pursue in school. I began listening to TWiP while delivering for Amazon this past spring after I had lost my normal job to the Corona virus. Your podcast made the delivery job much more enjoyable, and interesting, and hopefully no-one got a wrong package as a result… I believe that the offending parasite this week is a malaria, probably Plasmodium falciparum. The fever is an obvious symptom, but the rapid anemia, and low Na levels also hint to this parasite. I did want to ask why the Na levels are effected by malaria. The anemia makes sense, given the life cycle, but why hyponatremia? With global temperatures rising, many tropical diseases are traveling north. This is one of the reasons I am so interested in infectious diseases. Other thoughts that came to mind would be dengue fever, but this is viral, so not for this show! I also considered Ancylostoma Duodenale or N. americanus, because of the anemia, and that she has been gardening extensively. I do not think this is the case because of the high fever, and the rapid onset, but these would also cause rampant anemia. One other thought was Trypanasoma cruzi, however the fever would most likely have gone away more quickly? This is also primarily transmitted at night time, while sleeping in a house with a thatched roof. That was most likely not the case on Long Island.

Thanks again for all the insight and hours well spent this past spring,


Luke writes:

75 yo female, admitted with fever, body aches, cough, loose stool for 2 week, sodium 118: 

After some research on ‘UpToDate’, my guess is St Louis encephalitis, as long as we are keeping with the ‘viruses are parasites’ rhetoric…

There was a clue from Vincent suggesting a mosquito vector.

She’s negative for tick-borne diseases.

I think the low sodium is due to SIADH from an encephalitis.

I think S.L Encephalitis is the only arbovirus in the US that causes both an encephalitis and respiratory symptoms, as well as the GI symptoms. 



in Canberra, Australia

Owain writes:

Dear TWIP,

My guess for this week’s case is that this lady has babesiosis. I’m not entirely sure of my diagnosis as you said that tests for “other tick-borne diseases” such as Ehrlichia and Anaplasma were negative, but since Babesia wasn’t specifically mentioned I’m going to stick with it..! 

Given her lack of travel anywhere else, it must be something endemic to Long Island, which Babesia is reported to be. Her gardening likely gives her time to be exposed to the tick vector, and the vague symptoms (fever, body aches, mild cough, loose stools) as well as the more alarming blood picture of pancytopenia would fit. She’s also in a higher-risk group for more severe disease due to her age, which means she’s relatively immunosuppressed.

The only thing I couldn’t pin clearly on Babesia was the low sodium – is that just due to her being older and her homeostasis being upset by infection, or is this something more specific to babesiosis?

I also have to apologise for the confusion about my name last time! The pronunciation guide was intended to help, but I clearly made it too complex for my own good haha – “Owen” is fine!

I’m now working my way through TWIV and TWIM too – there are SO MANY hours of educational material to catch up on..! Thanks again for the great podcasts, and keep doing what you do!

Yours sincerely,


Andrew writes:

Kia ora from Pongaroa,

No book won yet. Who needs a book – not much time to read with all these TWIX Zoom-casts I am very happy to say. I get to see pets,  strategically placed books and what you all look like. 

I also see that I have been misspelling Dickson’s name – sorry.

Weather: – 13°C overcast with occasional rain

Covid-19: 77 days without community transmission in New Zealand. I would like to point out we had a huge advantage with our “team of 5 million”’s efforts to eliminate SARS-CoV-2. Dr. Siouxie Wiles, a microbiologist and science communicator. She heroically explained, in understandable terms, the developing science to the country on a daily basis during our lock-down and regularly since. Science educators rock!


The case of the lady gardener:

Ticks are excluded so I think we have to look at worms and of those I am forced to think of hookworms. I am assuming she picked up the critters ( a technical term according to Rich Condit) whilst gardening. With modern sanitation the chances of it being a human hookworm, like Necator americanus or Ancylostoma duodenale, are unlikely. I now have to think of an animal vector, probably a pet, that defecated in the garden. Under lock-down conditions animals would be able to roam more freely and people, bored with sheltering in place, might get out in the garden more. This would explain a recent rise in cases. 

Other considerations would be malaria bought by a mosquito stowing away on an international flights but there are almost no flights. Cryptosporidium maybe but there is no mention of a water habitat. 

So, I don’t like my diagnosis much and almost hope it is something else – I am still in for the book draw even if I am wrong.

Ngā mihi,


Elise writes:

Dear TWiP Trifecta, 

Greetings from a semi-abandoned Lower Manhattan where it is 91 degrees F (32.7 degrees C). As always, I need to tell you how very grateful I am to all of you for your work, your interest, your energy. All of your podcasts are so inspiring and engaging. There are days when things feel very hard and I find myself re-listening to the recent episodes of TWiP and TWiV that most challenged me (as a non-scientist) and I hope I’m learning and progressing. 

After failing in last month’s diagnosis, I’m seeking redemption with the Long Island gardener. I suspect she may have Babesiosis. During this period of “sheltering in” she has been gardening, which has kept her safely distant from other people and much less at risk for being exposed to COVID-19, but the hobby has made her much more available to interactions with local fauna in the form of ticks. Several varieties of tick prevalent on Long Island (some of which are rather new to the region, having crept up from the South) can transmit many pathogens simultaneously. Among the greatest hits of diseases spread by ticks on Long Island are: Lyme Disease , Babesiosis, Anaplasmosis and Borrelia miyamotoi. Most of those diseases are caused by bacterial infections spread by tick bites, but Babesiosis is a piroplasm (also spread by tick bites).

While many people can be infected with babesia microti and have no symptoms at all, the patient is in an age group that typically does have a greater chance for suffering from the cascade of malaria-esque symptoms brought on by Babesiosis. While her fever, flu-like symptoms and GI issues are common to many infections, the blood work results revealing hyponatremia, very low white blood cell, platelet and hematocrit counts all suggest hemolytic anemia for which babesiosis causes. 

I do hope the patient responds to treatment because this seems like such an insult in what are already difficult and worrisome circumstances. I hope she is undaunted and keeps up with her gardening. I attempted some apartment sunflower planting in this period and have not exactly had wild success… I actually suspect a parasite. 

Huge thanks and many best wishes to all of you. Your work is so important and your presence means the world to me. 

Best, best

in Lower Manhattan

Jody writes:

Dear Vincent, Daniel, and Dickson,

Hello from sunny Seattle, where 9/10 people (in my neighborhood anyway) are wearing masks on the street and 10/10 in all indoor spaces, and where only the very occasional individual reaches up and pulls the mask off of a store manager to spit in their face when they are told they cannot enter without wearing one. Today my family and I visited a free drive-through testing site run by our local fire department; everyone was friendly, funny, and professional, and my 7-year-old daughter (a budding virologist) braved her “booger swab” while squeezing her beloved stuffed tardigrade. It was set up in the old emissions testing site and my husband and I agreed that our brain biopsies (I think it was Ori Lieberman who used this phrase) were much more pleasant than any emissions test we ever found ourselves forced to endure there, despite the fact that I experienced a taste of adrenaline shakes on the second nostril. We were in and out in 9 minutes. 

Thank you so much for being my constant companions not just during this pandemic, but for the last six years. I have been lurking quietly until 2020, when I finally broke the seal and wrote to TWiV a few times. All of you TWiXers have played a great role in inspiring me to go back to school to study infectious disease after a 20-year career in graphic design, and in inspiring my daughter to want to become a virologist. They’re not eukaryotic parasites, but I thought you might get a kick out of seeing the bacterium stuffed animal and virus model she made a few months back (attached). 

So…onto the 75-year-old woman from Long Island, who has been gardening up a storm while sheltering in place during the pandemic. Although her exam was unremarkable and she doesn’t look ill, her complaints consist of fever, body aches, cough, and loose stools. Despite having normal blood work 3 weeks previous, the most recent tests showed decreased white blood cells, low hematocrit level, low sodium, and very low platelets. 

Despite Vincent teasing us with a question about mosquitoes right at the end there, my first thought was tick-borne diseases; here in the Puget Sound we are blissfully ignorant of just about all tick-borne diseases but I have read that a number of them are on the rise in the NE thanks to climate change and humans disrupting the landscape and fragmenting forest, creating the edge habitats that small rodents, deer, and the ticks that feed and breed on them love. 

I admit I quickly came up with a diagnosis, but will run through all the others I discarded. Many of the pathogens spread by ticks are bacterial: Anaplasmosis, TBRF, RMSF, Tularemia, and likely STARI. Others are viral: CTF, Bourbon virus, Heartland virus, and Powassan virus. Mosquito-borne infections include EEE (quite rare, only 6 reported cases in the US in 2018), WNV (again, a virus), and malaria, which I am not aware of being locally acquired currently in NY. Toxoplasmosis came to mind due to the time spent in the garden, but it seems unlikely that initial infection for a gardener would occur this late in life, and most people who become infected do not suffer the acute onset of signs and symptoms she is experiencing. 

Which leads me to Babesiosis, or “Long Island Malaria.” Daniel mentioned that he has been seeing about one of these cases per week, and according to the CDC website New York state has been seeing cases rise slowly but steadily, with 696 documented cases of Babesiosis in 2017. Babesiosis is caused by an infection with a wee parasite called Babesia microti, and is spread through the bite of infected blacklegged ticks, or Ixodes scapularis, the same tick that carries Lyme and anaplasmosis. Nymphs are only the size of a poppyseed, and in the NE US they are most active in the spring and early summer months, just the time of year when people are gardening and recreating outside! 

Diagnosis is usually done by examining blood specimens under a microscope and seeing Babesia parasites in blood cells. I am not a medical doctor, but if I were the closest thing to one in a small village and someone came to me for help, I would do my best to lay hands on a 7-10 day dose of Atovaquone + Azithromycin or a cocktail of Clindamycin + Quinine.

When returning to her garden, this patient may want to consider wearing permethrin-infused clothing, or spritzing her own clothing with the bottled stuff, which is apparently the synthetic form of a compound found in chrysanthemums which can cause paralysis and death in ticks and mites. She should also begin a habit of doing daily full body checks (including all her nooks and crannies, with the help of a good friend or a hand mirror), and could take a shower and throw all her clothes in the dryer on high heat when she comes inside to kill any nymphs still hanging on to the fabric. 

Crossing my fingers on winning a signed copy of the book, but if not I’ll write in again, and will aim to be more succinct!

Thanks for all you do — I hope you are all getting enough sleep and finding time to get outside. 

Vincent — get some exercise!


Carol writes:

Hello gentlemen–I am so happy to have found your podcast and have been enjoying the episodes very much! I would like to contribute an answer to the case study for TWiP 185. It appears that this lovely 75 years old lady may have babesiosis, caused by Babesia microti. I made my decision based on her lab results, home location (Long Island is endemic) and penchant for gardening (where ticks reside, especially in the spring and summer months). In my work as a medical laboratory technologist and current assistant professor at a local community college, I have identified this parasite and taught students both microbiology and hematology, where they learn to identify this organism and the related blood/clinical picture. It is always a challenge to the students to find the tetrads/ Maltese crosses of the intracellular parasitic ring forms in a blood smear. We learn to distinguish it from the Plasmodium ring forms of malaria based on morphology and patient case history. Interestingly, this patient appears to have pancytopenia which is a known consequence of infection with this organism, due to the hemolytic process and the probable sequestering of platelets in the spleen. Did the patient have purpura? Did they have splenomegaly? I’d love to know! The leukopenia was also unexpected for an infection (we normally see this as elevated, especially with microbes) but I suspect that there is an absolute lymphopenia and neutropenia noted on the CBC, but not given here. Resources are not clear on exact causes of neutropenia, from what I have read. I was initially confused by the hyponatremia and thought that maybe the cholesterol-lowering meds she was on was causing it, or the diarrheal stools she had been experiencing for 2 weeks (most likely) and probably not related to the babesiosis. After some research, I found that low sodium is often found as a consequence of Lyme disease (of which she was negative) and could be used as a primary indicator for diagnosis in endemic areas. This was not something I was previously aware of and will be sure to pass on to my future students! Keep up the great podcasts and I hope to be answering again soon.


Viki writes:

Dearest Twipers:

It’s a lovely 66 degrees F, 19 degrees C in Duluth MN, home of Trampled by Turtles. The weather has turned! It had been hot and humid, something we can’t bear.

It is a beautiful sunny afternoon here in Duluth MN,  81 degrees F, 27 degrees C and breezy.

I don’t have any formal training, but general knowledge says this must be hookworm. The gardener could have been infected whilst engaged in her hobby, and her symptoms would be cough and diarrhea. 

This Podcast Will Kill You has an informative and fun episode–“Opening a Can of Hookworms”, episode 23.

Devotedly yours,


I love all the microbe tv shows and am an avid listener. I first learned about twiv from This Podcast Will Kill You, and am grateful. Go two Erins!!! I’m waiting for my copy of the textbook for Virology 101 to arrive. I’m going to get educated!


Viki MBA, MA and MFA candidate


My daughters’ half brother is a PHD candidate at Tufts where he’s studying viruses. ( He (Andrew Whittier Day) got published in Lancet when he was working at a lab in Austin MN, at Hormel I think). He tested positive for covid 19 March 19, self quarantined , and donated plasma. Also he recommended twiv and said “It’s Vincent Raconello!”


Daniel writes: <=winner

Hi all,

Daniel here with a quick guess for the case study (Italy 34oC)

I know you said the woman was tested for tick diseases but I’m going with Babesiosis.

Thanks for the great show,


Kevin writes:

Case Study for TWiP 185

An elderly gardener. Feeling poorly for 2 weeks. Admitted to hospital with hyponatremia. A collision of geography, advanced age, exposure, signs and symptoms. TWiP case discussed on episode 176 (October 09, 2019) hovers in the background. Suffolk County New York is tick country. Many tick varieties live here and a high percentage of the nymphs carry a potpourri of pathogens transmissible to humans. Patient’s acute anemia is suspicious for hemolytic anemia since there is no history of blood loss. The low platelets also point in the direction of our culprit. Low sodium too. Hyponatremia (the most common electrolyte abnormality seen in clinical practice) is a big and confusing topic. Relevant here is the fact that hyponatremia is seen in malaria and is attributed to the syndrome of inappropriate ADH secretion. Malaria is a cousin to this patient’s parasite. In fact, according to the website Longisland.com, babesiosis is known as “Long Island malaria.” Digression from PD7: babesia had to wait until 1957 to be described as a human pathogen, and in the late 60s was known as ‘Nantucket fever’. Remember the days when diseases were named after locations? Long Island ticks are a veritable Air BnB of pathogens and a single tick may harbor babesia, borrelia and anaplasma. The Island’s various tick borne maladies include Lyme disease, ehrlichiosis, rocky mountain spotted fever and Powassan virus. Adding to Long Island’s woes is the lone star tick associated alpha-gal allergy, where a few of the bitten are stricken with an allergy to red-meat; perhaps a health benefit in disguise? Certainly a relief to ruminants.

Suffolk county, where our patient lives, has the highest rate of babesia infection rate in New York State. There were 163 reported cases there in 2016. Our patient has tick exposure risk due to her backyard bushwacking. She is at risk for more severe disease due to age over 50 years (other risks for severe disease: asplenia, immunosuppression, various other comorbidities). Preferred diagnostic test is blood smear examination but if parasitemia is low, molecular testing is needed. It is unclear why the patient’s tick borne disease panel did not pick up babesia since the standard panels usually include it. A brief differential diagnosis (within the infectious realm): malaria, anaplasmosis, Lyme disease, ehrlichosis, Powassan virus, RMSF, leptospirosis. Our focus on pathology and illness however, shouldn’t overlook the fact that the majority of babesia infections are asymptomatic. Treatment for our patient: Atovaquone+azithromycin; OR Clindamycin+quinine (for severe cases). Prevention of tick bites discussed below in ‘A Terminal Curiosity.’

Thank you for not rationing rationality. 


Gray EB, Herwaldt BL. Babesiosis Surveillance — United States, 2011-2015. MMWR Surveill Summ 2019;68:1-11

2,074 babesia cases USA in 2015, 94% from 5 NE states, case surveill…2/3 had thrombocytopenia


Long Island is the epicenter of tick borne diseases, and Babesiosis, caused by the parasite Babesia microti, is the most common parasitic disease in this region. Suffolk County reports every year the highest absolute number of Babesia cases in NY state, with 153 in 2016 (1). At SBUH, we have observed an steady increase in the number of hospitalized cases per year with babesiosis from 1 in 2008 to 16 in 2014 .  


The real surprise was the high prevalence of B. microti, the causative agent of babesiosis. B. microti was present in 17% of nymphs and 30% of adults in Suffolk County, which reported 197 babesiosis cases in 2014.

Holst FG, Hemmer CJ, Kern P, Dietrich M. Inappropriate secretion of antidiuretic hormone and hyponatremia in severe falciparum malaria. Am J Trop Med Hyg. 1994;50(5):602-607. doi:10.4269/ajtmh.1994.50.602

Narurkar R, Mamorska-Dyga A, Nelson JC, Liu D. Autoimmune hemolytic anemia associated with babesiosis. Biomark Res. 2017;5:14. Published 2017 Apr 8. doi:10.1186/s40364-017-0095-6

Babesiosis is endemic in selected areas in North America. Babesia infection is commonly associated with anemia, thrombocytopenia, hyponatremia and elevated liver enzymes. 

Kletsova EA, Spitzer ED, Fries BC, Marcos LA. Babesiosis in Long Island: review of 62 cases focusing on treatment with azithromycin and atovaquone. Ann Clin Microbiol Antimicrob. 2017;16(1):26. Published 2017 Apr 11. doi:10.1186/s12941-017-0198-9

Akel T, Mobarakai N. Hematologic manifestations of babesiosis. Ann Clin Microbiol Antimicrob. 2017;16(1):6. Published 2017 Feb 15. doi:10.1186/s12941-017-0179-z

Quest Diagnostics: Tick borne disease panel (Real-Time Polymerase Chain Reaction)

  • Anaplasma Phagocytophilum DNA, Qualitative Real-Time PCR
  • Babesia microti DNA, Real-Time PCR
  • Borrelia miyamotoi DNA, Real-Time PCR, Miscellaneous
  • Ehrlichia chaffeensis DNA, Real-Time PCR
  • Lyme Disease (Borrelia spp) DNA, Qualitative, Real-Time PCR, Blood


RE: alpha-gal allergy to red meat.

Long Islanders beware: A bite from the Lone Star tick can make you sick 




blood supply now being tested for babesia. This is a very recent (2019) development.

DONATED BLOOD–List of diseases screened:

Babesiosis (donations screened in high endemicity regions)

Chagas Disease

CJD and vCJD

CMV (some donations)

Hemoglobin Screening/Iron Management






West Nile Virus

Zika Virus 


ProMED-mail (07/27/20)

Archive Number: 20200726.7613880

Return of trench fever in Denver CO. Affecting homeless people with body lice.


Babesia is named after—>

Victor Babeş 1854-1926  Romanian. PhD in Vienna. Worked with Virchow, Koch, Pasteur and Cornil. (Incidentally, of relevance to certain polio researchers, Victor André Cornil († 1908) worked on poliomyelitis [Über Poliomyelitis anterior, 1877] and histologically confirmed Duchenne’s hypothesis regarding this disease). Babès worked on Texas fever (cattle babesiosis). PD7 has a concise history of Babeş in Chapter 14. 



Stay cool and ectoparasite free with these fashionable insect impervious garments. You’ll be the envy of the garden club. 

Andrea writes:

Hi TWiPpers, 

I am a new listener to TWiP podcast though a long time listener of TWiM, just can’t get enough of your podcasts these days! It is currently 16C and cloudy near Vancouver, BC. I am also enjoying the Virology lectures though much of it is beyond my ability, I love to try and learn.

After listening to TWiP 182, I would like to share an apartment experience with the notorious bedbug and it’s eradication without use of serious chemicals (the kind that might make you sick). I suffered bites of “breakfast, lunch and dinner” as described which were horribly itchy and painful. I was horrified that we had bedbugs but did not want to go the pesticide route or relocate as rental apartments are few and far between and you can end up with far worse. Later, after much laundry washing plus a very worthwhile investment in a mattress cover, the odd bedbug was still crawling out of woodwork or duct work and we received unwelcome visits from these tourists in the bed. Eternal vigilance is required!

After internet research and use of diatomaceous earth as a mechanical insecticide along possible bb routes we came upon the use of Borax which we added in a paste around the bed frame. We also used Borax with laundry detergent (both hot wash and added in final rinse). It did the trick. Though it took some months to knock the population down we were encouraged by the way the pests were weakened and unable to escape us when we changed bedding and did a “hunt”. Apparently the Borax and diatomaceous earth combo got under their chitinous “skins” and virtually exploded them in a satisfactory but messy manner. 

I was surprised that nobody else has suggested this method because it cannot be original with the long history that humans have with these infestations. Dryer heat may work but the laundry room of a building with infestations is not the place to try that method. I have heard that there are dogs who can be trained to scent out their hiding places but I hadn’t noticed odour. I suspect a smell would be from remains of their blood meal. I really liked the idea of black plastic bags of clothing and heating in the sun. Somehow I don’t think the climate of BC would be cooperative.

Thanks for your wonderful podcasts. We’d welcome you into our home, but you might hesitate after hearing about my less welcome visitors. 


Ati writes:

Dear twipers,

In my last email on TWIV, you wondered whether I was ‘he’ or ‘she’. I can reassure you that I am definitely ‘he’. 

Before I had enough of TWIV, I discovered TWIP while I was reading about Dickson on his Wikipedia page. Although initially I was disappointed that I didn’t discover your podcast much earlier, now I feel that I am over compensated because I don’t have to wait for another episode to be released (I can listen to as many episodes as I wish per day!!). I am still in the beginning of the episodes. 

I am originally from Ethiopia and in my early career as a young doctor, I was involved in management of patients with oncocerciasis in rural part of the country and was later briefly involved in African Programme for Oncocerciasis Control (APOC) mission for mapping of the disease. In clinic, to diagnose the disease, we used to give patients single low dose of Diethylcarbamazine (DEC) and bring them back the next day. If the intensity of itching was worse, we considered this as a confirmatory test for oncoceriasis and we gave them the full course of DEC (Ivermectin was not available in our center yet). I used to feel sorry for the patients (especially the kids) for enduring the itching. I now know that this is called the  Mazotti reaction and happens due to reaction as a result of death of the microfilariae. I must admit that I didn’t have in-depth understanding of parasites in general at the time. Now it is all making sense, thanks to your brilliant and wonderful podcast. You guys are fantastic! 

P.S. Dickson is such a wonderful conversant and historian, he makes the episodes look like a Netflix series. 


Ati Ferede

Dr A. Ferede, MD, MPH, FRCS 

Organ Transplant Surgeon

National Kidney Transplant Service (NKTS)

Beaumont Hospital, Dublin


Anthony writes:

Greetings Twiphozoites!

I just wanted to thank you all for the podcasts! As somebody who is self taught in biochemistry (do not ask how that happened!) and who has a colleague who is heading down the same path, your easily absorbed podcasts and Vincent’s virology lecture 2019 series on YouTube have greatly helped me and her along our rather unconventional paths! (We both have a home PCR kit we use to analyze non-pathogenic macro-fungi where we live!)

I will not have a guess at the case in TWIP 181 as I am rather bad with ecto-parasites and am rather more interested in pathogenic fungi and fungus-like-organisms (think such fascinating horrors as Balamuthia mandrillaris) but I am partly writing in to share with you a recently discovered worm that mimics the symptoms of primary amoebic meningoencephalitis to a T but is even more rare and deadly than the mentioned flagellate! (the worm was briefly mentioned in a letter in TWIP 132 I believe) it is known as Halicephalobus gingivalis and is sometimes a lethal pest of livestock but human infections mimic PAM and there have been no reported survivors unlike with PAM – I am wondering if Dr. Griffin has ever learned about it! It appears resistant to the bendazole class of drugs!!!!!

Once again I thank you all for the work you do and hope to hear more stories from Dickson about fish parasites as they are very very interesting!