Ingrid writes:

Dear TWIP team,

I really appreciated how Christina’s case study for #199 had the kind of difficulties of diagnosis (red herrings, testing problems etc) that are probably common in real-life clinical practice. That was great, and had the side benefit that only a modicum of brave souls sent in guesses and they all included interesting thought processes behind their guesses, not just pat scrapings off a google search.

I love TWIP including the write-ins but sometimes get a teeny bit tired of listening if there are huge numbers of them every time, esp if most of them are the same. Fewer guesses left enough time for a paper! I had caught the news earlier about this first ever successful Malaria vaccine and was hoping to hear the TWIP team’s reaction, thanks for covering it.

Thanks for all the fun cases, information and friendly discussions on TWiP, TWiV, TWEVO et al.

-Ingrid, Berkeley CA

(BIG RAIN all day today!!!! first big rain day that I can remember in two years, like the ‘old days’ standard and frequent fall-winter rain that I remember from the 60’s into the 80’s. I’m guessing this is the official end of this year’s fire season, and crossing fingers for enough more rain this winter/spring to ease our drought).

P.S. Vincent, I really like the new two-color background on the wall behind you in the Incubator! Big improvement on the plain white, and the colors are subtle not overpowering, just right.

Andrew writes:

Kia ora from Pongaroa,

Book won Yay!!! but I am still case guessing – I am addicted now and looking forward to seeing who wins a book on TWiP 200.

I have an idea for the book signing event. Make a film and call it “The Signing.” You can work out among yourselves who plays the Jack Nicholson part and who has to explain to Amy why there is axe-damage to the Incubator door.

On with the case of the gentleman who gets repeated cases of intestinal issues. My thinking is that he has what was erroneously called “Gay bowel syndrome.” It is basically cause a larger than normal dose of infectious matter that is passed during sexual activity. The dose is large enough to overrun the immune defences so that an acute infection, that normally would be quickly dealt with, becomes symptomatic until the body has a chance to ramp up and clear the pathogen. The sort of activity required is not restricted to gay sex and I imagine that practising safe sex would prevent future problems.


Martha writes:

Dear TWiP

I will be brief. I just got the heads up at the online virology course that a new TWiP was coming up. Of course I am still sending guesses although I won a book a few episodes back.

The case of the man with the complaint of recurrent abdominal discomfort. No other complaints. Treated for Giardia in the past. Treated now with Metronidazole with no resolution. His exam was otherwise normal. Labs only significant for Blastocystis and Endolimax nana.

At some point it was held to be true that Blastocystis was not a pathogen and did not cause symptoms in immunocompetent persons. But it seems some immunocompetent persons  do have symptoms. It also appears that there are some Blastocystis that are resistant to Metronidazole. So perhaps a course of the alternative treatment: Paromomycin.

Wishing you all the best