Alice writes:

Hello from a small cabin in the Chequamegon-Nicolet National Forest in northern WI. Today is a windy day with thunderstorms approaching slowly.

I recently became a fan of TWIP from a suggestion from a colleague and now thoroughly enjoy expending my parasite knowledge during my long runs.

This is my first entry and attempt. I learnt that loyal listening can give you clues and your recent guest discussed what I suspect is the diagnosis at length. I still have yet to watch Accidental Host.

I am not a long winded person, therefore I will simply say that I think this unfortunate host has Angiostrongylus cantonensis known as rat lung worm.  This is my leading diagnosis given the patients epidemiologic risk factor as habituating on an island in the pacific, where rat lung worm is endemic, leading to high likelihood of ingestion of snail/slug bits or slime on her fresh vegetables and her constellation of symptoms including eosinophilic meningitis and allodynia/abnormal sensations in arms and legs. I would provide albendazole in addition to corticosteroids for symptoms management for multiple weeks and hope she does well, although if I recall antihelminthic therapy has no proven benefit in multiple trials/reviews. Interesting case and now definitely need to find a way to watch Accidental Host.  

Thank you for this wonderful podcast!



Alice Lehman MD, CTropMed® (she/her)
Internal Medicine – Pediatrics Infectious Diseases Fellow
University of Minnesota

Christopher writes:

Hello TWIP professors, 

I’m writing from Santa Monica beach, California where I was listening to this episode. 

Two parasites that come to mind that cause eosinophilic meningitis are Baylisascaris procyonis, commonly known as raccoon roundworm, and Angiostrongylus cantonensis, known as rat lungoworm. 

I don’t believe raccoon roundworm is present in Hawaii but I would have asked the patient if she recently spent any time near raccoon latrines (like play sandboxes or gardens) in the continental United States. I believe it is more likely she has rat lung worm since it is found in Hawaii. Perhaps she was infected by accidentally eating a slug or snail. Maybe it was intentional, who knows. Some of these snails look tasty. 


Christopher Hernandez
MPH 2020
Infectious Diseases and Vaccinology 
University of California, Berkeley

Ben writes:

Dear TWIPer’s,

Thank you for my copy of PD7. Outside in Washington DC it is: 53% RH, 104 °Delisle, with gusts up to 2.2 meters per second.

Parasite: Angiostrongylus cantonensis

Rationale: Dr. Griffin’s friend sent treats from Hawaii along with this case study. The parasite is found there. The patient had Eosinophilic meningitis without focal lesions in the head appearing on the CT or MRI (PD7).

Thank you,


Ravi writes:

Dear TWiP Team,

I am currently writing this from Reno, Nevada. I will be starting school very soon as a freshman at the University of Nevada, Reno, and am currently situated in my dorm room where it is relatively comfortable. The weather has been surprisingly mild, although I’ve had to drink plenty of fluids. I’ve been a fan of this show and TWiV for several months now and really enjoy listening to it, especially as I can understand a large part of what you all are discussing. 

Anyways, as for the case, as soon as I heard it was from Hawaii, I immediately knew what it was, but I’ll reserve judgement and give a differential in the interests of fairness. The patient being described seems to be exhibiting clear neurological symptoms coupled with eosinophilic meningitis. This combination means it is almost certainly a parasite of some sort (well that and the show is called “This Week in Parasitism”).

As for the causes, there aren’t too many causes, the main ones being Taenia solium (Pork tapeworm / Cysticercosis), Gnathostoma spinigerum (Gnathostomiasis), and Angiostrongylus cantonensis (Angiostrongyliasis). Cysticercosis can almost be certainly ruled out as the symptom onset described in the case appears to be rapid, and cysticercosis usually manifests months to years later. Gnathostomiasis can be dismissed on similar grounds, as well as the fact that I could find an example of a case occurring in Hawaii from my quick searches in Google Scholar and PubMed.

That only leaves one possible cause of this woman’s symptoms, which is Angiostrongyliasis. The disease is endemic to Hawaii and numerous cases have been reported there. The symptoms match pretty well as she experienced an influenza-like illness before progressing to neurologic symptoms, which matches angiostrongyliasis. The abdominal pain is also a very common early symptom caused by the migrating larvae, and the urinary problems could be caused by the larvae irritating local nerves. The parasite has a definitive host in rats, who shed the parasitic worms in their feces, which snails (the intermediate host) then eat. Humans get the disease from eating raw snails or unwashed produce contaminated with snail or slug slime, which is probably how the unfortunate patient described in the case contracted it. Such as a shame that an illness as serious as this is so easily preventable with basic food hygiene!

As for the treatment, supportive care combined with intravenous steroids to reduce CNS inflammation is the recommended approach. Additional spinal taps may be recommended to remove excess spinal fluid in the event of increased CNS pressure. The worms will die on their own and most patients will make a full recovery, which is what I hoped occured in this case.

Looking forward to seeing a response soon!


Joann writes:

Dear TWiP Hosts: Drs. Racaniello, Despommier, Griffin and Naula,

Greetings from the beautiful Suncoast of Florida. I’m writing to you from my 76°F air-conditioned room but the outside temperature is 92°F, 33°C, with a humidity of 63% and a heat index of 108°F. That’s too steamy for me so I decided to join in the gross fun and tackle your case study.

Before I give you my (educated?) guess, I want to say I’ve been listening to TWiV for about six months and heard Dr. Despommier mention TWiP in an episode. I listened to “A Red Herring”, my first TWiP episode, and voilà – I’m already hooked like a raw fish with anisakis worms spoiling my sushi experience.

My background is in medical laboratory technology and other related activities. I’m currently retired but working to keep my mind and body healthy by following evidence-based information based on science. These podcasts from and especially Dr. Racaniello’s calm presence, and guidance have helped to reduce the confusion and anxiety I often feel during this age of intentional dissemination of misinformation.

The case of the adult Hawaiian woman with abdominal pain, allodynia, leukocytosis, and eosinophilia both in the peripheral blood and spinal fluid instantly reminded me of the increase reports of rat lungworm infections Hawaii was experiencing prior to the SARS-CoV-2 pandemic.

The Angiostrongylus worm’s life cycle primarily exists in the lungs of rodents such as rats. Larvae hatched from eggs produced by the adult female worm migrate up the rat’s trachea, are swallowed and excreted in the feces. Slugs and snails ingest the larvae-laced feces and become intermediate hosts for the worm. Humans are infected by ingesting raw water creatures, or fruits and vegetables contaminated with slugs and the larvae. It is therefore important to control rat and slug populations and to carefully wash all fruits and vegetables before consuming. Boiling and cooking these foods will also kill the parasite.

Individuals infected with the A. costaricensis species present with abdominal symptoms and may result in appendicitis which may require the removal of the appendix. A. cantonensis infections primarily involve the brain, meninges and sometimes the eye. The Hawaiian woman in this case appears to have symptoms that suggest the presence of multiple species. A definitive diagnosis can be made by recovering worms from the involved tissues, but this can be difficult and involves invasive procedures.

There doesn’t appear to be a specific treatment for the infection. Infections are supposedly self-limiting and may resolve on their own. Immune and inflammatory reactions to the dying worms appear to cause the symptoms, thus anthelmintic drugs may worsen the symptoms. Corticosteroids may help with symptom control.

My diagnostic guess is that the patient is experiencing both abdominal and cerebral angiostrongyliasis. If this diagnosis is incorrect this exercise will be an especially good teaching moment. I seem to learn more when I make a mistake.

Thank you for the opportunity to participate in this learning exercise. I look forward to hearing other participants comments and differential diagnoses. Keep the podcasts coming.



Michael writes:

This presentation is an example of “Eosinophilic meningitis”. If you have this diagnosis in Hawaii, particularly on the Big Island, you have likely been infected with Rat Lung Worm (Angiostrongylus cantonensis) and the clinical syndrome is neuroangiostrongyliasis (rat lungworm disease). 

This nematode was first discovered in China in 1935, but is now endemic in Asia, Australia, the Caribbean islands and Pacific islands; it has also spread to the American continents with more than 2,800 cases of human infection reported in 30 countries. The life cycle was originally elucidated by Mackerras and Sandars in Brisbane, Australia, more than 60 years ago, before the parasite was generally recognized to be a rare human pathogen.

In Hawaii, these clinical findings are adequate for diagnosis of neuroangiostrongyliasis but a confirmatory diagnostic test using polymerase chain reaction (PCR) to detect A. cantonensis DNA in CSF or other tissue can be performed by the State Laboratories Division.

There is no specific treatment for mild, self limited disease. 

However, preliminary evidence-based clinical guidelines for the diagnosis and treatment of neuroangiostrongyliasis have evolved. The larval parasites cannot reproduce in humans and will die eventually, causing inflammation. The preliminary guidelines call for a complete neurologic examination and CNS imaging; a detailed history of possible exposure to snails/slugs, rats, or other things suggesting a risk for infection; and a lumbar puncture to diagnose and relieve headaches caused by the disease. In some cases, the PCR may be negative early  but will become positive later. Therefore, if clinical suspicion is high and the first PCR is negative, the LP should be repeated about 5 to 10 days later. It is not necessary to wait for the PCR results (which may take 2 to 3 business days to become available) to begin treatment. Steroids should be given as early as possible to reduce inflammation. Anti-parasitic drugs, such as albendazole, may be helpful, although there is limited evidence of this in humans. If albendazole is used, it must be combined with steroids to treat any possible increase in inflammation caused by dying worms. 

People can be infected when they deliberately or accidentally eat a raw snail or slug that contains the lung worm larvae or if they eat unwashed lettuce or other raw leafy vegetables that have been contaminated by the slime of infected snails or slugs.

To prevent angiostrongyliasis, don’t eat raw or undercooked snails or slugs, and if you handle snails or slugs, be sure to wear gloves and wash your hands. Eating raw or undercooked freshwater shrimp, land crabs and frogs may also result in infection, although, there has not been any documented cases in Hawaii. You should also thoroughly inspect and rinse produce, especially leafy greens, in potable water, and boil snails, freshwater prawns, crabs, and frogs for at least 3–5 minutes. Eliminating snails, slugs, and rats found near houses and gardens might also help reduce risk exposure to A. cantonensis.

For added prevention, cooking food by boiling for 3 to 5 minutes or heating to an internal temperature of 165 degrees Fahrenheit for at least 15 seconds can kill the parasite that causes rat lungworm disease.

Dramatic pathology and worm burdens:

Thanks for all you do…

From Michael in Ngunguru (’nun-guru”)

Michael Howard MD PhD FACEM FACEP
Emergency Consultant
Whangarei Hospital, Aotearoa NZ

Eyal writes:

Dear Professors Racaniello, Despommier, Griffin and Naula.

G’Day from Sydney Australia where the weather is 18c and sunny.

Apologies for not submitting my guess for last month’s case. I was visiting Israel for a month and let me just say that 45c heat is not very conducive to doing anything useful.

Also, Dr Griffin, thank you so much for adding the case description to the show notes.

As an uneducated person who doesn’t speak Medicinuese I find myself relistening to the case description multiple times. and that’s just to pick up on the medical terms before then going off and reading what they mean. Having the description handy made this so much easier as well as being able to go back and review the case progression.

From my uneducated perspective, the case looked like a central nervous system issue (dizziness, diffuse hyperesthesia, and allodynia (which got worst later).

At first, I was thinking of a brain-eating amoeba. Unfortunately (and maybe fortunately for her, as these seem to be mostly fatal) this didn’t fit the symptoms which are: Severe frontal headache,  Fever, Nausea, Vomiting and in severe cases (which this looks like) also: Stiff neck, Seizures, Altered mental status, Hallucinations and Coma.

Searching the web for similar symptoms of: worsening abdominal pain, bilateral hip and leg pain, dizziness as well as a prognosis of eosinophilic meningitis I could only find 2 cases describing Brain Worms with Cerebrospinal Fluid Eosinophilia ( in both those cases the culprit was Angiostrongylus cantonensis.

So my guess is Angiostrongylus cantonensis infection which has penetrated the CNS causing meningitis. treatment would probably be complex as the immune response would have to be managed and stabilised, especially once the worm treatment starts to ensure the immune system does overreact to the dead worms.

As always,

It is such a pleasure learning new things I have never had the chance to.


Sara writes:

Dear Drs. Racaniello, Despommier, Griffin and Naula, 

I’m writing from a sunny, 88-degree Fahrenheit afternoon in Philadelphia. 

For this week’s case, I am so grateful an LP was obtained because it narrows the differential significantly!  There are very few parasites that cause eosinophilic meningitis.  I think this is a case of Angiostrongylus cantonensis, the terrifying “rat lungworm.”  The patient’s residency in Hawai’i is her primary risk factor. I guess she acquired the infection from eating fresh produce (probably salad) with a tiny slug or snail full of A. cantonensis larva. The larva migrate from the intestines and love to crawl along nerves. Given that all nerves eventually lead to the brain, the larva often find themselves in the brain where they develop into adult worms, as happened with this patient for whom the crawling worms created headache, allodynia, and paresthesias. Confirmatory testing with A. cantonensis PCR could be performed, though I don’t think it would be required. 

I would treat the patient’s neuroangiostrongyliasis with a course of steroids, and I do not think antihelminthic therapy is required. I learned the above from Dr. Claire Panosian a few episodes back!! Thanks to her, when anyone mentions a trip to Hawai’i my brain jumps to thoughts “rat lungworm.” I cannot wait to see her informational film on rat lungworm when it is finally distributed!!

Had the patient described racoons frequenting her vegetable garden, I would have guessed Baylisascaris meningitis. 

Had the patient been eating raw freshwater fish, I would have guessed gnathostoma meningitis. 

Thank you so much for yet another amazing episode!! 

With gratitude, 


Ricardo writes:

Greetings TWiP Team,

 My name is Ricardo and I am reaching out to you from Los Angeles, CA. The weather today is a warm and sunny 80 degrees F. I would like to start off by saying, to all members of TWiX, your passion’s for education are inspirational. Thank you for the wealth of information and advice you all have shared throughout the years. As a non-traditional undergraduate student aspiring to major in Microbiology and Immunology I am constantly using different episodes of TWiP, TWiM, and Immune to study and for inspiration on how to present various topics in microbiology to fellow undergraduates. After completing Intro to Microbiology, I was left fascinated. So, when I was offered a position as a Microbiology Supplemental Instructor, tutor, at Long Beach City College by my professor I was instantly interested. It has now been a year of tutoring and I love talking about microbiology more every semester. Prior to shifting to full time student work, I spent 8 years of active duty service in the Marine Corps. The plan was always to return to school. I never really knew what I wanted to do. As a matter of fact, I still don’t. There is one thing that I do know for sure, something this podcast has helped me realize, I need to find a career in INFECTIOUS DISEASE. This stuff is MIND BLOWING. For now, I am working on courses that will allow me to apply as a transfer student to a university that offers a Microbiology and Immunology degree.

Onto my diagnosis, I believe this individual is suffering from Angiostrongyliasis. The main detail that caught my attention in the information provided about the patient/case was the eosinophilic meningitis and the presence of eosinophils in the CSF. Eosinophilia pointed me in the direction of a helminth infection and from there I had to find out which ones caused the given symptoms. After some googling and “CDC-ing,” I decided that Angiostrongylus genus was our culprit. In the last few weeks Dr. Griffin has made one thing clear to me. YOU CAN BE INFECTED WITH MORE THAN ONE PATHOGEN. Both cantonensis and costaricensis combined seem to correspond to the signs/symptoms presented by the patient.

Looking forward to the answer of this case and hope to win a copy of Parasitic Disease! That would be an amazing resource!

Kimona writes:

Dear TWiP Team, (re: TWiP #208 case)

I did NOT experience the “AHA” moment that Dr. Dickson so clearly expressed, when listening to this poor Hawaii’an woman’s evolving ailments. My diagnosis is derived by means of exclusion following a search on parasitic causes of eosinophilic meningitis (EoM) diagnosed on her CSF exam. EMG and nerve conduction studies were normal, which also supports a central etiology (brain and/or spinal cord).

My strongest contender is Angiostrongylus cantonensis, which occurs typically in southeast Asian countries and Pacific Islands, including Hawaii. Infection is acquired by eating raw or undercooked mollusks and crustaceans or contaminated vegetables. After ingestion, L3 larvae penetrate intestinal walls, gain access to bloodstream and migrate to CNS, where they often die in meningeal capillaries inducing an eosinophilic inflammatory response. Symptoms usually arise within 2 weeks and heavy infestation in the brain/meninges can produce severe neurological symptoms of meningitis (headache, stiff neck, fever) but also body aches, ataxia, abdominal pain, muscle weakness and even urinary retention/incontinence (her “UTI”) – whereas spinal cord involvement can produce radiculitis.

A. costaricensis causes abdominal angiostrongyliasis, causing abdominal pain, fever, and peripheral eosinophilia but does not migrate to the brain. Perhaps she is coinfected with both?

Diagnosis: is made by a history of headache, likely larval exposure w/in 3 months and eosinophilia in >10% of WBCs in CSF. MRI could show cerebral congestion and microcavities correlating with larval migration. Yet, 66% have a normal MRI, and I suspect the same applies to CT. CSF reveals large eosinophils and is sometimes cloudy and described like ‘coconut juice’, which is said to be pathognomonic for angiostrongyliasis.

PD7 mentions an ELISA test for A. cantonensis crude antigen and RT-PCR of CSF can detect DNA from less than one larva.

Treatment: aims at reducing the inflammatory response and relieving pain. Albendazole x2 weeks is mentioned, yet cautions this can trigger an enhanced inflammatory reaction from massive parasitic death, so concomitant anti-inflammatory drugs (like prednisolone) may be used.

Other parasitic infections that I found listed as inducing an eosinophilic meningitis include: Gnathostoma, cysticercus, Schistosoma, Toxocara, Baylisascaris, Paragonimiasis, and Trichinella. I have included my rationale below as to why they would be less likely than angiostrongylus infection (but no need to read “on air”!)

This case presentation had me puzzled and I can’t wait for the next TWiP to drop.

In suspense……Kimona

Martha writes:

Dear TWiP sters. I hope I’m not too late responding to the case in episode 208. I’ll try to be brief since I think you’ll be getting a lot of responses to this case of a Hawaiin woman with eosinophilic meningitis. Her case is remarkable for hyperesthesia and allodynia. No mention is made of dietary intake or animal contact. A quick google search indicates that this can be caused by three parasites: Angiostrongylus cantonensis, Baylisascaris procyonis and Gnathostoma spinigerum. 

B. procyonis is a raccoon ascarid. Although raccoons are not native to Hawaii, some have made the trek to Hawaii. It’s not clear if the parasite came with the raccoons. I’m guessing that Dr. Griffin asked about contact with raccoons and if the patient had exposure to raccoon feces this would have been mentioned. So I’m eliminating this.

G. spinigerum is prevalent in Asia, specifically Thailand and Japan, and in Mexico. No mention is made of travel to these locations. So  this is off the list of suspects.

A. cantonensis is present in Hawaii. It is acquired by ingestion of uncooked slugs. The hyperesthesia is characteristic of the infection. So in spite of no mention of the patient’s diet, I’m guessing this is an infection with A. cantonensis.

Best wishes to all


Gina writes:

Regarding the Hawaiian woman with fever,  abdominal pain , itching all over, allodynia, and eosinophilia and other symptoms.  

My best guess is  A. cantonensis.  

Thank you for all your work.  🙂  

I’m looking forward to hearing the answer.


Michelle and Alexander from the First Vienna Parasitology Passion Club write:

Dear quadrivalent TWiPsters,

 The case described in the last episode was about an adult woman living in Hawaii who presented to the ER with multiple symptoms including abdominal pain, several days of fever, urinary hesitancy and generalized pruritus. Labs showed mild leukocytosis and no eosinophilia. The patient was treated for acute UTI and then sent home. The next day she returned to the hospital because of worsened abdominal pain, bilateral hip and leg pain, allodynia – which wasn’t responsive to analgesics, increased leukocytosis, eosinophilia and the feeling of electric eels swimming through her body. CT scans showed no anomalies, EMG and nerve conduction studies were also normal. Finally a lumbar puncture demonstrated CSF eosinophilia. 


Gnathostoma species: Neurognathostomiasis may cause possibly fatal eosinophilic meningitis and myeloencephalitis. Commonly, CT scans would show signs of subarachnoid hemorrhage or intracerebral hemorrhage. Also, gnathostoma is not endemic in Hawaii. 

Baylisascariasis procyonis: While endemic in the United States, there are no reports of neural larva migrans of this species in Hawaii. The disease is very rare and has mostly been described in small children with oral exposure to contaminated soil. Serology from serum and CSF should exclude this diagnosis if doubt remains.

Toxocara species: These worms invade various tissues including the brain, the liver, the eyes and the heart. The larvae cause mechanical damage to the infected tissue, resulting in unspecific clinical symptoms. Eosinophilic meningitis is uncommon. 

Non-parasitic: cryptococcal meningitis is rare in immunocompetent hosts. Coccidiomycosis commonly presents with pulmonary symptoms and would result in a low CSF glucose. 

Angiostrongylus cantonensis seems the most likely culprit. 

Infection with Angiostrongylus cantonensis, also known as the rat-lungworm, is known to invade the central nervous system and is a common cause of eosinophilic meningoencephalitis.

Infections with A.cantonensis usually occur in Southeast Asia, the Pacific Islands including Hawaii (where our patient lives), the Philippines, Taiwan and Australia. There are also few reports on the disease occurring outside of these regions, for example in Nigeria or Cuba. A variety of freshwater snails, land snails and slugs are known to be intermediate hosts for A. cantonensis. Rats are the definitive hosts. Paratenic hosts include certain amphibians, prawns and fish. 

Adult worms live in the right ventricle and pulmonary arteries of rats and wild rodents. Female worms then lay their eggs, which hatch in the pulmonary arteries. From here, the first stage larvae make their way to the pharynx, where they are swallowed and later passed through feces. At this point they are usually ingested by an intermediate host, such as slugs or snails. After two molts, third stage larvae are now able to infect mammals. 

If intermediate or paratenic hosts are ingested by mammals, third stage larvae migrate to the brain and occasionally the lungs or eyes. In humans, larvae may reach the fourth or fifth stage, but cannot reach reproductive maturity. 

Symptoms of neuroangiostrongyliasis include the classic presentation of meningitis with headache, neck stiffness, confusion, reduced consciousness and increased inflammatory markers. More specific to this disease are the sensory symptoms described in this case, including hyperalgesia, allodynia and dysesthesia. In some patients, there is ocular involvement with blurring or loss of vision.

When neuroangiostrongyliasis is suspected, lumbar puncture with cell count, CSF protein, lactate and glucose is the first step. In the setting of eosinophilic meningitis and classic presentation, a presumptive diagnosis can be made. If available, CSF PCR can be used to make a definitive diagnosis, or in more tragic cases, autopsy provides further insight. 

Therapy has long been controversial and antihelminthic therapy was often withheld in favor of corticosteroids, so as not to exacerbate CNS inflammation. A recent review of human and animal reports by Jacob et al (10.1093/cid/ciab730) found favorable outcomes after treatment with albendazole and related drugs with or without steroids in more than 90% of human cases and no concern for neurological deterioration after initiation of therapy. Therefore, I would (angio-)strongly consider early albendazole therapy. 

To prevent infection, fresh produce should be thoroughly washed with clean water, although the infected slugs are very small and can easily be missed. The consumption of raw or undercooked crabs, shrimp or frogs, which can act as paratenic hosts, should also be avoided. Finally, control of the definitive host, the name-giving rat, also plays an important role.

The most remarkable aspect of this parasitic disease is probably the extraordinary severity of neurological symptoms such as allodynia, hyperalgesia and electrifying pain, which are  unusual in meningitis and encephalitis. The generalized distribution points towards diffuse inflammation of the central nervous system as a response to infection, as opposed to direct tissue damage caused by invasive larvae. 

Thank you for this great case. All the best, 

Michelle and Alexander from the First Vienna Parasitology Passion Club

Justin writes:

Hi Dickson, Christina, Daniel, and Vincent,

Long time listener (to all the TWi Podcasts), first time submitter for case diagnosis. A. cantonensis/Rat Lungworm from eating an intermediate host (freshwater shrimp, land crabs, frogs, snails, slugs, etc) probably from salad or other produce causing Angiostrongyliasis. A PCR test can be used for confirmation.

Kept the diagnosis short since I mainly wanted to write and ask about a local concern. I recently moved to Orange County, California, and I’ve been frequenting the local swimming hole, Newport Dunes. I think it used to be an estuary (before redirecting the Santa Ana River by dams), so now it is more like a large tidal pool where people go for recreational activities. I’ve noticed lately that visitors bring their babies with diapers to Newport Dunes, and I routinely see the parents throwing the diapers in the trash during their visits and washing their babies in the community showers next to the beach. These are the type of showers that run for a few seconds to rinse sand off of feet, so there isn’t any drainage, and the water and whatever is washed off either dries on the sidewalk or flows onto the beach. I had been using those showers after swimming to rinse my feet, but I stopped doing so after seeing all the used diapers and soiled babies being washed in those areas. What risks do you think this poses to the public in the area either from the residue on the sidewalk or the runoff into the beach next to the estuary? I remember a lot of the earlier TWiPs would discuss the risk of dogs pooping on beaches, but with the changing behaviors in the U.S., I was curious what steps might I be able to recommend to the staff at Newport Dunes regarding human feces on the sidewalk and sand. 

Thank you for any advice on this. I’ve always enjoyed the podcast, as well as all the others available on Microbe.TV. I’ve probably averaged 4 hours per day for the last 2 years listening to all of them, and eventually adding on other podcasts like Food Safety Matters, Meet the Microbiologist, The Minor Consult, and Hidden Brain. You all got me started with this hobby, and it just keeps expanding as my former job as a lab tech allowed me plenty of time to listen while doing qPCR or Flow cytometry, and now I can just keep up with all of them during my breaks here and there. I’d love to see a return of Urban Agriculture, but I sense that that ship has definitely passed. My current job has me in the food safety industry, and I’m hoping to get involved in sustainable agriculture later in life.

Thank you for all the information and entertainment over the last couple of years,


Kevin writes:

Dear Doctors TWiP,

I will be brief, as I want to make sure that my case guess for TWiP 208 makes it in time. My guess is Angiostrongylus cantonensis. 

Worm regards,


(have not won a book yet)