This Week in Parasitism

TWiP solves the case of the patient who developed an intensely itchy, red papular rash after close contact with chickens and their bedding, where small mites were found.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Hero of the Month: Ogobara Doumbo (Lancet, AJTMH, Lancet)
• Letters read on TWiP 290

New Case

Man in 30s with well controlled diabetes, elevated AST ALT liver tests, asymptomatic. Ultrasound of liver, multiple cysts. Born in rural Yemen, grew up on farm with cattle, sheep, donkeys, 3-4 indoor/outdoor dogs, bathroom inside house, frequently swam in fresh water, as adult worked in construction, 2010 moved to capital, in 2017 Moved to US works in Brooklyn.

March 2023 get abnormal lab results. Decide to follow, 1 year later, repeat ultrasound, 3 new lesions 1-2 cm range, triggers abdominal MRI, has enlarged liver 21 cm, hepatic steatosis, cysts. June 2024 has acute right side lower back pain, goes to ED, they say its musculoskeletal. A year later May 2025 goes back to Yemen, develops abdominal discomfort, then resolves. Oct 2025 develops day of severe diffuse abdominal pain, fever, admitted with wbc elevated, eosinophil 100, liver enzymes normal. CT shows multiple cysts 6.5 x 5 cm, with small internal cysts, few have internal enhancing curvilinear serpiginous material.

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Music by Ronald Jenkees

TWiP explains a single-cell analysis of immune cells in the blood of dogs with canine leishmaniosis, providing a detailed picture of how the immune response changes as the disease progresses.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Single immune cell atlas of canine leishmaniosis (iScience)
• Clinical staging in CanL (LeishVet)
• TWiP study – information and survey

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Music by Ronald Jenkees

TWiP solves the case of the NYC woman in her 30s who developed 3 weeks of significant watery diarrhea after eating at a Taco Bell Restaurant.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 288
• Parasite of the month – Parelaphostrongylus tenuis — meningeal worm (brainworm)
  • Wikipedia entry
  • P. tenuis in ruminants (Food Animal Pract)
  • P. tenuis in white-tailed deer (Int J Parasitol Parasites and Wildlife)
• TWiP study – information and survey

New Case

Early teen, otherwise healthy, develops rash, for a few weeks, problem at night. All over the body. Helps with backyard chicken coop, plays with chickens. Dad looks through bedding, finds tiny red mobile things. Suggest changing bedding, tell teen not to help with chickens. Then rash disappears in a few days.

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Music by Ronald Jenkees

Mumtaz Balkhi joins TWiP to discuss phase 1 and 1b trials of the schistosomiasis vaccine SchistoShield which demonstrate that it induces functional immune memory responses in US and African populations.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Mumtaz Y. Balkhi

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• SchistoShield Phase 1 and 1b results (npj Vaccines)
• TWiP study – information and survey

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Music by Ronald Jenkees

TWiP solves the case of the adult female with a 2 year old child who develops anal irritation, but the child and the husband are fine.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 286
• Hero – Otto Wucherer
• TWiP study – information and survey

New Case

Recent case. Woman in 20s, lives in NYC, goes to urgent care with 3 weeks of significant watery diarrhea, not improving. Otherwise healthy, no travel, works in office in NYC, at some point prior to onset she ate at a Taco Bell. Put on twice a day medication, molecular test of stool confirms diagnosis. Don't know when, or what she ate. Trying to replenish fluid losses. Not immunosuppressed.

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Music by Ronald Jenkees

TWiP reviews our current understanding of the biology of Cyclospora, the parasite currently causing a large multistate outbreak in the US traced to contaminated lettuce, and why it is so difficult to control.

Hosts: Vincent Racaniello and Christina Naula

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• Current Knowledge of Cyclospora cayetanensis (Comp Rev Food Sci Food Safety)
• TWiP study – information and survey

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Music by Ronald Jenkees

TWiP solves the case of the 39-year-old man originally from Guatemala, who moved to one of the NYC boroughs in 2023 and presented with headaches for nearly 1 year.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 284
• TWiP study – information and survey

New Case

Recent ID consult: MD/PhD mother doing research, married with child 2 yo, female develops anal irritation, husband is fine, child is fine. Parasitic etiology is considered. Referred to academic ID providers, turns out she had this etiology considered, had received some treatment, got a little better, symptoms returned, treated again, got better, symptoms returned. Got some hard to find testing equipment, and confirm suspicion. Treat once, then again in two weeks. Not any better, still irritation. What do we do? HIV neg, no prior medical issues, no travel.

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Music by Ronald Jenkees

TWiP reviews the projected impact of climate change on the burden of Cryptosporidium in Mali, Kenya, and The Gambia.

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• Impact of climate change on Cryptosporidium (J Inf Dis)
• Letters read on TWiP 283
• TWiP study – information and survey

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Music by Ronald Jenkees

TWiP solves the case of the nonbinary patient in his 30s with a history HIV/AIDS presenting with 3 weeks of subjective fevers, chills, generalized weakness and voluminous ostomy output.

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• Parasite of the Month: Leucochloridium paradoxum (the green-banded broodsac)
• Letters read on TWiP 282
• TWiP study – information and survey

New Case

39-year-old man originally from Guatemala, who moved to one of the NYC boroughs in 2023 and currently lives with his siblings and cousins, presented with headaches. He reports headaches for several months, possibly nearly 1 year. Over the past 2 weeks, he has had intermittent numbness on the left side of his face and in his left arm and foot, with difficulty standing due to sensory changes in his feet. He states these symptoms are new. He reports a fall related to the numbness but denies balance problems. He denies fever or chills. He has intermittent nausea and vomiting but denies diarrhea, abdominal pain, or other complaints. He works as a busboy in a restaurant and states that he only cleans and does not prepare food. In Guatemala, he used to eat street tacos containing pork and beef, sometimes with undercooked meat. He is a former smoker who quit 4 years ago after smoking for 10 years. He drinks alcohol 3–4 times per week, typically 2–4 drinks per occasion, but not daily. He reports no sexual activity for 1–2 years.

General: no acute distress HEENT: NC/AT, anicteric, vEEG Neck: supple, normal ROM Lungs: clear to auscultation bilaterally Heart: S1, S2 present, normal rate/rhythm Abdomen: Soft. Nondistended. Nontender. Neuro: AAOx3, no obvious focal deficits Extremities: No cyanosis. No edema.\ Skin: Warm. Dry. No visible rash. Psychiatric: Appropriate affect and mood for situation.

CT HEAD WO IV CONTRAST-Cystic structures scattered along the subarachnoid space, for example, right sylvian fissure/frontotemporal cortical sulci, right > left suprasellar cistern, interpedicular cistern, basal cistern and left sylvian fissure. Associated mass effect with minimal leftward midline shift (0.2-0.3 cm). Calcifications at the left temporal region. There is no obvious acute intracranial hemorrhage.

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Music by Ronald Jenkees

TWiP reviews gene expression in wood ants infected with the larval lancet fluke, which causes them to leave their nest and attach to a flower until they are eaten by a grazing mammal.

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• Gene expression in wood ants infected with lancet fluke (Mol Ecol)
• Visualisation of the master manipulator in the brain of its ant host (Sci Rep)
• TWiP study – information and survey

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Music by Ronald Jenkees