This Week in Parasitism

Christina from Glasgow joins the TWiPlets to solve the case of the Elderly Gentlemen with Full Body Rash, and to present a new clinical case for listeners to solve.

Guest: Christina Naula

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• Hero: Tony Fauci
• Tony Fauci on TWiV 219 and 641
• Letters read on TWiP 189

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Case Study for TWiP 189

At a clinic in Ghana, woman seen for hernia, large swelling in right upper abdomen that grew steadily in previous year. Exam found to have mass, too high for inguinal hernia. Thought to be in liver. Mother, subsistence farmer, 50s, not unwell, no jaundice, mobile, overweight. Lump was firm, did not appear to be fluid filled, did not reduce under pressure, smooth, over 20 cm. Concern was liver cancer. Due to remoteness of clinic not possible to order tests. One test was done which could deliver the diagnosis.

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Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Baby with Hydrocephalus, and present a new clinical case for listeners to solve.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Letters read on TWiP 188

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Case Study for TWiP 188

Man in 90s, suffering for months, healthy, hypertension, diabetes, large man, over 6 ft, 200 lb, rash. Full body rash for months. Gone through allergy med, cream, prednisone, some helped but regressed. Tried ivermectin 3 pills, got better for a few weeks, then rash worsened. Primary care doc did thorough exam, found abnormal area between toes, did scraping, sent to lab. When came back, asked some questions. Wife is also suffering. Gave larger dose of ivermectin, repeated 2 weeks later, wife also treated, and then recover. Not COVID-19, no HIV-AIDS, no drinking or smoking. Started before COVID, first in wife. Had gone on trip, not far away, stayed in hotel. No pets.

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Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Middle Aged Woman with Loss of Vision in One Eye, and discuss the role of heme oxygenase in the various protozoan infections.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Heme oxygenase-1 in protozoan infections (PLoS Path)
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• Letters read on TWiP 187

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Case Study for TWiP 187

Pregnant newly married, living North Shore, first pregnancy. Affluent family, measured successful lawyer who cooks. Organic eating. Boy born at 9 mo, has midwife, has delivery at home. Baby has enlarged head. OB diagnosed with hydrocephalus. Mother healthy. No meds. Works in retail store, lives with husband, not working for second half of pregnancy. Drank alcohol rarely. No significant travel. Patient reports having no pets but her brother owns small farm, and husband likes serving rare meats, all kinds, which she has eaten since she married him. Will do ultrasound, CT, blood work.

Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Elder Gardener Feeling Poorly, and discuss the three-dimensional ultrastructure of Plasmodium falciparum during cytokinesis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Three-dimensional structure of malaria parasite (PLoS Path)
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• Letters read on TWiP 186

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Case Study for TWiP 186

Middle aged woman quite upset, referred to Daniel. Sheltering at home, one day looking at her children, noticed problem with vision. When covers right eye, notices area of loss of vision in left eye. No other associated symptoms. Admitted to hospital, blood tests, eye exam (lesion in back of eye had developed). Blood: WNV serology, another was done but he's not saying. Comes back positive. No cat or dog exposure. Healthy, no prior medical problems, no surgeries, no toxic habits, HIV unknown, married.

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Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Wife of a Guy with Cyclospora Diarrhea, and discuss the discovery of an intrinsic oscillator that drives the bloodstream stage cycle of the malaria parasite.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Intrinsic oscillator in malaria parasite (Science)
• Malaria parasite has intrinsic clock (Science)
• Letters read on TWiP 185

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Case Study for TWiP 185

Seeing this type of case 1/week for last several weeks. 75 yo female, admitted with fever, body aches, cough, loose stool for 2 week, sodium 118. Sheltering in place in Long Island, some gardening, no travel. Blood testing detected low sodium. COVID-19 negative, no other symptoms. Blood work: wbc 2000; hematocrit 24; platelets 40; sodium 120s. Unremarkable physical exam. Lyme test negative; other tick borne diseases negative.

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Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Safari Goer With Watery Diarrhea, and explain how a microsporidian endosymbiont of Anopheles mosquitoes might impair the transmission of malaria.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Contribute to Parasites Without Borders
• Microsporidian impairs Plasmodium transmission (Nat Comm)
• Hero: Eugene T. Lyons (obituary)
• Image credit: Josh
• Letters read on TWiP 184

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Case Study for TWiP 184

69 yo female with several months of abdominal symptoms started in S. Africa, water shortage as described for her husband in the previous TWiP. Husband had C. cayetanensis. Her symptoms improved; her stool was positive for B. hominis and E. nana. Given many different treatments. Then comes to see Daniel. Some abdominal discomfort, mucosy stools. All past med/surg unremarkable, nothing in family, sent for repeat labs, stool O&P all normal including GI PCR

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Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Female with Itchy Anus, and reveal the structure of a roundworm membrane protein involved in digestion of nutrients.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Structure of roundworm digestive complex (PLoS Path)
• Hero: Dr. Anthony Fauci
• Fauci Pharmacy (TWiV 219)
• Letters read on TWiP 183

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70 yo male. Returns with wife from safari in S. Africa. Reports suffering from 2 weeks watery diarrhea. Severe water shortage in S. Africa, limited washing water, hand sanitizers to clean hands so problem with hand hygiene. 5 days after arrival he and wife have water diarrhea, 12 per day, nauseated, abdominal cramping. Ab no effect. Stool culture, ONP, negative. Healthy, no past med/surg, no allergies, nothing runs in family. Stool sent off for ONP acid fast stain, also GI PCR panel. Prompts treatment for 7 days trimethoprim sulfamethoxazole, resolves.

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Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Ugandan Volunteer With Morning Bites and discuss integration of HIV-1 into the Schistosome genome, with a sprinkling of COVID-19 throughout.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• HIV-1 integration into Schistosome genome (PLoS Path)
• Image from John Southall's Treatise of Buggs, 1730.
• Letters read on TWiP 182

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60 yo female comes in with husband, grew up in Lima Peru. Having issue had when child, would get itchiness around anus, mother would have her eat pumpkin seeds. Every 2-3 weeks wakes up with severe itching. Put in q-tip and extracted something, has video of it. ONP stool cultures negative. Referred to Daniel. Negative medical history, no allergies, no surgeries, no medications. Does travel, mainly to Uganda. HIV negative, no toxic habits. Husband reports no symptoms. Has children/grandchildren.

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Music by Ronald Jenkees

Dickson, Daniel and Vincent solve the case of the Two Volunteers With Watery Diarrhea, discuss diagnosis of SARS-CoV-2 in the New York area, and reveal an approach to preventing honeybee colony collapse by imbuing their gut bacteria with the ability to produce antiviral and antiparasite double-stranded RNAs.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Daniel on TWiV Special
• Engineered symbionts limit honeybee pathogens (Science)
• Letters read on TWiP 181

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Risks of being helpful. Volunteer from previous case. Diarrhea is gone, now has second issue. Since coming to Uganda noticing on waking in AM often has series of 1 cm red raised lesions in a line, 3-4, on torso. Swollen and itchy. New ones in the AM. Manager says welcome to Uganda. They move out of room, leave bedding behind. Lesions stop. What is going on and when can they move back into room?

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Music by Ronald Jenkees

The TWiP professors solve the case of the Ugandan Child with Splenomegaly, and reveal that mutations in the P. falciparum genome that confer artemisinin resistance interfere with endocytic uptake of hemoglobin.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Endocytosis pathway mediates artemisinin resistance in malaria parasites (Science)
• Letters read on TWiP 180

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Uganda with a twist. Meets two people with watery diarrhea, 12 episodes/day, loss of appetite. No fever, no blood in stool. Living for months at staff guest house. One week prior to onset went on weekend trip to area with waterfalls. Were served outdoor meal: meat, salad, fruit. Recommends empiric treatment trimethoprim/sulfamethoxzole for 7 days. Prompt resolution of diarrhea. A few days later, upon drinking coffee with milk gets severe cramps. 20s, long term female volunteers.

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Music by Ronald Jenkees