This Week in Parasitism

The TWiP trifecta solves the case of the Professor Who Went to Brazil, and discuss an amazing case of a tapeworm that turned into a tumor in an AIDS patient.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Do young doctors need more sleep? (Slate)
• H. nana tumor in AIDS patient (NEJM)
• Hymenolepiasis (CDC)
• H. nana lifecycle (CDC/Wikipedia)
• Image credit
• Letters read on TWiP 99

Case study for TWiP 99

This week's case is a 53 yo woman visiting family in US, comes in with intense belly pain, right upper part of belly. Has become strict vegetarian after having breast cancer, on raw vegetable diet (carrots, collect plants in local markets). From Bolivia. Lives in agricultural area, avoids sheep, fearful of dogs. Housekeeper. Married, lives with husband. Noticed pain when came to US. Breast cancer: localized, removed lesion, no therapy, months ago. No allergies, family healthy. No insect bites, lives in concrete house. Physical exam: not febrile, right upper quadrant is very tender, some liver enlargement. CBC: 10,000 white count, mostly eosinophils, liver function: AST, ALT, AlkPhos all normal. Neuro exam: normal. Five months before this diet, she did have normal diet. Some meat, drank milk.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

TWiP is a MicrobeTV production

The TWiP-lets reveal Balamuthia infection in the Children from Peru, and discuss resistance to pyrethroids revealed by RNA sequencing of Anopheles mosquitoes.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Balamuthia (CDC)
• Pyrethroid resistance in Anopheles (Parasit Vectors)
• Voltage-gated sodium channels
• Pyrethroid (Wikipedia)
• Image credit
• Letters read on TWiP 98

Case study for TWiP 98

This week's case is a Professor clinician, teacher, researcher. In his 50s, he presents with lesion on big toe, anterior portion, tip, nodular. No surrounding redness, area is itchy. Has a small central black area the size of pencil tip, concerned because feels is getting larger over last week. Spooky. Travels, last in Brasil, had been for a few weeks, noticed toe issue a week after returned. Spent time on beach, but wore flip flops. Different types of beaches, crowded and not crowded. Went with wife. Healthy man, no prior medical problems.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

The paratenic hosts reveal a case of scabies in the Traveling Salesman, and discuss a role for natural antibody in protection from infection with Plasmodium.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Parasite Nobel Prizes 2015
• Ivermectin story (Nat Rev Micro)
• Ivermectin target (Brain Res)
• Gut microbiota and Plasmodium protection (Cell)
• Natural antibody (virology blog)
• Image credit
• Letters read on TWiP 97

Case study for TWiP 97

Daniel has two cases this week. Two people with similar presentations. A 12 yo girl in Peru presented for care with painless dark brown area on right knee. Has brothers and sisters, often play together. No trauma, but area is expanding. Months later develops cognitive changes. Second case is a 5 yo boy from the coastal region of Peru brought in by Mother, has red swollen area on face. Mom says while playing scratched nose, swelling right cheek, eye, nasal obstruction, no response to antibiotics. MRI of both show infiltrating process. Girl, left side of brain, middle cerebral artery territory. Boy in frontal region, midline area. Thus both skin lesions associated with infiltrating process in brain. Came into clinic months after lesions started, and lesions still present.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

The TWiPanosomes solve the case about the Young Woman who Went to Belize, and relate how sandfly saliva skews the immune response and increases risk of cutaneous leishmaniasis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Sandfly exposure and risk of cutaneous leishmaniasis (J Inf Dis)
• TWiP 14: Leishmania
• Image is L. longipalpis (credit)
• Letters read on TWiP 96

Case study for TWiP 96

Daniel's patient for this week is male patient referred for consultation by OB-GYN: his wife is pregnant, has been admitted and is about the give birth. It is her first pregnancy. There are concerns about the husband's skin problem and whether it is a threat to his pregnant wife. No lesions on woman, husband recently developed itchy skin problem on his hands. Bilateral. Small papules on webs of fingers, brown lines, blood clots at ends, has clearly scratched the lesions. Skin between fingers is involved. Travels, often stays in cheap hotels. Beds not clean. Last trip 1 month before symptoms. Midwest travel. Family history of heart disease. Sales occupation. No animal exposure. Travels to medium to large cities.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel solve the case about the 33 year old Chinese male with watery diarrhea, and discuss whether arsenic in drinking water might lead to treatment failures for Leishmania infections.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• TWiP 17: Entamoeba histolytica
• Arsenic exposure and Leishmania treatment outcomes (PLoS NTD)
• TWiP 14: Leishmania
• Letters read on TWiP 95

This episode is sponsored by ASMGAP.

Daniel's patient for this week is a 28 yo single female, returns from beach vacation with new boyfriend. Two weeks in Central America (Belize). Often found secluded beaches. Good health, noticed upon her return had small nodules/papules on front of thighs. Thought were insect bites, became very itchy. Noticed serpiginous red lines forming, radiating out from bumps. Felt things moving in her skin. Benadryl did not help. Daniel say something similar occurs in Lima. Healthy, no allergies, surgeries, no relevant family history, using barrier contraception, sexually active. Only drinks alcohol socially. Boyfriend did not report symptoms. She did lie on sand, used thin fabric. Stayed in hotel. There were wild dogs on beach. During her stay she ate ceviche. No intestinal symptoms.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel solve the case about the man from El Salvador, discuss the use of tyrosine kinase inhibitors to treat onchocerciasis and filariasis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Targeting filarial tyrosine kinases (J Inf Dis)
• Onchocerciasis on TWiP 24
• Filariasis on TWiP TWiP 25
• Image shows c-abl kinase bound to imatinib (red)
• Image credit
• What good are ticks?
• Letters read on TWiP 94

Daniel's patient was seen in the clinic. He is a 33 yo chinese male, from Chinatown NYC, for several months on and off has had watery diarrhea, headaches. Tried reflexology, chiropractic therapy, with no results. Has traveled quite a bit, been in Chile (was there a few months before). Came to US when young. Grew up in the US. In Chile, has had many sexual partners, >50, of both sexes, also has done many drugs. Two years ago was diagnosed with chronic HIV, CD4 count 685, on ARVs triple therapy, virus loads are well controlled. Has had syphilis, nose job, no medication allergies. Lives with family. On exam, afebrile, looks well. Symptom onset a few months after last Chile visit. Is an addventurous eater.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel solve their fishy tale, and present a new case study for your consumption.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Freezing and the quality of sushi (Clin Inf Dis)
• Anisakis biology (CDC)
• Image credit
• Letters read on TWiP 93

April 2015 a 177 lb 5ft10in 39 yo man seen as outpatient in ID clinic, reports 2 y ago had issues with constipation on and off; throat hurts; feels closing when lies down. For several years has had skin irritation on upper chest and arms. Tried to donate blood, was rejected, told to see doctor.

Emigrated to US from El Salvador 2002, married, reports no extramarital sex, smokes 2-3 cigs/day, now quit; had drinking issue in past, no more; was agricultural worker in rural part of El Salvador; has history of asthma, on a number of medicines, including steriod nasal spray, inhaler, no visual problems, healthy appearing, not allergic to medicines. Family history: mother heart attack and diabetes; father peptic ulcer disease.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel discuss how fluctuation in the price of guinea pig food could help transmission of the agent of Chagas disease, and present a new case study for your consumption.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Ascaris on TWiP 21
• Ascaris lumbricoides life cycle (jpg)
• Child with distended abdomen due to Ascaris (jpg)
• Bottlenecks and Chagas disease (Proc Biol Soc)
• Letters read on TWiP 92

A 20 yo Japanese female student went to the emergency room with severe abdominal pain. nausea, had vomited. Had just enjoyed homemade sushi an hour or two previuosly. She prepared the sushi: rice, salmon, tuna rolls. Salmon was local, caught by boyfriend. Tuna from store, sushi grade. No past medical history, mother with anemia. Takes oral contraceptives. No toxic habits. No travel. Monogamous. Temp 100.2, bp 140/90, hr high 90s, breathing upper teens. Physical exam normal except appears distressed in pain, belly extended, tender in left upper quadrant. Friends ate sushi but no one else got sick. All guests ate both types of fish.

Send your diagnosis to [email protected]

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel review how Viagra might be used to block transmission of Plasmodium falciparum, and introduce a new case study.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Malaria life cycle (jpg)
• cAMP regulates gametocyte infected erythrocyte deformability (PLoS Path)
• P. falciparum in bone marrow (Blood)
• Image credit
• Letters read on TWiP 91

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email

Vincent, Dickson, and Daniel discuss identification of an erythrocyte protein essential for invasion of Plasmodium falciparum, and introduce a new case study.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

• Dermatobia hominis (Wikipedia)
• Plasmodium falciparum erythrocyte invasion (Science)
• Plasmodium life cycle (TWiP #10)
• Letters read on TWiP 90

Send your questions and comments (email or mp3 file) to [email protected]

Subscribe to TWiP (free) in iTunes, by the RSS feed or by email