This Week in Parasitism

TWiP 253: Sub-Saharan somnolence


Listen Later

TWiP solves the case of the man with somnolence and something extra-erythrocytic, and presents a new puzzle for you to solve.

Hosts: Vincent RacanielloDaniel Griffin, and Christina Naula

Subscribe (free): Apple PodcastsGoogle PodcastsRSSemail

Links for this episode
  • Join the MicrobeTV Discord server
  • Letters read on TWiP 253
New Case

26-year-old female with no past medical history.  Patient is from Georgia in the US and is volunteering in Hérico, Guinea (town in the Lélouma Prefecture in the Labé Region of northern-central Guinea). She arrived in Guinea in December  2023.  She was taking doxycycline for malaria prophylaxis and says that she has not missed any doses

On October  2024 she presented with fever and dry cough.  Lab work was done and follow up planned for the following day.  The patient slept poorly, was febrile to 104 and had ongoing cough.  The next day she went to the hospital and was evaluated in the ER for acute febrile illness of unclear etiology.  

In the hospital, VS were 97.9F, BP 105/70, P 94 Oxy sat 98%, normal physical exam.

She was started on Augmentin and Coartem.

Pause here to think about the differential at this point and maybe some more history and what testing you might want

WBC 14, Hb 13, HCT 40, PLT 285, Neut abs 8, Eos Abso0.80; BUN/creat  normal, AST normal; ALT 44, GGT 125

Stool parasite screen + for some sort of eggs, malaria smear negative, CXR with b/l infiltrates

She was given a medication (vomited 30 min after dose received).  She then received a second dose of medication 5 hours after the first) and was discharged. The following day the patient returned to the ER, stating that she felt worse.  Her temperature had climbed to 104 overnight, and she developed watery diarrhea and nausea.  There were no additional episodes of vomiting.  She was given an additional dose of a medication, ibuprofen, and started on ceftriaxone 1 gm IV Q12 hrs.  During the day she continued to have low grade fevers and developed abdominal pain.  That night she was again febrile to 104 F.   

She remained admitted for 5 days with ongoing symptoms of diarrhea, nighttime fevers and diffuse abdominal discomfort.  Three more malaria tests were negative (rapid test and slide review)

Blood cultures collected – no growth

She continued to have mild elevation of WBC and slight elevation of AST and ALT.

The patient was transferred to a different hospital. They give her a different medication, and within 24 hours symptoms resolve. 

What is the diagnosis and what happened here with management?

Become a patron of TWiP 

Send your questions and comments to [email protected]

Music by Ronald Jenkees

...more
View all episodesView all episodes
Download on the App Store

This Week in ParasitismBy Vincent Racaniello

  • 4.9
  • 4.9
  • 4.9
  • 4.9
  • 4.9

4.9

450 ratings


More shows like This Week in Parasitism

View all
Hidden Brain by Hidden Brain, Shankar Vedantam

Hidden Brain

43,663 Listeners

This Week in Virology by Vincent Racaniello

This Week in Virology

2,059 Listeners

MicrobeWorld Video by American Society for Microbiology

MicrobeWorld Video

29 Listeners

Meet the Microbiologist by Ashley Hagen, M.S.

Meet the Microbiologist

37 Listeners

Nature Podcast by Springer Nature Limited

Nature Podcast

763 Listeners

This Week in Microbiology by Vincent Racaniello

This Week in Microbiology

518 Listeners

This Week in Evolution by Vincent Racaniello

This Week in Evolution

169 Listeners

Microbios by Brendaliz Santiago-Narvaez

Microbios

12 Listeners

BacterioFiles by Jesse Noar

BacterioFiles

20 Listeners

MicrobeWorld Video (audio only) by American Society for Microbiology

MicrobeWorld Video (audio only)

4 Listeners

Editors in Conversation by American Society for Microbiology

Editors in Conversation

25 Listeners

Science Magazine Podcast by Science Magazine

Science Magazine Podcast

826 Listeners

Science Friday by Science Friday and WNYC Studios

Science Friday

6,327 Listeners

This Week in Virology by Vincent Racaniello

This Week in Virology

232 Listeners

In Defense of Plants Podcast by In Defense of Plants

In Defense of Plants Podcast

1,243 Listeners

Immune by Vincent Racaniello

Immune

275 Listeners

Annals On Call Podcast by American College of Physicians

Annals On Call Podcast

188 Listeners

Short Wave by NPR

Short Wave

6,330 Listeners

Public Health On Call by The Johns Hopkins Bloomberg School of Public Health

Public Health On Call

623 Listeners

The Curious Clinicians by The Curious Clinicians

The Curious Clinicians

372 Listeners

MicrobeWorld Video HD by American Society for Microbiology

MicrobeWorld Video HD

4 Listeners

Infectious Disease Puscast by Vincent Racaniello

Infectious Disease Puscast

85 Listeners