TWiP solves the case of a man in his 50s reporting months of abdominal discomfort, who takes mebendazole and some time afterwards vomits a worm into the sink.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• The giant intestinal worm, Ascaris lumbricoides (TWiP 21)
• Parasitic Diseases Lectures #24: Giant Intestinal Worm (YouTube)
• Letters read on TWiP 235
• Hero: Ernst A. H. Friedheim

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New Case:

I first learned about this case from a colleague at work who tells me that their friend has just gotten really sick. The friend is described as having had multiple illnesses over time but that he has never been as sick as he recently got. He reports that the illness began as a diffuse myalgia with fever, there was some sore throat, noted swelling in the neck, and overwhelming fatigue. He tells some of his friends that he is feeling really terrible and it turns out that some of his friends also feel poorly. It turns out that about a week prior to the onset of his symptoms he and a number of friends attended a large dinner where venison and boar was served. 

This individual is then seen in our office. Some testing is done. He feels really terrible and despite being reassured that he should get better without treatment he is given therapy.

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TWiP discusses hookworm infection and the phase 1 clinical trial for a hookworm vaccine that could one day protect children from the hookworm anaemia, and reduce transmission of this infection.

Hosts: Dickson Despommier, Daniel Griffin, and Christina Naula

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• Hookworm vaccines in school-aged children in Gabon (Lancet Inf Dis)
• Step forward towards hookworm vaccines (Lancet Inf Dis)
• Hookworm vaccine protects dogs (FASEB J)
• Hero: Muriel Robertson

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Music by Ronald Jenkees

TWiP solves the case of the physician with no significant previous medical history who is currently doing their fellowship training develops diarrhea, and presents a new clinical case for our astute listeners to solve.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Hero: Keith Vickerman
• Letters read on TWiP 233

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New Case study:

I was recently asked about this case while I was off visiting Denmark. A man in his 50s has been reporting months of abdominal discomfort and decides to go discuss this situation with a local pharmacist. He describes this discomfort, some nausea, and some bloating of the abdomen. The pharmacist recommends that he take mebendazole. He takes the mebendazole and some time afterwards he vomits a worm into the sink. The worm does not have any obvious segmentation and appears completely nonsegmented and is moving around. One end is very pointy and the other little less so. 

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Music by Ronald Jenkees

TWiP reviews the cellular lives of Wolbachia, a gram-negative bacteria that infects many arthropods and filarial nematodes with very different outcomes – parasitism or mutualism.

Hosts: Dickson Despommier, Daniel Griffin, and Christina Naula

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• Cellular lives of Wolbachia (Nat Rev Micro)
• Hero: Patricia F. Walker

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Music by Ronald Jenkees

TWiP solves the case of the Woman With White Worms, and presents a new clinical case to decipher.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Hero: Ann Bishop

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New Case study:

A physician with no significant PMH who is currently doing their fellowship training develops diarrhea. The diarrhea is significant enough that they are beginning to feel weak, lightheaded, and end up going to the local ER. The physician lives in NYC, works most of the time but did just get back from a week-long vacation in Florida with their long-term partner where they got a chance to swim in the pool and get some sun. They returned feeling well and then noted the onset of the diarrhea. The diarrhea was watery, with some abdominal cramping but no noted blood or actual fever. The stool did not have a strong smell and no floating stools were reported. The physician was given IVF and returned home feeling better but now gets a call that there is a parasite on the stool testing and is recommended to take a medicine they have never heard of 3x per day for 3 days. 

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Music by Ronald Jenkees

Maria Adelaida Gomez joins TWiP to discuss her career and the work of her laboratory on understanding the healing process during cutaneous leishmaniasis.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

Guest: Maria Adelaida Gomez

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• CIDEIM
• Healing in cutaneous leishmaniasis (J Immunol)

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Music by Ronald Jenkees

Eyal joins TWiP to solve the case of the Female Traveler with Intermittent Fever and Ring Enhancements in the Liver.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

Guest: Eyal Leshem

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Case Study for TWiP 229

Woman in her 40s is referred to me to be seen in the office from one of my colleagues. She reports that she has been having recurrent issues with worms exiting her anus and vagina since 2018. She reports that she lives with her husband and 4 children and they have never reported any issues. She reports that initially she took something over the counter and things resolved. She then a couple years later has this problem again and this time discussed the problem with her housekeeper from El Salvador who gave her an antiparasitic tablet from her home country. This problem has now recurred and she was referred to a GI doctor who she explains laughed at her and suggested she see a psychiatrist. She come in now very upset and tearful. She relates that she has this itching that wakes her up at night and was able to take pictures of something she found on the anus. She has photos as well as a video of a thin white 1 cm motile thing with on end coming to a point. 

She reports a normal nonrestrictive diet. She reports no travel outside the US or even outside the local area. No PMH, no PSH, family history of different cancers. She does not work outside the home. She reports no pets. She has an unremarkable exam and labs only notable for low vitamin D. 

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Music by Ronald Jenkees

TWiP discusses a tapeworm that causes extreme lifespan extension in infected ant workers, and a candidate antibody drug for prevention of malaria.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Extreme lifespan extension in tapeworm-infected ant workers (Roy Soc Open Sci)
• Candidate antibody drug for prevention of malaria
• Ceilidh goes viral (YouTube)

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Music by Ronald Jenkees

Jim Small joins TWiP to solve the case of the 41 year old Man with sudden GI distress and itchy hives, followed by a discussion of parasites and childhood stunting.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

Guest: Jim Small

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• Parasites and childhood stunting (Trends Parasitol)
• Letters read on TWiP 227

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Music by Ronald Jenkees

TWiP reviews some parasite stories of 2023, including progress in the control of malaria and polio, and review a connection between parasites and childhood stunting.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Second malaria vaccine (Nature)
• Malaria report 2023 (WHO)
• Malaria and climate change (WHO)
• Parasites and childhood stunting (Trends Parasitol)
• Sea creature spotted off Japan identified (Science)

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Music by Ronald Jenkees

Lee Gottesdiener joins TWiP to help solve the case of the 46 Year Old Man with Ongoing Upper Extremity Swelling, and review plant‑based production of a protective vaccine antigen against the bovine parasitic nematode Ostertagia ostertagi.

Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula

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• Vaccine against cow parasite (Vert Farm Daily)
• Protective vaccine against bovine parasitic nematode Ostertagia ostertagi
• Hero: Dr. Katy Ewer
• Letters read on TWiP 225

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Case Study for TWiP 225

41-year-old male mechanical engineer, former Army Ranger trainee, moved from Denver, CO to Chattanooga, TN. He was in his usual state of vigorous health, hiking, doing Spartan races, working on his semi-rural property,  and commuting to his place of work daily when about three months previous to his diagnosis, he began having episodes of sudden GI distress with diarrhea, followed by itchy hives in axilla and groin. He treated these episodes with Benadryl and got relief. At 10 PM one evening, he had another such episode, again took Benadryl, but began to experience gradual onset but relentlessly increasing shortness of breath and wheezing. He was taken at high speed to the Emergency Room by his wife. He reported that relaxation with a repetitive, meditative prayer seemed to control the symptoms but said it was like his throat was closing.

Past history includes variable exercise and cold-induced asthma treated with an inhaler as a child, with only rare episodes in adulthood related to high exposure to allergens like cat dander. Family history is not contributory. Diet was omnivorous. They had one dog, a labradoodle named Raphael, which they chose because he was “hypoallergenic.”

In the Emergency Department, he was treated with bronchodilators, intramuscular epinephrine, and antihistamines, and the symptoms abated.

The experienced ED physician ordered a diagnostic test, having seen other similar cases in the region. A lifestyle intervention was successful.