TWiP solves the case of the middle-aged man with eosinophilia and a history of sexual activity with paid sex workers in Okinawa, and presents a new case for you to solve.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Letters read on TWiP 249

Woman in 30s or 40s goes to Belize and after returning notices a lesion on her face. She goes to see several physicians and despite a number of topical creams the ulcer on her face does not heal. She is then referred to our office where a certain parasitic infection is considered and we involve our friends at Columbia to help us with the diagnosis..

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Music by Ronald Jenkees

TWiP reviews the observation that infection of Azlheimer’s disease mice with Toxoplasma gondii reduces brain amyloid density globally and regionally.

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

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• Toxoplasma reduces amyloid in brain (J Inf Dis)
• Hero: Theodor Hiepe (Parasitol Res)

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Music by Ronald Jenkees

TWiP solves the case of the Manhattan man with pain on urination or ejaculation, and presents a new case for you to solve.

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

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• Hero: Charles Louis Alphonse Laveran
• Letters read on TWiP 247

A middle-aged male is referred to evaluation because of eosinophilia. This man is married, living here in the NY tristate area, and this was picked up on ‘routine blood work’ by his primary care doctor. This man had been in the military, serving as a marine, with time spent in Okinawa, Japan. This individual does report sexual activity with paid sex workers while in Okinawa  but has been monogamous with his current wife for many years. A number of investigations are done with a test coming back showing serological evidence of a prior parasitic infection and he was treated with an antiparasitic medicine with resolution of the eosinophilia. The eosinophilia returned and he was referred to us. Blood work is now down showing evidence of a viral infection that might explain why the eosinophilia returned after treatment. Pt is HIV negative. This was prior to the COVID-19 pandemic. He is on no medications and in general feels fine.

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Music by Ronald Jenkees

TWiP taps into Dickson’s knowledge of Trichinella to discuss an outbreak in humans who consumed rare bear meat, and the impact of globalization and climate change on the epidemiology of the species.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Outbreak of human trichinellosis (CCDR)
• Impact of climate change on Trichinella (Food Waterborne Parasit)
• Letters read on TWiP 246

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Music by Ronald Jenkees

Founder of Floating Doctors Ben LaBrot joins TWiP to solve the case of the 1 year old in northeastern Panama with a fatal leg infection, followed by a discussion of the history and mission of Floating Doctors.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Ben LaBrot

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• Floating Doctors
• Letters read on TWiP 245

A man in his early 20s comes in reporting pain when he urinates or ejaculates. He reports that he is sexually active. He does confide that he has been in a relationship with a woman but he had a sexual encounter outside this relationship about 2 weeks ago when they were on a break and he did not wear protection. He feels like he needs to urinate more often and describes thin white discharge from the penis. He reports that he has no history of any sexually transmitted infections and had no medical issues prior to this.

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Music by Ronald Jenkees

Lilach Sheiner joins TWiP to talk about her career and her work on engineering Toxoplasma gondii secretion systems for intracellular delivery of multiple large therapeutic proteins to neurons.

Hosts: Vincent Racaniello, Dickson Despommier, and Christina Naula

Guest: Lilach Sheiner

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• Engineering T. gondii for protein secretion (Nat Micro)

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Music by Ronald Jenkees

TWiP solves the case of the Woman with White Worms, and submits a new case involving a 1 year old in northeastern Panama with a fatal leg infection.

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

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• Enterobius, the pinworm (TWiP 19)
• Hero: Mary Pritchard

This case comes from Panama mid summer 2024. A provider for Floating Doctors working in the coastal region in northeastern Panama. This case involves a one year old, so the history is a bit difficult, but there may have initially been a scratch or some sort of break in the skin. Otherwise healthy but over a period of time this area expands and becomes a deep necrotic wound on the leg. Several other nearby wounds develop and become deep and infected. By the time this one year old is seen by the provider much of the leg appears eaten away. This is just the tip of the iceberg as a number of others develop similar wounds in the area. No prior medical history.

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Music by Ronald Jenkees

TWiP reviews a study showing that intestinal helminth infection impairs vaccine-induced T cell responses through an IL-10 pathway, which compromised protection against antigenically drifted SARS-CoV-2 variants.

Hosts: Vincent Racaniello, Daniel Griffin and Christina Naula

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• Worms impair COVID vaccines (Sci Trans Med)
• Heligmosomoides image (Wiki Commons)

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Music by Ronald Jenkees

Sean Murphy joins TWiP to discuss his career and the work of his laboratory to assess the daily natural history of asymptomatic Plasmodium infections in adults and older children in Katakwi, Uganda.

Hosts: Vincent Racaniello, Dickson Despommier and Christina Naula

Guest: Sean Murphy

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• Daily natural history of Plasmodium infections (Lancet Microbe)

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Music by Ronald Jenkees

TWiP solves the case of the AIDS patient who developed fever and watery diarrhea after drinking NYC tap water, and present a new case for your sleuthing.

Hosts: Vincent Racaniello and Daniel Griffin

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• Cryptosporidium (TWiP 18)
• Letters read on TWiP 239

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New Case

Man in his 70s originally from Mainland China, then Hong Kong who has been living in the US for decades is admitted to the hospital with fever for 6 days. He reports that he saw his primary care physician in Queens and was referred to the hospital after blood work revealed a sodium level of 123 and an increased monocyte count. Pt reports drenching sweats, lots of outdoor activity walking in local parks in Queens. He reports he does not feel particularly sick. PMH-HTN, BPH PSH-neg Social-retired, no wife, has one son, no pets, no exotic exposures or recent travel VS febrile to 39.5, tachycardia, meets sepsis criteria PE -unremarkable Labs, nl wbc, eos-0, elevated neutrophils and monocytes, Na-123, elevated AST, elevated ALT, low platelets, low Hct, CT Chest A/P unremarkable

Send your guesses to [email protected] with TWiP 239 in the subject line

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Music by Ronald Jenkees