This Week in Parasitism Vincent Racaniello

TWiP solves the case of the Hiker from Queens who Denies Bug Bites, and reveal two different malaria experimental vaccines that target different parts of the parasite life cycle.
Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula
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Links for this episode Malaria transmission-blocking vaccine (Lancet Inf Dis) mRNA vaccine against malaria (Nat Immunol) Letters read on TWiP 220 Become a patron of TWiP
Case Study for TWiP 220
Sent by Michelle and Alexander from the First Vienna Parasitology Passion Club
A 36 year old male presents to the local ED with shortness of breath. Additional symptoms included a stinging pain in different parts of his extremities, fatigue, abdominal cramps and bowel irregularities. On exam he was resting comfortably and his vitals were normal, but the patient appears very distressed by his symptoms. His left eye showed signs of irritation, including redness and swelling. A detailed history reveals travel to the Caribbean about 4 years ago and several short trips to central and east Africa, all between 5 and 10 years ago. His initial labs were grossly unremarkable and a chest x-ray showed no abnormalities. The patient himself suspected a specific parasitic etiology of his symptoms, so we performed a number of serologies and stool examinations in search of  parasitic diseases. None of the tests revealed evidence of an ongoing infection. 
He is HIV negative and not sexually active at the moment. He has no pets and no other recent travel history. He eats a normal diet and has been out of work for two years.
Thank you for the opportunity to participate in this fantastic project! All the best, 
Michelle and Alexander from the First Vienna Parasitology Passion Club
Send your case diagnosis, questions and comments to twip@microbe.tv
Music by Ronald Jenkees

TWiP solves the case of the 19 month old Female Having Issues, and discusses the finding that selection for insecticide resistance can promote Plasmodium falciparum infection in Anopheles mosquitoes.
Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula
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Links for this episode Insecticide resistance in mosquitoes promotes Plasmodium infection (PLoS Path) Letters read on TWiP 219 Become a patron of TWiP
Case Study for TWiP 220
73 y/o M w/ no significant PMhs who is referred to ED for fever, lethargy and progressive weakness as for the past 2 weeks. Thursday of the prior week he went to his PCP and blood work was performed. CBC demonstrated RBC inclusions. Labs also demonstrated anemia,  thrombocytopenia, mildly elevated total bili and ALT.  He was started on PO azithromycin and atovaquone on Saturday, however, he has not noted much improvement. He was seen in our office Monday and reports intermittent fever to 102, continued chills . Additional symptoms include dark urine, chills, occasional diaphoresis. Normally patient rides his bike 15 miles a day and runs 3 miles per day but states now he barely has the energy to walk a few feet and is now in a wheelchair. He report that he regular goes for Runs in parks in Queens.
He denies any bug bites, tick bites, rashes, blood transfusions in the past year.
Send your case diagnosis, questions and comments to twip@microbe.tv
Music by Ronald Jenkees

TWiP solves two cases this week, the Man with Issues after COVID-19, and the Man with Left Arm Weakness, then describe how the malaria parasite evades mosquito immunity by glutaminyl cyclase–mediated posttranslational protein modification.
Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula
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Links for this episode Malaria parasite evades mosquito immunity (Proc Natl Acad Sci USA) Letters read on TWiP 218 Become a patron of TWiP
Case Study for TWiP 218
A fun twist for today. Did I mention recently I was spending time with Paul Calle at the Central Park and instead of Jeff Bezos showing up for Dinner Chevy Chase was there.
Here we have the case of a 19 month old female who seems to be having some issues. Lots of increased respiratory effort even with minimal exertion. Some issue with loose stools and then followed by the onset of facial swelling.  No sig PMH or PSH, fairly confident there is not smoking or drinking of alcohol and certainly not HIV+. On exam the increased respiratory effort that is audible.
Directed testing reveals canine coccidia and giardia in the stool.
So what is going on? Should I be worried about my daughter who has had lots of exposure?

Send your case diagnosis, questions and comments to twip@microbe.tv

Music by Ronald Jenkees

TWiP solves the case of the Man With Dog Exposure, and discuss rapid and spontaneous post-partum clearance of Plasmodium falciparum related to expulsion of the placenta.
Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula
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Links for this episode Post-partum clearance of P. falciparum (J Inf Dis) Letters read on TWiP 217 Become a patron of TWiP
Case Study for TWiP 217
We have two cases today!
A man in his 60s who provides IT support for a bank and all done via zoom and remote work is referred to me. He reports having issues after COVID diagnosis Sept 5th, 2022. He had 4 vaccine doses and with diagnosis was treated with Paxlovid. Feel better than about week 3 wakes up with URI symptoms for about one week and by the 28th was improving. He had cold agglutinins detected. Referred to ophtho by his primary with some eye discomfort and noted to have elevated intra-ocular pressure elevation. Sleep and fatigue were a problem but slowly improving. Cognitive issues noted but improving. 
He reports an issue a few years prior to this current problem where he developed fever, a sore throat, tender lymph nodes in the neck both in front and in the back. This resolved after about a week but was then followed by months of fatigue, sleep disturbances and not feeling well.  He reports no specific dietary preferences and reports no cat exposures. He saw several physicians and one did a number of blood tests. 
A man in his late 30s presented to an ER at an outside hospital prior to ultimately being transferred to an academic center in NYC.. He reports onset of left arm weakness that prompted him to come to the ER. He reports on pointed questioning that he had COVID about one month prior and felt he had fully recovered. He did have a headache that preceded the onset of weakness. The OSH triggers their stroke protocol and perform a head CT which reveals a hypodense lesion on the right side of the brain not consistent with a stroke.
A bit more history is obtained, some further testing is done,and based on this the patient is transferred on some sort of therapy.
Send your case diagnosis, questions and comments to twip@microbe.tv
Music by Ronald Jenkees

Eyal joins TWiP to solve the case of the case of the Feverish Patient from Israel, and reveals his training and experience with travel medicine in Israel.
Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula
Guest: Eyal Leshem
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Links for this episode Letters read on TWiP 216 Become a patron of TWiP
Case Study for TWiP 216
This is a case from one of my colleagues in North West China. Many years ago when I was asked to teach at Kunming University I had a plan to climb in the beautiful Tianshan mountains and again a second time when I ended up distracted at the southern edge of the Gobi desert and instead spent time in a Tibetian monastery. Stories for another day. For today we have:
A man right around age 30 who presented with right lower extremity weakness, numbness and issues with bowel and bladder function. When he was just a few years old he had reported dog exposure and had a lesion removed from his liver. No reported dog exposure since he was young. He is found to have a mass in the right upper buttock. His wbc is normal but ESR and CRP are elevated. He has a CT which reveals cystic lesions and significant destruction of L5 through the sacrum and coccyx.
What could this be and what is recommended as next steps.
Send your case diagnosis, questions and comments to twip@microbe.tv
Music by Ronald Jenkees

TWiP solves the case of the case of the boy in Uganda with a mobile piece of spaghetti in the gallbladder, and reviews papers on female genital schistosomiasis in rural Madagascar, and a volatile sex attractant of tsetse flies.
Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula
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Links for this episode •Female genital schistosomiasis in rural Madagascar (PLoS NTD)
•A volatile sex attractant of tsetse flies (Science)
•Letters read on TWiP 215
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Case Study for TWiP 215
This case was shared with my by a former student of the Diploma in Tropical Medicine and Hygiene course I coordinate, Prof Eyal Leshem, who is the Director  of the Institute for Travel and Tropical Medicine at the Sheba Medical Center in Tel Aviv and Clinical Associate Professor at the School of Medicine at Tel Aviv University, Israel. This case is of a 24 year old male who presented to the emergency room at the end of February with a 4 day history of fever, starting three weeks after he returned from a long trip.
He reports traveling in India during October of the past year. From November to early January, he stayed in Papua New Guinea, from where he traveled to Thailand, returning to Israel in early February. On admission he reports a daily fever up to 40 degrees C, which I think is 104 Fahrenheit. He also mentions an itchy rash and dry cough.
We learn a bit more about this patient. In Thailand, he received a five-day course of doxycycline due to a febrile illness, which resolved after treatment. During his stay in Papua New Guinea he hiked in the jungle, was bitten by multiple insects and also report finding leeches attached to his lower legs. One insect bite on his hip took a while to heal. He also reports swimming in multiple rivers. While travelling, he did not have unprotected sexual encounters but he admits to eating street food and home made food regularly. He received pre-travel vaccines and when he was in Papua New Guinea took Atovaquone Proguanil prophylaxis daily, discontinuing therapy a week after he flew to Thailand. On physical exam he is alert and oriented, vitals normal, the examination is unremarkable except for three cropped vesicles on his penis, which the patients says are itchy. A healed insect bite on his lower hip is also noted. His white blood count and differential are normal without eosinophilia. His haemoglobin is 13 g/dl, which is borderline normal and his platelet count is lower than normal with a count of 100,000 per microlitre of blood.
What is your diagnosis? What test or tests would you like to order to confirm your suspicion. We would like you to be as accurate as you can when identifying the parasite causing this man’s symptoms. What are special considerations you need to think about for treatment?
Send your case diagnosis, questions and comments to twip@microbe.tv
Music by Ronald Jenkees