This Week in Parasitism – Details, episodes & analysis

TWiP discusses a 41-year long human infection with Schistosoma mansoni, and CRISPR screens that reveal genes essential for Cryptosporidium survival in the host intestine.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• 41 year old Schistosoma infection (J Travel Med)
• Genes essential for Cryptosporidium survival in host intestine (Nat Comm)

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Music by Ronald Jenkees

TWiP solves the case about the female who traveled to Brazil and upon returning home felt movements under her scalp on the back of her head, and present another case for your solving, a man with abnormal brain MRI.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

Guest: Eyal Leshem

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• Life cycle of Dermatobia hominis (CDC)
• Letters read on TWiP 267
• TWiP study - information and survey 

Man in his 40s, married with 2 children, on Eliquis for a prior DVT, diet-controlled diabetes, who is admitted for evaluation of an abnormal brain MRI. He left AMA but then developed vomiting and returned.

CT- Large peripherally enhancing mass lesion in the deep left cerebral hemisphere is associated with considerable vasogenic edema/infiltrative nonenhancing tumor. Mass effect results in left-to-right subfalcine herniation and entrapment of the right lateral ventricle. Findings are typical for glioblastoma. Intracranial abscess tumefactive multiple sclerosis and brain metastasis may mimic this appearance. Recommend supplemental imaging evaluation including gadolinium-enhanced MR brain.

MRI- Dominant heterogeneously enhancing mass in the left basal ganglia/peri-insular region measuring 3.1 cm AP by 2.8 cm TR by 2.9 cm cc, with surrounding vasogenic edema resulting in mass effect and midline shift, as detailed above, concerning for high grade glial neoplasm versus metastasis. Additional leptomeningeal nodule in the right postcentral sulcus. Additional smaller peripherally enhancing lesion in the right lateral temporal region with suggestion of leptomeningeal component and measures approximately 0.8 x 0.8 cm, with mild surrounding vasogenic edema.

They do a biopsy and pathology comes back as: – Brain tissue with extensive necrosis acute chronic inflammation, and rare microorganisms (on permanent section)

-Brain, designated "left brain lesion", excision:

– Brain tissue with extensive necrosis acute and chronic inflammation, reactive gliosis and occasional microorganisms

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TWiP describes how a gut commensal protozoan influences respiratory disease outcomes by shaping pulmonary immunity, and body shape variation in lice that parasitize diving hosts.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Gut commensal shapes pulmonary immunity (Cell)
• The deeper the rounder (Sci Rep)

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Music by Ronald Jenkees

The Giardians of the Galaxy solve the case of the Woman With a Colonic Stowaway from Hispaniola, and discuss activation of intestinal tuft cells by Trichinella spiralis.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• T. spiralisand intestinal tuft cells (PNAS)
• Hero: Carl Theodore Ernst Van Siebold
• Letters read on TWiP 168

18 month old child, on medical mission for previous year with older sibling and 2 parents. Back in US for 2-3 months, just as leaving remote location were given dose of allbendazole. Call comes to Mom, child is at child care and has passed something. It is serpiginous, 5-6 inches in length, moving a bit. Not flat, but round. Child otherwise fine.

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Music by Ronald Jenkees

The Tremendous Trio solve the case of the Woman With Foul Steatorrhea, and reveal breakdown of the glycocalyx associated with severe and fatal malaria.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Glycocalyx and severe malaria (Clin Inf Dis)
• Hero: Bridget Ogilvie
• Letters read on TWiP 167

Woman 30 yo, traveled to DR, went to tourist part. On return for yearly physical, asked about her chronic constipation. She said does not have it any more, has normal bowel habits. A few weeks after her return this occurred. Primary care doc was intrigued, sent off some tests. Found Entamoeba hartmanni. What might the doc have done? What were the consequences of infection?

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Music by Ronald Jenkees

The Podfessors solve the case of the Teenager With Swollen Scrotum, and continue the story arc of Daniel's favorite cells, B-1 cells, and their association with protective immune responses in human Chagas disease.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• B1 cells and Chagas disease (Front Immunol)
• Daniel discovers B1 cells (J Exp Med)
• Hero: Bridget Ogilvie
• Image credit
• Letters read on TWiP 166

Recent consult from gastroenterologist. 61 yo woman on trip to Thailand, Cambodia for a few weeks. Developed diarrhea, took azithromycin, 3 days. Diarrhea continued, back in states now ongoing a few weeks. Left lower abdominal pain, bloated, gassy, loose stools, stick and foul smelling. Not sexually active, but is relevant. Not restrictive in what she ate. Drank bottled water. Did not eat raw items.

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Music by Ronald Jenkees

The TWiP team solves the case of the Four Year Old with Fever, Headache, and Cough, and discuss the release of extracellular vesicles from Leishmania amazonensis that manipulate the host immune response.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Crackles (Wikipedia)
• Extracellular vesicles released by L. amazonensis (Front Microbiol)
• Hero: Marietta Voge
• Image credit
• Letters read on TWiP 165

Still in Uganda. Young boy came from a distance to see Daniel, teenager with large swelling in scrotum, left side, 4-6 cm diameter, superior to testicle. Not only young man in area with similar problem. Daniel asked, are there people with large swollen legs? He said yes, my brothers wife, left leg is large, swollen, irregularity. Nontender. Can be transilluminated, and it glows.

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Music by Ronald Jenkees

The TWiP legends solve the case of Surfer Sans Septum, and discuss how two symbiotic bacteria in the tsetse fly allow colonization with Trypanosoma brucei.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• A Tale of Three Species (mBio)
• V.B. Wigglesworth (Wikipedia)
• VB Nimble, VB Quick
• Hero: James Paget
• Letters read on TWiP 164

Welcome to Uganda. Mother brings in 4 yo female child, end of rainy season, concerned that has one day of fever, headache, cough. On exam looks ill, unremarkable except rapid heart rate, localized crackles in right lower lung. Several children in family. Spends day swimming in local stream. Take care of animals. Help gather drinking water in morning. Live in dirt floor home, thatch roof, with animals around. Saw many others with same problem. What tests do you want to do?

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Music by Ronald Jenkees

The doctors of awesome solve the case of the Woman Who Visited Lebanon, and reveal that immunoglobulins protect the olfactory organ of trout against infection with the Ich parasite.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Mucosal Ig protect trout from Ich (PLoS Path)
• Hero: Sir Patrick Manson
• Letters read on TWiP 163

From here in US before leaving for Uganda: male has lesion affecting nose. Has been having problem with nose for 2 yr, in 40s, surfer, hit nose with board. Southern eastern Costa Rica. After that had blood and scabs from nose. Inside of nares, scab formed. Did not improve with time. Saw ENT doc on LI, said he hit nose and needs reconstructive surgery. Entire septum destroyed. 20+ years ago had non healing ulcer on left hand, saw physician in CR, was treated for 20 days.

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Music by Ronald Jenkees

The TWiP professors solve the case of the Baby With Pericardial Effusion, and discuss whether the flagellate without a flagella, Dientamoeba fragilis, causes human illness.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Patients with Dientamoeba fragilis infection (Am J Trop Med Hyg)
• Hero: Dr. Eloise B. Cram
• Image credit
• Letters read on TWiP 162

A fresh case. Woman in late 30s born in Palestine, moved to NY. Presented for care with sore throat, swollen lymph nodes. Married Lebanese man, he's still there, travel back in forth. Had been in Lebanon for 3 weeks before illness. Ate special raw meat dish while in Lebanon. No other animal exposure. Small children at home, works in office. No medical/surgical history, no meds. On exam, has posterior cervical lymphadenopathy. Otherwise normal exam. HIV negative. Low grade fever.

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

Music by Ronald Jenkees