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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  CIDEIM Healing in cutaneous leishmaniasis (J Immunol)  Become a patron of TWiP Send your questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 230: Healing cutaneous leishmaniasis with Maria Adelaida Gomez

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Become a patron of TWiP 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.  Send your questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 229: The very hungry flatworm

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  Extreme lifespan extension in tapeworm-infected ant workers (Roy Soc Open Sci) Candidate antibody drug for prevention of malaria Ceilidh goes viral (YouTube)  Become a patron of TWiP Send your questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 228: Parasitic fountain of youth

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  Parasites and childhood stunting (Trends Parasitol) Letters read on TWiP 227  Become a patron of TWiP Send your questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 227: Alpha-gal syndrome

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  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)  Become a patron of TWiP Send your questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 226: Successful systems attract parasites

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  Vaccine against cow parasite (Vert Farm Daily) Protective vaccine against bovine parasitic nematode Ostertagia ostertagi Hero: Dr. Katy Ewer Letters read on TWiP 225  Become a patron of TWiP 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.

TWiP 225: Wandering worm with Lee Gottesdiener

Chuck Knirsch returns to TWiP to discuss the Neglected Tropical Diseases Roadmap published by WHO, which sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups. Chuck Knirsch returns to TWiP to discuss the Neglected Tropical Diseases Roadmap published by WHO, which sets global targets and milestones to prevent, control, eliminate or eradicate 20 diseases and disease groups. Hosts: Vincent Racaniello, Dickson Despommier, and Chuck Knirsch Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  Neglected Tropical Diseases Roadmap (WHO) World malaria report 2023 (WHO)  Become a patron of TWiP Send your questions and comments to twip@microbe.tv

TWiP 224: Neglected tropical diseases roadmap with Chuck Knirsch

TWiP solves the case of the Haitian female with AIDS and voluminous diarrhea, and review the pathogenesis, epidemiology, prevention and treatment of malaria and Chagas disease. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Click arrow to play Download TWiP #223 (63 MB .mp3, 88 minutes) Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode   Malaria (Lancet) Chagas disease (AJTMH) Hero: Joe Cook Letters read on TWiP 223  Become a patron of TWiP Case Study for TWiP 223 46 yo man with minimal pmh, elevated cholesterol, ongoing right upper extremity swelling, 5-10 years intermittently. Goose egg swelling on hand, foot. Lasts for hours, every few months. Go to ER, right upper extremity. Lives in NYS suburbs, Is vet and epidemiologist. Has done extensive travel, Liberia, Ghana, DRC, Uganda, Rwanda, 2 week duration. Doing work, fair amount of animal contact with bats, rodents, birds. PE unremarkable except for swelling of right arm. Blood work unremarkable. 2.5 yr later notice prickling irritation under right eyelid, think they see undulation under skin.  Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 223: Voluminous diarrhea

At the meeting of the American Society for Tropical Medicine and Hygeine in Chicago, Natasha joins TWiP to solve the case of the Man with a Generalized Seizure and Infectious Forms in the Brain. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Natasha Spottiswoode Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  Treatment of Balamuthia encephalitis with nitroxoline (Emerg Inf Dis) Letters read on TWiP 222  Become a patron of TWiP Case Study for TWiP 222 Haitian creole speaking, cachetic female in her 50s w/ hx HIV (noncompliant on medication), migrating from Haiti brought in by her daughter for dysphagia, cough x days, associated with NBNB vomiting, oral thrush extending to soft palate, concerning for oropharyngeal candidiasis. Weeks of nonresolving diarrhea. Admitted for failure to thrive and deconditioning, found to be Parainfluenza 3 positive), undergoing TB rule out. Diarrhea is voluminous, pt is dehydrated, there has been significant weight loss and lethargy over the last few weeks. MHx: HIV  Shx: Lives in haiti Remarried, Last sexual encounter 2 years ago. Denies illicit drug use. Drinks alcohol  Allergies: No Active Allergies Labs return with CD4 count in the 50s, elevated viral load. CD4 55/3% Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 222: Balamuthia in the brain with Natasha Spottiswoode

Michelle and Alexander join TWiP to solve their case of the 36 Year Old Male with shortness of breath, stinging pain in the extremities, fatigue, abdominal cramps, and bowel irregularities, and discuss host cell invasion by Trypanosoma cruzi. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guests: Michelle Naegeli and Alexander Grieb Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode   cAMP-dependent invasion by Trypanosoma cruzi (PLoS NTDS) Letters read on TWiP 220  Become a patron of TWiP Case Study for TWiP 221 This is the case of a  man in his 50s, with no remarkable prior medical history, who received care at a hospital in northern California, USA, after experiencing a generalized seizure. Magnetic resonance imaging (MRI) demonstrated a solitary left temporal lobe T2 hyperintensity with gadolinium rim enhancement and surrounding edema. After receiving treatment with dexamethasone and levetiracetam, he was transferred to an academic medical center. Examination by neurology consultants noted disorientation, inattention, moderate aphasia (difficulty communicating), and mild right hemiparesis. Cerebrospinal fluid (CSF) testing revealed increased nucleated cells up to 80/UL (60% lymphocytes, 17% neutrophils, 23% monocytes), protein concentration 38 mg/dL, and glucose concentration 100 mg/dL.  They proceed to do a brain biopsy from the left temporal lobe lesion with cultures from the brain biopsy sample that did not grow bacteria, fungi, or mycobacteria. They performed metagenomic next-generation sequencing (mNGS) on a CSF sample and sent brain biopsy samples for universal broad-range PCR amplicon sequencing (uPCR) for bacteria, fungi, Mycobacterium tuberculosis, and nontuberculous mycobacteria. which is preliminarily reported as showing well-formed granulomata with acute inflammation. Rereview of neuropathology raised concern for certain round infectious forms that are about 50um in size with some surrounding clearing and a dark area within these forms. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 221: Delusional parasitosis

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email 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 220: Denies any bug bites

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email 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 219: Sick as a dog

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email 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 218: Malaria parasite evades mosquito

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email 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

TWiP 217: ChatGPT solves the case

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 Subscribe (free):  Apple Podcasts, Google Podcasts, RSS, email 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 216: A challenging case

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 Subscribe (free): Apple Podcasts,  Google Podcasts, RSS, email 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 Become a patron of TWiP 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

TWiP 215: A mobile piece of spaghetti

Kay Schaefer joins TWiP to solve the case of the German Male with Hematuria, and discusses Tropical Medicine Excursions, which provides patient-oriented training courses for healthcare professionals who wish to improve their clinical skills in tropical medicine and travelers’ health in the endemic regions of Uganda, Tanzania and Ghana.   Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula  Guest: Kay Schaefer    Subscribe (free):  Apple Podcasts,  Google Podcasts, RSS, email  Links for this episode   Join MicrobeTV Discord server TROPMEDEX Letters read on TWiP 214   Become a patron of TWiP  Case Study for TWiP 214  Still in Uganda but now in a clinic in Entebbe. A boy, less than age 10, who grows up in very limited conditions, dirt floor home with other siblings presents with recurrent right upper abdominal pain, fevers, and first undergoes blood work that shows eosinophilia. He has an abdominal ultrasound performed which shows what looks like a mobile piece of spaghetti in the gallbladder with dilated ducts. He also has a stool examination performed.  Send your case diagnosis, questions and comments to twip@microbe.tv  Music by Ronald Jenkees

TWiP 214: Tropical medicine excursions with Kay Schaefer

Jessie Stone joins TWiP to solve the case of the Boy With a Swollen Belly, and discusses Soft Power Health, a clinic that she founded in Uganda to provide healthcare for people in need. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Jessie Stone Subscribe (free): Apple Podcasts,  Google Podcasts, RSS, email Links for this episode •Soft Power Health •Letters read on TWiP 213 Become a patron of TWiP Case Study for TWiP 213 A 49 y.o. German male is seen with significant gross hematuria. He reports no travel outside Europe but does report that he visited France twice, 7 years before and 1 year before. He reports swimming in the Solenzara River in the southeastern part of the island, near a busy campsite. He might have gone into the Gravona River in western Corsica near Ajaccio, at a turtle park and near a campsite, and at the Tavignano River. The patient also reported swimming in the Restonica River. He reports never swimming in the Cavu River and using GPS data from his smartphone and camera, he reconstructed his bathing sites precisely and this history was confirmed. Exam was unremarkable. Complete blood count was unremarkable and did not show eosinophilia. This complaint triggered cystoscopy and biopsies that were sent for histological analysis. These findings triggered referral to the Tropical Medicine department at LMU Hospital Munich. Now in the next episode we will have a guest to discuss this case as well as tell us a bit about themselves. I am hoping people will tell us what they think this might be but then perhaps do a bit of research and go into a little more detail. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 213: One deadly snail with Jessie Stone, MD

Shauna Gunaratne joins TWiP to solve the case of the Man from Mali with Painless Skin Lesions, and discuss her plans for a tropical medicine institute in New York City. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Guest: Shauna Gunaratne Click arrow to play Download TWiP #212 (51 MB .mp3, 84 minutes) Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode  Letters read on TWiP 212  Become a patron of TWiP Case Study for TWiP 212 14 year old boy with a history of slow progressive development of abdominal ascites over years.  Appears wasted and malnourished. Afebrile, no history of weight loss or night sweats, no history of TB exposure, HIV negative. Had an older brother who died the year before of apparently the same disease. Had lived early life by the shores of lake Victoria. Currently has really impressive abdomen. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

TWiP 212: The Man from Mali with Shauna Gunaratne

TWiP solves the case of the Man from Hong Kong with Multiple Comorbidities, and discuss safety and efficacy of a monoclonal antibody against malaria in Mali. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts,  Google Podcasts, RSS, email Links for this episode   Monoclonal antibody against malaria trial (NEJM) Hero: Stephen Hoffman Letters read on TWiP 211  Become a patron of TWiP Case Study for TWiP 211 Man in his 20s originally from Mali who comes in with a dermatological complaint about 1 mo after he returned from spending time in Bamako, Mali with friends and family. Reports this has been going on for months and he is getting very frustrated as he is not getting any answers. He relates that this started with itching over a “blackhead” resembling a pimple that was itchy and very small. Over the subsequent months it started to get larger with ongoing itchiness but no pain. No erythema or warmth in the area. Other lesions developed in addition to the first one. There was no drainage from the skin lesions. He started putting triple antibiotic ointment on his lesions that he bought from a pharmacy. He then went to his primary doctor who prescribed a topical medication and PO antibiotics but this did not help.  He reports that when in Mali he stayed in his house with his parents, siblings, grandmother and other extended relatives – more than 40-50 people under one roof. food made by his family, reports consumption of only cooked meat, no uncooked meat. Ate salads and uncooked vegetables. No contact with any animals, no pets in the home. Denies any contact with any pets or farm animals such as pigs, cows, horses, cattle. Denies swimming in any lakes or ponds. No hiking or outdoor activities. No riding horses. Was sexually active in Mali with women and is HIV negative.  On examination he has a 10 cm lesion over anterior L thigh, with verrucous and vegetative appearance with yellow crusting over central area and heaped up lesion, not undermined. No erythema, warmth or drainage. Has a similar smaller lesion measuring about 3 cm on R flank. Has a 3rd smaller lesion with some mild crusting and about 2cm over R posterior thigh. He ends up getting a biopsy that reveals: HISTOLOGIC FEATURES That ARE NOT DIAGNOSTIC.  THERE IS NO EVIDENCE OF any specific organisms.  THE EXOGENOUS MATERIAL WHICH COULD REPRESENT SOME TYPE OF FOREIGN BODY IS NOT IDENTIFIABLE AS PART OF A FLY OR ARTHROPOD, NOR IS IT TYPICAL OF A SPLINTER AND ITS PRESENCE IN THE SPECIMEN MAKES IT PROBLEMATIC AS TO ITS SIGNIFICANCE. MICROSCOPIC DESCRIPTION: WITHIN THE DERMIS THERE IS A DENSE DIFFUSE MIXED CELL INFLAMMATORY INFILTRATE INCLUDING MANY PLASMA CELLS AND NEUTROPHILS. THERE IS EXOGENOUS MATERIAL.  PAS, GMS, FITE AND GRAM STAINS ARE NEGATIVE FOR INFECTIOUS ORGANISMS. Additional testing is ordered that leads to the diagnosis. He is planning on returning to Mali and perhaps sooner than originally planned if h

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