TWiP reviews the projected impact of climate change on the burden of Cryptosporidium in Mali, Kenya, and The Gambia.

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• Impact of climate change on Cryptosporidium (J Inf Dis)
• Letters read on TWiP 283
• TWiP study – information and survey

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Music by Ronald Jenkees

TWiP solves the case of the nonbinary patient in his 30s with a history HIV/AIDS presenting with 3 weeks of subjective fevers, chills, generalized weakness and voluminous ostomy output.

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• Parasite of the Month: Leucochloridium paradoxum (the green-banded broodsac)
• Letters read on TWiP 282
• TWiP study – information and survey

New Case

39-year-old man originally from Guatemala, who moved to one of the NYC boroughs in 2023 and currently lives with his siblings and cousins, presented with headaches. He reports headaches for several months, possibly nearly 1 year. Over the past 2 weeks, he has had intermittent numbness on the left side of his face and in his left arm and foot, with difficulty standing due to sensory changes in his feet. He states these symptoms are new. He reports a fall related to the numbness but denies balance problems. He denies fever or chills. He has intermittent nausea and vomiting but denies diarrhea, abdominal pain, or other complaints. He works as a busboy in a restaurant and states that he only cleans and does not prepare food. In Guatemala, he used to eat street tacos containing pork and beef, sometimes with undercooked meat. He is a former smoker who quit 4 years ago after smoking for 10 years. He drinks alcohol 3–4 times per week, typically 2–4 drinks per occasion, but not daily. He reports no sexual activity for 1–2 years.

General: no acute distress
HEENT: NC/AT, anicteric, vEEG
Neck: supple, normal ROM
Lungs: clear to auscultation bilaterally
Heart: S1, S2 present, normal rate/rhythm
Abdomen: Soft. Nondistended. Nontender.
Neuro: AAOx3, no obvious focal deficits
Extremities: No cyanosis. No edema.\
Skin: Warm. Dry. No visible rash.
Psychiatric: Appropriate affect and mood for situation.

CT HEAD WO IV CONTRAST-Cystic structures scattered along the subarachnoid space, for example, right sylvian fissure/frontotemporal cortical sulci, right > left suprasellar cistern, interpedicular cistern, basal cistern and left sylvian fissure. Associated mass effect with minimal leftward midline shift (0.2-0.3 cm). Calcifications at the left temporal region. There is no obvious acute intracranial hemorrhage.

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Music by Ronald Jenkees

TWiP reviews gene expression in wood ants infected with the larval lancet fluke, which causes them to leave their nest and attach to a flower until they are eaten by a grazing mammal.

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• Gene expression in wood ants infected with lancet fluke (Mol Ecol)
• Visualisation of the master manipulator in the brain of its ant host (Sci Rep)
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Music by Ronald Jenkees

TWiP solves the case of the 3 yo child, who recently immigrated to the US from Central America, in the ER with acute right lower quadrant abdominal pain and a rather active serpiginous wormlike 'thing' wiggling away in the child's appendix.

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• Hero: Rudolf Ludwig Carl Virchow (1821-1902)
• Letters read on TWiP 280
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New Case

3 yo child who recently immigrated to the US from Central America is brought in to the ER with acute right lower quadrant abdominal pain. The mother is concerned about the pain as well as nausea and vomiting. This is acute and the ER provider is concerned that this might be an acute surgical emergency. They order an US in this child and they are surprised to see a rather active serpiginous wormlike 'thing' wiggling away in the child's appendix. I was sent the Ultrasound video which I really enjoyed. What to do?

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Music by Ronald Jenkees

TWiP reviews a phase 2 clinical trial of a recombinant vaccine against N. americanus glutathione S-transferase-1, an enzyme that performs a crucial enzymatic step in
hookworm blood feeding.

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• Phase 2 hookworm vaccine clinical trial (Lancet Inf Dis)
• Phase 2 Schistosoma vaccine clinical trial (Vaccines)
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Music by Ronald Jenkees

TWiP solves the case of the male in his 20s from Hokkaido, Japan, who developed fatigue and rash, followed by fever and myalgia 6 days later, after eating a raw bear eyeball.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Hero: Sir Nicholas White (1951 – 2026) (Guardian, Lancet)
• Letters read on TWiP 278
• TWiP study – information and survey

New Case

3 yo child who recently immigrated to the US from Central America is brought in to the ER with acute right lower quadrant abdominal pain. The mother is concerned about the pain as well as nausea and vomiting. This is acute and the ER provider is concerned that this might be an acute surgical emergency. They order an US in this child and they are surprised to see a rather active serpiginous wormlike 'thing' wiggling away in the child's appendix. I was sent the Ultrasound video which I really enjoyed. What to do?

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Music by Ronald Jenkees

TWiP reviews the global, regional, and national burden of Chagas disease, and comparison of doxycycline and rifampicin for the treatment of onchocerciasis.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Burden of Chagas' disease (Lancet Inf Dis)
• Doxycycline vs rifampicin in treatment of river blindness (Open For Inf Dis)
• The kissing bug by Daisy Hernandez
• TWiP study – information and survey

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Music by Ronald Jenkees

TWiP solves the case of the man in his 60s experiencing weight loss, fatigue, and loss of appetite.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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• Hero: Bailey K. Ashford
• Letters read on TWiP 276
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New Case

Male in his 20s from Hokkaido, Japan, developed fatigue and rash, followed by fever and myalgia 6 days later. He was a group of five individuals on a hunting trip prior to this and reports that 3 friends are just fine but one other individual developed similar symptoms. He reports that they had been hunting the Ussuri brown bear, which is larger and more aggressive than the Asian black bear. They had been successful and all five of them had consumed well cooked bear meat. He does share that he is aware of infectious risk from eating bear and thus the meat was well cooked. He and the one fellow hunter who did get sick were unique in that they each ate one of the eye balls raw. This is a tradition that is felt to give the consumer the great vision that these animals are purported to have.

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Music by Ronald Jenkees