TWiP 280: The wriggling diagnosis

BERJAYA

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.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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New Case

A nonbinary patient in his 30s with a history HIV/AIDS (CD4 <100, VL is very elevated, not taking ART  on a regular basis, hx Mpox s/p tecovirimat, HHV8 w KS, genital/gluteal condyloma acuminata (genital warts), invasive rectal SCC, hx MRSA perirectal abscess w fistula status post diverting loop colostomy and chronic anorectal pain, DVT and PE formerly on Eliquis, CVA 2024, bipolar disorder presenting with presenting with 3 weeks of subjective fevers, chills, generalized weakness and voluminous ostomy output.

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Music by Ronald Jenkees

TWiP 279: Tolling for hookworms

BERJAYA

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.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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Music by Ronald Jenkees

TWiP 278: Trichinella from eating bear eyeballs

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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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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 277: Rif-ing on river blindness

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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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Music by Ronald Jenkees

TWiP 276: Travel history is the key

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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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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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TWiP 275: Novel malaria vector control

BERJAYA

TWiP reviews the effectiveness of long-lasting spatial repellent emanators against malaria in humanitarian crisis settings in northern Nigeria, and Dengue suppression by male Wolbachia-infected mosquitoes.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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TWiP 274: Four tablets for bloating

BERJAYA

TWiP solves the case of the 40 year old male who travels to India and develops intestinal bloating and diarrhea.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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New Case

I am asked to consult on a man in his 60s who is experiencing weightloss, loss of appetite, and fatigue. He who was born in El Salvador, came to the US at age 19, former 40 pack-year smoker (quit 2007), w HTN, HLD, preDM, GERD. He reports that over the last 3 weeks prior to this admission he lost 50 lbs, has anorexia, fatigue. Had 1 instance of post-prandial NBNB emesis (attributes to overeating). Also reports syncopal episode 1week PTA, relays was diaphoretic getting up from bed and passed out, presented to OP cardiologist for cardiac evaluation w/o reported abn and told that he was likely dehydrated and does not need to present to ED though labs at that time with elevated WBC and low Na. He goes to the ER anyway and 

Er Vitals – tmax 39.1C, HR 70s-90s

– WBC 20.85, H/H 11.7/34.5 (microcytic), PLT 561; Na 127 -> 125 (s/p IVF), gamma gap 5 (albumin low at 3), ALP 196, AST 67, ALT 75; lactate 3.8 -> 1.2 

– CXR, CTH NC: no acute finding

– CTAP IC: Gastric mass exophytic from the gastric antrum with associated lymph nodes in the adjacent mesentery and suggestion of direct extension into the left lobe of liver. These are suspicious for malignancy. 

US-Liver: Heterogeneous, multiseptated hypodense lesion measuring 6.3 x 6.9 x 8.0 cm, visualized within the right hepatic lobe without internal vascularity on color Doppler. Additionally, there is a 2.7 x 2.3 cm heterogeneous, multiseptated hypodense lesion within the left hepatic lobe.

Dive deeper into the history and he reports that right before he became ill he visited his mother in El Salvador for 3 days and then after returning to the US had some loose stools and began to feel ill. 

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TWiP 273: Intestinal parasites in dogs

BERJAYA

TWiP reviews intestinal parasites in dogs and their association with clinical manifestations of canine visceral leishmaniasis.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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TWiP 272: Don’t look and you won’t find

BERJAYA

TWiP solves the case about the man with positive Strongyloides serology who is waiting for a kidney transplant.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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New Case

40 year old man travels to India, is only there for a week before he develops problems. Bloating, diarrhea. Weathers the storm. Returns to US. Stool sent for testing. Some interesting results. Comes back positive for Hymenolepis nana, Blastocystis hominis, Giardia intestinalis. Recommended he take four tablets. Flatulence. HIV negative. He ate food that were prepared in the home but also out. Delhi area. 

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Dear TWiP listeners,

Have you ever wondered how TWiP shapes your understanding of science? We have! To find out more, Christina and the team are running a survey based study to learn more about how TWiP contributes to your scientific literacy and trust in science. Listen to the segment in this episode (TWiP 267) where Christina discusses the study’s aims and scope.  

Anyone who listens to TWiP can participate. The survey is anonymous and we do not collect personal data that could identify you. There are no potential disadvantages or harms in taking part, other than using a few minutes of your time. You will receive no direct benefit from taking part in this study. However, the information that is collected during this study will give us a better understanding of who our listeners are, and why they choose to listen to TWiP. We can use this understanding to make TWiP even better!

This is an academic study and we aim to disseminate our findings to the wider public, including you. For example, we’ll have a conversation about the findings on a future episode of TWiP, we plan conference presentations and publication in a relevant academic journal

The project has been reviewed and approved by the University of Glasgow College of Medical, Veterinary & Life Sciences Ethics Committee. Application 200250013

You can find the study, detailed participant information, and consent information here: 

TWiP study – information and survey 

TWiP 271: The silent lesion

BERJAYA

TWiP explores female genital schistosomiasis and associated genital infections in Southern Malawi, a neglected tropical disease.

Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula

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Music by Ronald Jenkees

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Christina Naula, Ph.D.


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Daniel Griffin, M.D.,

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Vincent Racaniello, Ph.D.


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