This Week in Parasitism

TWiP is a podcast about the tiny creatures that live in and on us.

TWiP 269: Peripatetic Martin Grobusch 11/21/2025

TWiP 268: A loyal parasite 11/09/2025

TWiP 267: It dropped from her scalp 10/21/2025

TWiP 267: It dropped from her scalp 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: , , and Christina Naula Guest: Subscribe (free): , , , Links for this episode Join the MicrobeTV Life cycle of Dermatobia hominis on TWiP 267 New Case 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 Become a of TWiP Send your questions and comments to /episode/index/show/twip/id/38728195

TWiP 266: Wraps and ivermectin for malaria 10/06/2025

TWiP 265: Things that jump are cleaner than things that squat 09/26/2025

TWiP 264: Toxoplasma changes your brain 08/29/2025

TWiP 263: Tick-tock 08/21/2025

TWiP 262: Do schistosomes affect behavior? 07/29/2025

TWiP 261: A case for Dr. Hickam 07/04/2025

TWiP 261: A case for Dr. Hickam TWiP solves the case of the pregnant woman from Tanzania with dehydration and 3 weeks of bloody stool, a situation that would confuse Ockam but not Dr. Hickam. Hosts: , , and Christina Naula Subscribe (free): , , , Links for this episode Join the MicrobeTV Hero: Dame Bridget Ogilvie ( and ) on TWiP 261 New Case I feel like the back section of our book has been a bit neglected. The new PD 8th Edition is posted on our website so please download a copy and extra points to anyone who can tell us what that is on the cover. Three individuals are involved here with a rather impressive travel history. We have a mom, a daughter and a son who reach out for guidance. Initially one of them found something small dark and about the size of a poppy seed embedded in their skin. This led to a more involved investigation where they found that all three had similar findings but some of these were larger, some a bit larger, one was actually described as mobile. They all feel fine and report no skin rashes. They have a number of concerns about what these are, if they might carry disease, what to do about removing them and should there be testing or treatment. The interesting travel and exposure history. They report that just prior to this they spent a week on a remote island off the coast of Scotland with extensive hiking in tall grass and boggy areas with deer, rabbits, and lots of sheep. An Island called Harris and Lewis and then just that Saturday hiking in wooded areas around Loch Ness and in the Cairngorns. Sunday out hiking and running on Long Island and then Wednesday when these mystery objects were found they had just been hiking and going for a run in Cape Cod. They report on Cape Cod the trail they followed had a fallen tree and they had to crawl underneath it prompting this skin inspection. -lots of questions here… What might these be and how do we identify them? Is the travel history relevant? Are there any timing issues that impact what we do? Should we try to remove these and if so how? Any testing or treatment indicated? Become a of TWiP Send your questions and comments to Music by /episode/index/show/twip/id/37228690

TWiP 260: Daily rhythms 06/24/2025

TWiP 259: Know your knowlesi 06/02/2025

TWiP 258: The deeper, the rounder 05/13/2025

TWiP 257: Malaya and Malaysia 04/20/2025

TWiP 256: Amazing antimalarial drug resistance 04/04/2025

TWiP 255: Katayama fever 03/22/2025

TWiP 254: Our hero Dickson 03/09/2025

TWiP 253: Sub-Saharan somnolence 02/22/2025

TWiP 253: Sub-Saharan somnolence TWiP solves the case of the man with somnolence and something extra-erythrocytic, and presents a new puzzle for you to solve. Hosts: , , and Christina Naula Subscribe (free): , , , Links for this episode Join the MicrobeTV on TWiP 253 New Case 26-year-old female with no past medical history. Patient is from Georgia in the US and is volunteering in Hérico, Guinea (town in the Lélouma Prefecture in the Labé Region of northern-central Guinea). She arrived in Guinea in December 2023. She was taking doxycycline for malaria prophylaxis and says that she has not missed any doses On October 2024 she presented with fever and dry cough. Lab work was done and follow up planned for the following day. The patient slept poorly, was febrile to 104 and had ongoing cough. The next day she went to the hospital and was evaluated in the ER for acute febrile illness of unclear etiology. In the hospital, VS were 97.9F, BP 105/70, P 94 Oxy sat 98%, normal physical exam. She was started on Augmentin and Coartem. Pause here to think about the differential at this point and maybe some more history and what testing you might want WBC 14, Hb 13, HCT 40, PLT 285, Neut abs 8, Eos Abso0.80; BUN/creat normal, AST normal; ALT 44, GGT 125 Stool parasite screen + for some sort of eggs, malaria smear negative, CXR with b/l infiltrates She was given a medication (vomited 30 min after dose received). She then received a second dose of medication 5 hours after the first) and was discharged. The following day the patient returned to the ER, stating that she felt worse. Her temperature had climbed to 104 overnight, and she developed watery diarrhea and nausea. There were no additional episodes of vomiting. She was given an additional dose of a medication, ibuprofen, and started on ceftriaxone 1 gm IV Q12 hrs. During the day she continued to have low grade fevers and developed abdominal pain. That night she was again febrile to 104 F. She remained admitted for 5 days with ongoing symptoms of diarrhea, nighttime fevers and diffuse abdominal discomfort. Three more malaria tests were negative (rapid test and slide review) Blood cultures collected – no growth She continued to have mild elevation of WBC and slight elevation of AST and ALT. The patient was transferred to a different hospital. They give her a different medication, and within 24 hours symptoms resolve. What is the diagnosis and what happened here with management? Become a of TWiP Send your questions and comments to Music by /episode/index/show/twip/id/35389995