This Week in Parasitism

TWiP solves the case of the adult female with a 2 year old child who develops anal irritation, but the child and the husband are fine.
Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula
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Letters read on TWiP 286
Hero – Otto Wucherer
TWiP study – information and survey
New Case
Recent case. Woman in 20s, lives in NYC, goes to urgent care with 3 weeks of significant watery diarrhea, not improving. Otherwise healthy, no travel, works in office in NYC, at some point prior to onset she ate at a Taco Bell. Put on twice a day medication, molecular test of stool confirms diagnosis. Don't know when, or what she ate. Trying to replenish fluid losses. Not immunosuppressed.
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Music by Ronald Jenkees

TWiP reviews our current understanding of the biology of Cyclospora, the parasite currently causing a large multistate outbreak in the US traced to contaminated lettuce, and why it is so difficult to control.
Hosts: Vincent Racaniello and Christina Naula
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Current Knowledge of Cyclospora cayetanensis (Comp Rev Food Sci Food Safety)
TWiP study – information and survey
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Music by Ronald Jenkees

TWiP solves the case of the 39-year-old man originally from Guatemala, who moved to one of the NYC boroughs in 2023 and presented with headaches for nearly 1 year.
Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula
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Letters read on TWiP 284
TWiP study – information and survey
New Case
Recent ID consult: MD/PhD mother doing research, married with child 2 yo, female develops anal irritation, husband is fine, child is fine. Parasitic etiology is considered. Referred to academic ID providers, turns out she had this etiology considered, had received some treatment, got a little better, symptoms returned, treated again, got better, symptoms returned. Got some hard to find testing equipment, and confirm suspicion. Treat once, then again in two weeks. Not any better, still irritation. What do we do? HIV neg, no prior medical issues, no travel. 
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Music by Ronald Jenkees

TWiP reviews the projected impact of climate change on the burden of Cryptosporidium in Mali, Kenya, and The Gambia.
Hosts: Vincent Racaniello and Christina Naula
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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.
Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula
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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