TWiP 285: Why Is Cyclospora So Hard to Contain? Parasitologists Explain the 2026 US Outbreak

TWiP solves the case of the NYC woman in her 30s who developed 3 weeks of significant watery diarrhea after eating at a Taco Bell Restaurant. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server Letters read on TWiP 288 Parasite of the month – Parelaphostrongylus tenuis — meningeal worm (brainworm) Wikipedia entry P. tenuis in ruminants (Food Animal Pract) P. tenuis in white-tailed deer (Int J Parasitol Parasites and Wildlife) TWiP study – information and survey New Case Early teen, otherwise healthy, develops rash, for a few weeks, problem at night. All over the body. Helps with backyard chicken coop, plays with chickens. Dad looks through bedding, finds tiny red mobile things. Suggest changing bedding, tell teen not to help with chickens. Then rash disappears in a few days. Become a patron of TWiP  Send your questions and comments to [email protected] Music by Ronald Jenkees

Mumtaz Balkhi joins TWiP to discuss phase 1 and 1b trials of the schistosomiasis vaccine SchistoShield which demonstrate that it induces functional immune memory responses in US and African populations. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Guest: Mumtaz Y. Balkhi Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server SchistoShield Phase 1 and 1b results (npj Vaccines) TWiP study – information and survey Become a patron of TWiP  Send your questions and comments to [email protected] Music by Ronald Jenkees

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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server 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. Become a patron of TWiP  Send your questions and comments to [email protected] 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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server Current Knowledge of Cyclospora cayetanensis (Comp Rev Food Sci Food Safety) TWiP study – information and survey Become a patron of TWiP  Send your questions and comments to [email protected] 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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server 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.  Become a patron of TWiP  Send your questions and comments to [email protected] 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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server Impact of climate change on Cryptosporidium (J Inf Dis) Letters read on TWiP 283 TWiP study – information and survey Become a patron of TWiP  Send your questions and comments to [email protected] 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 Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server 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. Become a patron of TWiP  Send your questions and comments to [email protected] 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. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server 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) TWiP study – information and survey Become a patron of TWiP  Send your questions and comments to [email protected] 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. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server Hero: Rudolf Ludwig Carl Virchow (1821-1902) Letters read on TWiP 280 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? Become a patron of TWiP  Send your questions and comments to [email protected] 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. Hosts: Vincent Racaniello, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Join the MicrobeTV Discord server Phase 2 hookworm vaccine clinical trial (Lancet Inf Dis) Phase 2 Schistosoma vaccine clinical trial (Vaccines) TWiP study – information and survey Become a patron of TWiP  Send your questions and comments to [email protected] Music by Ronald Jenkees