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Hosts:\xa0Vincent Racaniello,\xa0Dickson Despommier,\xa0and\xa0Daniel Griffin

The\xa0TWiP Masters\xa0solve the case of the Australian Wildlife Carer, and review evidence that nodding syndrome may be\xa0caused by an autoimmune reaction to the parasitic worm that causes river blindness.

Become a\xa0patron\xa0of TWiP.

• Nodding syndrome an\xa0autoimmune disease?\xa0(Sci Transl Med)
• Nodding syndrome: Preventable and treatable (Sci Transl Med)
• River Blindness\xa0lyrics (Google Play)
• Image credit
• Letters read\xa0on TWiP 129

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Young male in 30s, presents to ER with male partner, NY area, chief complaint over 1 month significant diarrhea, watery, non bloody. Abdominal cramping. Feels poorly, low energy, fever. Some vomiting, lost noticeable amount of weight, can\u2019t stay hydrated. Past: AIDS positive, not on meds, last CD4 <50, viral load elevated and uncontrolled. Non contributory family history, no meds. Social history: had worked in office, can no longer; lives with male partner; occasional alcohol, no pets, no other significant exposures. Partner also AIDS, also not on therapy. Physical: febrile, 38.5C, 115 bp, 95/65, 18 resp, thin male, clearly uncomfortable. Oral thrush in buccal mucosa. No subungual saliva. Lungs clear, abdomen diffusely tender, increased bowel sounds. Labs: elevated creatinine, BUN, decreased sodium, elevated WBC count with significant eosinophilia. No pets or houseplants.\xa0

Send your case diagnosis, questions and comments to\xa0twip@microbe.tv

Music by\xa0Ronald Jenkees