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TWiP 35 Letters

Trudy writes:

The more I listen to your fantastic podcasts, the more I love them. wO0t. I am the Naples, Fl nurse/artist who has written before.

Because I did get the pleasure of tracking reportable diseases and conditions in Florida, I was struck to know that other states did not require reporting of giardiasis.
Thought you might find the link to the list in my state interesting.

I do have a question...if you answered it can you mention the podcast number, please? It is more of a TWIM question, but I would like both of your comments because of the urban gardening interest by Dr. D. When tomatoes were suspected of being the source of a widespread salmonella outbreak in the not too distant past, there was speculation that the organism was contained within the tomatoes' cells!!! I garden, was a biology art major before finishing my BSN. This made absolutely no sense considering the differences between animal and plant cell structure. Also, what does Dr. D. think of organic gardening?

You also may find it interesting that Florida does allow land application of bio solids after processing in a wastewater treatment plant. Considering some of the encysted pathogens, I always felt this was unwise. Not every County allows it.

All the best from your very loyal long learner with ear buds which are rapidly embedding as a result of your "infectious podcasts"...


Dang, you are the best, guys. Listening to the podcast about crypto right now.

Gave you 5 stars and wrote a "glowing review" (ala Mark Crislip) on iTunes.

Alexander writes:

Dear Drs. Despommier and Racaniello,

I've really enjoyed listening to your podcast and learning about all of the fascinating parasitic diseases that they don't teach us enough about in medical school. I'm a student at Boston University School of Medicine but currently taking a year off to do HIV research in Uganda. Among other things, I'm hoping to perform a retrospective study looking at the impact (if any) of soil-transmitted helminth infection on antiretroviral treatment outcomes in a cohort of HIV-infected individuals in rural Uganda.

At any rate, my real question for you has to do with treatment of schistosomiasis. I happened to be swimming in Lake Victoria last weekend (self-preservation is not one of my strong points...) and am thinking it may not be a bad idea to take some PZQ. My question is: how long does one need to wait after potential exposure to schisto for PZQ to be effective? My favorite new textbook, Parasitic Diseases 4th Edition by Despommier et al (have you heard of it?) says that PZQ is effective against the adult organism. However, it sounds like it takes several days for schistosomulae to migrate from the infection site to the liver, only then at which time they develop into adults. Provided that schistosomulae are also susceptible to PZQ and the drug has good subcutaneous tissue penetration, it should be fine to prophylax even within the first days after exposure. However, if this is not the case it may be necessary to wait some period of time to ensure that any schistosomulae have had time to transform into adult worms before administering PZQ. Any thoughts on this?

Finally, I just wanted to say thanks for taking the time to create and sustain TWIP. It's always a pleasure to listen in, and I'm actually finding the information you provide in the podcast (coupled with your wonderful textbook) to be quite clinically relevant here in Uganda.

Thanks, and all the best,

PS - here's an idea for a future TWIP episode: a review of clinically relevant (or otherwise interesting) interactions between parasitic infections and other infections, e.g. genital schisto increases susceptibility to HIV infection in women. I think one important and possibly under-emphasized point by Peter Hotez and others at the forefront of advocacy around NTDs is that it is valuable to target NTDs not only for the purpose of eliminating these infections themselves but also for mitigating any pathogenic synergy they might have with other more "sexy" diseases like HIV.

Cedric writes:

Dear Vincent and Dickson,

I recently read this paper discussing the phenomenon of self medication in animals. The authors speculate that this behavior was selected for, at least in part, due to the antiparasite properties of many of the plants, animals, or materials consumed by animals for reasons other than nutrition. I was wondering if Dickson had any more information on this process, and what his opinions are regarding the origin of self medication in regard to parasites.

Thanks so much for all of your work in developing TWiV, TWiP, and TWiM. Your discussions have given me a real head start in my undergraduate biology classes, and I look forward to every episode.


Ricardo writes:

Novel Drug Wipes out Deadliest Malaria Parasite Through Starvation

Theodore writes:

Good day (or night),

Starting from October I've listened to about half of the TWIVs, all the TWIMs and the TWIPs. I find them to be very enjoyable, the semi-Socratic method of teaching is quite refreshing. However, two particular subjects have been underplayed.

First Toxoplasma. The papers by Fekadu, Lindova and McAllister are great primers for the studies regarding the behavioural effects of T. gondii. The Gaskell one is by far the most interesting though. So, hands down, the leading theory for schizophrenia's etiology is an inappropriate level of L-dopa, the precursor for such molecules as dopamine and epinephrine. Depending on the population studied, seroprevalence of T. gondii induced IgGs among patients with schizophrenia is as high as 97.7%. Though there is some ambiguity as certain studies report a 42% seroprevalence amongst schizophrenics, compared to 11% in controls. Regardless of the exact rate, it has a statistically significant presence in schizophrenics and people with other mental health problems.

Just a correlation though. A tongue in cheek refute of correlative studies is the stork theory (will be paraphrased/butchered). The idea is that from 1970-1985 there was a surge in the German birth rate. At the same time, there was a surge in the stork population of Germany. Their coincidence was statistically significant. Of course, we know this is bupkis. Storks and babies aren't actually related. However, if we found that there was a drop in condom sales, we could have an aha moment, due primarily to the fact that we can name the mechanism for why that correlation actually matters.

Back to Gaskell, and the aha mechanism for toxo and schizophrenia. Their group shows that T. gondii has two fully functional enzymes specific for producing L-dopa, and they show that these genes are transcribed specifically when the parasite infects neural tissues, and that the enzymes produced do make L-dopa. We really can't prove that toxo causes schizophrenia with Koch's postulate since putting a brain parasite into a volunteer isn't all that nice. However, I'm flummoxed to think of anything else that is needed to point at T. gondii as the causative agent for some types of schizophrenia.

Ricardo writes:

Global warming wilts malaria


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