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TWIP: Schistosomiasis Case

1:12:14 recording · AUTO · 3 speakers

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Brief overview

A pregnant Tanzanian woman's bloody, sticky diarrhea proved to be two parasites, Giardia and Entamoeba.

  1. Hickam's dictum: two parasites, one patientSticky fatty stool pointed to Giardia while the visible blood pointed to Entamoeba, and the stool exam found both.
  2. One drug covered both infectionsMetronidazole treats Giardia and amoebiasis, and is acceptable in the second trimester of pregnancy.
  3. Amoebiasis keeps three-times-daily dosingDaniel noted metronidazole moved to twice daily for anaerobic infections, but amoebiasis is still 500 mg three times a day for 10 days.
Executive Summary AI
  • Daniel Griffin presents a 32-year-old pregnant woman in northern Tanzania, dehydrated after three-plus weeks of sticky, bloody diarrhea, HIV negative, with low hemoglobin and elevated creatinine, who drinks river water and whose case Occam would confuse but Hickam would solve.3:20
  • Listeners split between schistosoma mansoni, Entamoeba histolytica and Giardia, while Christina Naula picked Giardia plus chronic schistosomiasis and Vincent Racaniello picked Giardia plus Entamoeba.31:17
  • The stool ova and parasite exam showed both Giardia and Entamoeba, confirming the two-parasite answer and showing why the lab, not the presentation, directs treatment.33:59
  • She was treated with metronidazole 500 milligrams three times a day for 10 days — amoebiasis still needs three-times-daily dosing, unlike anaerobic infections — plus fluids, and recovered quickly.35:14
  • Angela in Bristol won the signed copy of Parasitic Diseases, and Daniel opened a new themed case: a mother, daughter and son who found poppy-seed-sized objects embedded in their skin after hiking in the Outer Hebrides, the Cairngorms, Long Island and Cape Cod.38:49
Key Quote
“So I've been totally immersed in parasites this week.”
— Christina Naula1:09
Key Quote
“But before we do that, I want to remind you that we do these podcasts to give you real science, no misinformation, no lies, and we don't have ads.”
— Vincent Racaniello1:52
Key Quote
“So the Giardia is an obvious one because of the stool, but it doesn't cause blood, as Christina said.”
— Vincent Racaniello33:37