TWiP 175: None alone pathognomonic

The TWiP'ers solve the case of the Sudanese Boy With Fever, and reveal antibodies against that slow invasion of red blood cells potentiate other malaria-blocking antibodies.

Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin

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• Antibodies that slow malaria invasion (Cell)
• Hero: Sir Leonard Rogers (pdf)
• Letters read on TWiP 175

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70 yo man born in India, came to US 1985. Has not gone back for 2-3 years. Admitted with acute onset of fever, cough, not eating well. Was fine until a week ago, had lost consciousness, fever 102F. Negative cultures for urine and blood. Some kidney stones, type II diabetes, elevated cholesterol, no surgeries. No family medical issues. Started on vancomycin on zosyn. Works in post office, lives with house in private home. No toxic habits. Has history of hiking trip 1-2 months prior, in Rhode Island, in June. No pets, animals. Exam unimpressive. Labs: crit 25, hemoglobin 9. Platelets 39. Bilirubin 5.3. Liver enzymes slightly elevated. Chest CT clear, blood smear: anisocytosis, microcytosis, polychromasia, 4.3% reticulocytes. Daniel orders one test, 90 minutes later starts treatment. HIV negative.  

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Music by Ronald Jenkees