The TWiP crew solves the case of the Ecuadorian with Immunodeficiency and Chronic Diarrhea, and discuss oral transmission of Chagas disease in mice. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Become a patron of TWiP. Links for this episode: Imaging Chagas after oral transmission (Sci Rep) NJ invasive species strike team and app Red Mother Hero: Angelo Dubini Image credit Letters read on TWiP 156 Case Study for TWiP 156 While on ID consultant service on LI during July, asked to see woman in late 70s admitted for fever, confusion, diarrhea. 2-3 days of abdominal pain, nausea, vomiting. Week prior was a family party, drank two large glasses Scotch. Had watery, nonbloody diarrhea 4-5 times per day; vomiting 2-3 times/day. Developed 103F fever, headache, lost appetite, 4-5 days did not eat. Hospitalized. No one else in party became ill. 2005 had episode of turning yellow after visiting Nepal. No surgeries, no allergies, no diseases running in family. ITP on prednisone, other drugs listen to podcast as well as PMH. Social history: worked in retail shop in Kathmandu, retired. Born west Bengal India, moved to Kathmandu as teenager, lived until 50s in nice part of town. Moved to LI 25 years ago, returns periodically to Nepal, last in 2017 for 2 months. Earlier this month had done 3 day camping trip with family on LI in tents. Brought water to drink, no contact with animals. Belly: small liver on percussion, no enlarged spleen, fluid wave, belly distended, white count elevated 38,000, no eosinophils. CAT scan of belly: cirrhotic liver, some acidic fluid. Notice intracellular ring forms less than 4% on smear. Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees