Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin The TWiP Masters solve the case of the Australian Wildlife Carer, and review evidence that nodding syndrome may be caused by an autoimmune reaction to the parasitic worm that causes river blindness. Become a patron of TWiP. Links for this episode: Nodding syndrome an autoimmune disease? (Sci Transl Med) Nodding syndrome: Preventable and treatable (Sci Transl Med) River Blindness lyrics (Google Play) Image credit Letters read on TWiP 129 This episode is brought to you by Blue Apron. Blue Apron is the #1 fresh ingredient and recipe delivery service in the country. See what’s on the menu this week and get your first 3 meals free with your first purchase - WITH FREE SHIPPING - by going to blueapron.com/twip. Case Study for TWiP 129 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’t 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.  Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees