Shivang joins the TWiP triumvirate to solve the case of the New Yorker With Rash and Pins and Needles, and reveal how agrochemicals increase risk of human schistosomiasis by causing high snail density. Hosts: Vincent Racaniello, Dickson Despommier, and Daniel Griffin Guest: Shivang Shah Become a patron of TWiP. Links for this episode: Even dinosaurs had parasites (Cosmos Mag) Why some people are wormier than others (RSTMH) Angiostrongylus species in badger lungs (thanks, Rachel!) Spread of rat lungworm (Hawaii News Now) Aussie teenager swallowed slug (news.com.au) Agrochemicals increase snail numbers (Nat Comm) Parasite Hero: Émile Brumpt Image credit Letters read on TWiP 149 Case Study for TWiP 149 31 yo man ulcer on let, 4 cm diameter. Raised borders, reddish and hard. Feels well, concerned not resolving. Started as bump, slowly enlarged, ulcerated, 1 month now. Healthy, no prior med, diabetes in mom. Works in field with machete, lives with family, social drinking, smoking. Lives in isolated villages on Northern Panama archepelago, many animals and insects. Homes are raised, slats on floor. No fever, normal bp hr, breathing low teens. Healthy athletic young man, otherwise good health except for ulcer on left leg. Non tender, no pain, base of ulcer red; no purulent material, borders raised but not undermined. Feels hard around edge, no scab. Did dermoscopic exam: erythema, small yellowish teardrops, small white starbursts. Send your case diagnosis, questions and comments to [email protected] Music by Ronald Jenkees

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