House S08EP8 “Perils of Paranoia”
The producers of House have always done a good job of having a nicely balanced soundtrack; with this title, they hopefully will work the Kinks song into the episode somewhere. We are up to the Fall Finale, and if the screencap shown here is any indication, it’ll go out with a bang, or at least a pencil shot into Wilson. On this week’s episode, a local prosecutor apparently suffers an MI while interrogating a witness in court. The team thinks initially that it might be High Anxiety (and props in advance to the writers if they manage to work in a Mel Brooks homage), however the customary search of the patient’s domicile turns up a huge arsenal of weaponry, suggesting a more significant psychological disorder. Now updated with the case, and SPOILERS!
Well, that was satisfying for me! Ending the first half of the season with a rant about failure to vaccinate. House would have given a thumbs up for my recent rants. Our prosecutor, Tommy, shows multiple signs and symptoms throughout the episode, including chest pains, significant breathing irregularities, and hallucinations, which completely stumps everyone for the first 53 minutes. House’s moment of epiphany occurs in the scene in the screen cap above, when he realizes that something must be blocking Tommy’s airway, and deduces that it might be a pseudomembrane. A quick look into his trachea reveals this additional sign that had been over looked in the previous patient workup. The final diagnosis? Diphtheria, plus being an idiot for refusing to get vaccinated against common infectious diseases.
Diphtheria is caused by a Gram positive bacterium called Corynebacterium diphtheriae, whose major virulence factor is the appropriately named diphtheria toxin. Colonization by C. diphtheriae in the airway results in production of the toxin, which begins to damage the cells of the airway and beyond. The main treatment for diphtheria is antibiotics administered as early as possible, and for more advanced cases such as we saw this evening, the administration of antitoxin, a preparation of antibody which inactivates toxin in the antibody (artificially administered passive immunity). Long time readers of the BIO230 blog (meaning anyone from before the Fall 2011 term) will recall this posting from last spring, detailing the Nobel Prize-winning work of Emil von Behring, a German physician who first developed the serum therapy to treat diphtheria.
Was diphtheria a surprise to the team? Absolutely. According to the Centers for Disease Control, there has not been a laboratory confirmed case of diphtheria in the United States since 2003. Since 1980, the incidence has been about 1 in 100 million or less annually; prior to 1920 when a vaccine was introduced the incidence was about 1 in 1000, with a fatality rate with treatment of about 5 to 10 percent.Elsewhere in the world, diphtheria is considered an emerging infectious disease, and there have been massive outbreaks in the countries of the former Soviet Union since the 1980’s, with over 200,000 cases in that time. It is because of these alarming statistics that immunization against diphtheria is still maintained here in the US as part of the tripartite DPT (diphtheria-pertussis-tetanus) booster shot that should be given every 10 years.