House S08EP10 “Runaways”
On the next episode of House: an underage homeless patient (played by Jane Doe) needs a surgical procedure when her conditions worsen, but no one is available to give consent. She confesses that she ran away from her drug addict mother, but when Mom shows up at bedside, House’s team surmises that the situation may be deeper than they suspect. Meanwhile, some Foreman and Taub hijinks add some much needed comic relief. Will House’s “Yellow Albeo Anura” frog be up for the frog race? Back after the break with a disease recap and spoilers!
Our young runaway patient is avoiding her negligent mother, and has been doing pretty well on her own for a few years. Mom showed up at her hospital bed mid-way through the episode, and affirms that things weren’t great while she was actively parenting, but things weren’t all bad: how about that trip to Florida that we had? Jane Doe continues to worsen with all sorts of orifices spewing blood, until finally she loses consciousness mid-sentence, which House says is indicative of a cerebral aneurism bursting that he had warned about 15 minutes earlier. The only treatment that appeared to give any relief of the symptoms at all was some anti-inflammatory medication (steroid therapy).
House’s final epiphany moment occurs when he places some significance on the mother’s earlier remark about the trip to Florida. At this point, he makes the final diagnosis of ascariasis: a systemic infection by roundworms that generally is asymptomatic and localized to the gastrointestinal system, but at times can become systemic and cause the myriad of symptoms seen in this episode. The disease is common worldwide, with estimates of about one quarter of the world’s population being infected with the parasite, mainly in Africa and Asia. In the United States, ascariasis is considered an endemic disease, with up to 4 million people mostly infected subclinically; these estimates are determined by examining sewage catchment basins for the presence of ascaris eggs.
Humans are the definitive host for Ascaris lumbricoides, and the worm requires a human host to complete its life cycle. The female can lay up to 200,000 eggs that get passed in the feces, and the eggs are very durable and can persist in the environment until taken back up orally into another host. Treated sewage used as fertilizer in agriculture can then spread viable eggs onto crops, which represents a major US risk factor for acquiring ascariasis.
If we were going to look for a particular quibble in the episode, I would put it at the point of diagnosis: House made the call of ascariasis purely based on the symptoms exhibited by the patient, whereas the definitive clinical laboratory diagnosis is made based on the presence of the worms identified in a fecal smear slide. The recommended treatment however (high dose mebendazole for up to 3 days) would have little in the way of serious side effects, and would resolve the infection if it is present rapidly.