House S08EP15 “Blowing the whistle”

Likely NOT part of the diagnostic process

On the next episode of House, we will follow the story of an Army veteran, who in his refusal to fill out his patient history, allows the show to comment on the importance of loyalty to one’s family. Plus, House is trying to pull one over on his team by making them think he is sick, and requires an intervention. Haven’t they realized yet that he is one step ahead of them?  Back Tuesday morning with a disease recap and SPOILERS:

The Army PFC has been charged with treason, as he leaked a highly classified incident report to the press.  As he was being taken into custody, he had a tonic-clonic seizure prompting his transfer to Princeton Plainsboro and House’s team. Other symptoms that develop during the episode include circulatory issues (abdominal bruising), pancreatitis, an inflamed spleen, liver problems, a spiking fever, and renal insufficiency.

House on the other hand has tricked his team into thinking that he is going into liver failure himself, by taking St. John’s Wort and acetiminophen, in order to provoke one of the team to go to Foreman behind his back. Even after 8 seasons, no one expected House to have been faking it until the end of the episode.  House’s final epiphany for the patient’s diagnosis comes here, with the final diagnosis of typhus.

Rickettsia are small bacteria—here stained red...

Rickettsia rickettsia, inside a tissue culture cell

Typhus is a bacterial disease caused by the obligate intracellular pathogen Rickettsia typhi, a small Gram negative bacterium that lacks a cell wall. Because it is an obligate intracellular parasite, it cannot be grown in pure culture on agar plates, and must be cultured in the lab by growing it inside tissue culture cells. Typhus is a classically vector-transmitted disease, which enters the susceptible host via biting insects such as fleas or lice.  A rickettsial-based disease was previously seen in this “BOGUS” episode of House two seasons ago, however in both cases the ultimate treatments are the same: antibiotics to clear the infection. All beta-lactam antibiotics are useless for Rickettsia, not because the pathogen is resistant to the antibiotic but because it lacks a cell wall. However, broad spectrum antibiotics such as tetracycline are effective.

Typhus and other Rickettsia diseases are considered endemic in the United States, but only about 100 cases are reported annually. Outbreaks of typhus occur with a breakdown in sanitation, which allows humans to come into more frequent contact with the rodent reservoirs and their insect vectors. Significant outbreaks occurred during World War I in American soldiers overseas, with control measures to eliminate biting lice were only poorly effective. Death by typhus was a common complication of other conflict-associated injuries. The patient in this episode of House contracted typhus while in Afganistan, where the incidence of disease is significantly higher than in the US and was a realistic mechanism for contracting the disease.

Next week on House:  House drops a bomb on Wilson. The possibilities are endless.

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About ycpmicro

My name is David Singleton, and I am an Associate Professor of Microbiology at York College of Pennsylvania. My main course is BIO230, a course taken by allied-health students at YCP. Views on this site are my own.

Posted on April 2, 2012, in House Party!. Bookmark the permalink. 3 Comments.

  1. Not actually going to be able to watch this tonight, as I am in Campbell Hall with the review session.

  2. “Even after 8 seasons, no one expected House to have been faking it until the end of the episode.”

    Chase should have stuck with his initial instincts. Early in the episode he said something to the effect of, “He’s fine, the only reason you think House is sick is because that’s what he wants you to think.” (I believe it was said to Adams.)

    I think that it is interesting that even though Chase is the only one who respects House enough to trust him and his judgement even after a near death experience that House “caused” earlier in this season, he was ultimately the one who went against his better judgement and undermined his boss.

    • Yeah, I wrote up the intro paragraph Sunday morning with the “Haven’t they realized yet that he is one step ahead of them?” comment. I was not in suspense with that plot line.

      Chase has become one of the most interesting characters in the entire show this season, mainly because they’ve actually taken the time to flesh out a bit of his backstory with a few episodes. After the same interval, they’ve really only had a single Foreman-centric episode with his brother a few seasons back.

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