House S08EP15 “Blowing the whistle”
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.
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.