House S08EP17 “We need the eggs”
Only about a month of episodes left in the series before House rides off into the sunset. This week on House, the team takes on the case of a man who starts crying blood. The hijinks half of the episode is provided by House’s efforts to retain the services of his favorite “companion.” My quick Google searching for “tears of blood” turns up a variety of hits, most pointing at recent head trauma as the cause of the condition. Others remain a mystery! Back Tuesday morning, with the diagnosis recap and episode spoilers!
Full disclosure: I did not get to watch the episode this evening, as we only have one television, and my daughter wanted to watch Eureka, so I will rewatch House when it pops up next week On Demand. I did go through the episode recap on the Fox.com website however. As I surmised, head trauma was the very first diagnosis, and was discounted in about 2 seconds due to no evidence of head trauma. The patient Henry exhibits a number of recurring symptoms including respiratory “crackles,” liver failure, neurological dysfunction, and a fever spike.
A number of diagnoses are considered and discounted in turn: a sinus thrombosis, drug abuse, clostridial bacterial infection, and finally meningitis. It is this last diagnosis that turns out to be correct when House recognizes “a strange looking teapot” as a Neti Pot, a device that is designed to spray water into the sinus cavities in order to relieve allergy symptoms. House concludes that Henry has primary amoebic meningoencephalitis, due to infection with the protozoan pathogen Nagleria fowlerii, which was the point that I had to haul out the “Bogus” tag, due to the producers’ choice in trotting out an already extremely rare infectious disease for a second time on the show. The patient was put onto the anti-protozoan medication metridnazole to resolve the infection.
Nagleria infections are not common in the United States, with just 32 infections over the past 10 year period. Most cases of Nagleria infection occur during the summer months, particularly in the Southern tier states, as the organism is normally found in warm bodies of water and is acquired when people dive into the water forcing water into the nasal cavities. The seasonal and geographical associations make it extremely unlikely that two cases would occur in New Jersey, in mid-April (the last episode featuring Nagleri fowlerii aired almost exactly 6 years ago.)
The Centers for Disease Control Nagleria website does specifically include instructions how to minimize risks of infection using Neti Pots, so presumably this mode of transmission has been documented, but my quick search of Pubmed did not turn up any relevant hits, so I think it is safe to assume that the risk of acquiring amoebic meningoencephalitis via nasal irrigation is pretty minimal. The CDC’s recommendation for eliminating the risk is to use distilled water during irrigation or water that has been filtered to remove organisms, and to wash the device between uses.