House S08EP17 “We need the eggs”

Via Fox. com

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 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.


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 15, 2012, in Bogus!, House Party!. Bookmark the permalink. 6 Comments.

  1. This one sounds really interesting, as are most of the mysterious illnesses on House. Recent head trauma seems like it would be too simple for a House episode so I can only imagine where this symptom will lead us.

    • Updated on Tuesday morning; I had to break out a diagnosis of “BOGUS” for this one, but mainly because I do not yet have a “LAZY” tag to put on episodes.

      I think that re-using diagnoses is a symptom that the show has perhaps run its course, so it’s probably a good thing that it is winding up at the end of this season.

      • Two cases in a six year period is too frequent for this infection? House could never run its course its a classic!! Nowhere else will you find a cynical yet funny as hell, pill popping genius of a doctor making rare medical diagnoses! This show breaks tons of rules on all kinds of different levels which is why its so great. Every show is like a medical mystery puzzle with some funny comedy thrown in for good measure. The producers were banking on no one remembering a diagnosis that was shown almost a decade ago…

        • Some BIO230 stats for you: as of today (April 18, 2012) there have been 241 postings over the past 18 months, or roughly 1 post every two to three days. In that time, I have tagged something as “Bogus” a total of ten times, and in several of those the topics were specifically chosen for amusement value, or to make a scientific point. However, in 38 episodes of House that I’ve stuck up a post on, I found out this morning that I tagged that episode as “Bogus” a total of SIX times, for an average of about 16% of the time. Why did I call it “Bogus?” A number of reasons, and I think that I had a good argument with this episode. The writers have traditionally prided themselves on the ultimate plausibility of the medical condition on each episode, and while I won’t deny that Nagleria infection wouldn’t be possible, it certainly isn’t likely particularly twice in a geographical region (New Jersey) that doesn’t have outbreaks to begin with.

          I actually really liked the first episode that featured this diagnosis, and whenever I have a semester in BIO230 where I can discuss protozoan diseases, I like to illustrate Nagleria with that episode. In this episode, the rationale seemed completely forced, and according to the CDC website and the NIH website, not scientifically valid.

  2. What’s the purpose for the title of the episode…what do eggs have to do w anything??

    • It was a throw away line early on in the episode. House was interviewing a candidate for the role of “companion,” and she said that she liked Annie Hall, however she couldn’t come up with a reason except that it was the most popular of Woody Allen’s movies. Unacceptable for House, who said that she should have come up with something, anything with a prompt that big, including “but I needed the eggs.” This is the punchline to an old Woody Allen routine:

      A man goes to a psychiatrist and says, “Doc, my brother’s crazy, he thinks he’s a chicken.” The doctor says, “Why don’t you turn him in?” The guy says, “We would. But we need the eggs.”

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