This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 4 of season 1, called Maternity, Newborn babies in the hospital are becoming ill due to an epidemic. After an investigation, which includes giving them different antibiotics (used against bacteria), it turns out all babies were actually infected with a virus called echovirus 11. They got it through teddy bears in the hospital. The teddy bears were covered with the virus since the lady delivering them was carrying the virus herself.

Dr. House checking babies around the hospital to see if they’re sick. Photo by Fox Broadcasting Company. Credit: Darren Michaels/FOX.

Danger level: High

What is it?

Echoviruses are viruses that belong to a family of viruses called enteroviruses. There are 32 types of echoviruses, each having a number. The House episode dealt with type 11. Infection with it in the first 2 weeks of life can cause a severe disease which can lead to death.

Who gets it?

Several studies have shown that the enterovirus family of viruses accounts for more than 50% of visits to the ER by infants and young children during the spring and fall time.

Infections are more common among people from lower socioeconomic status, since overcrowded living conditions and poor hygiene can contribute to transfer of the virus.

These viruses are known to cause widespread outbreaks.

The infections are more common as age decreases – meaning they are more common in babies than in older children and adults.

What causes it?

People get infected with echoviruses by contact with other people. Usually they’re transferred by feces – meaning someone who was in touch with infected stools didn’t wash their hands very well and contacted another person. Sometimes it can be transferred from mouth secretions (as happened in the House episode, where the old lady’s secretions covered the teddy bears).

The virus can also be transmitted through contaminated water or food, and also through contaminated swimming pools.

These viruses can replicate in our mouth and nose. Most of them, though, are swallowed and reach out intestines, where they multiply. From there, they reach the blood, using it to get to organs in our body, such as the brain, liver, spleen, bone marrow, heart and lungs. In these organs they continue to multiply.

After about 4-6 days from the time the baby (or adult) was exposed, they reach the blood again. At this time symptoms start to show.

Echovirus 11. This is how the bugger looks like under a microscope.

How does it feel?

Echoviruses can cause a few things:

1. Fever – This is the most common symptom in young infants and children. The fever usually starts suddenly, and is often accompanied by irritability of the child.

2. Rash

3. Meningitis – This is an inflammation of the brain’s coverings. You can read about it in our article here.

4. Encephalitis – This is an even more serious condition than meningitis, since instead of the brain’s coverings being infected, the brain itself is inflamed.

5. Muscle and joint infections – It can cause muscle aches, which usually resolve after the infection.

6. Pleurodynia – This is a condition which causes attacks of pain in the lower chest. It’s also called Bornholm disease.

7. Myopericarditis – This is an inflammation of the heart’s muscle and its coverings. This is what killed the babies in the House episode.

How is it discovered?

The virus can be found in the blood or other infected organs in the body.

How is it treated?

In spite of what was shown on the House episode, there isn’t any specific treatment for the virus. There are studies being conducted on some new drugs, but none has been shown to work so far.

Many of the babies getting encephalitis die, although children and adults have a better outcome. Most of the people getting myopericarditis actually live and go on with their lives without any leftovers, in contrast to the House episode.

The best thing you can do is practice basic hygiene, such as hand washing, especially when in contact with sick people. Also disinfection of contaminated surfaces can help to stop the spread.

If you’re a pregnant woman close to giving birth you should avoid contact with people who are infected with an echovirus. If you are pregnant and get infected, delivery shouldn’t be hasted. On the contrary – waiting gives the fetus more time to get protection through your blood.

Related posts:

1. Subacute Sclerosing Panencephalitis (As Seen on House MD)
2. Rabies – All You Need To Know (As Seen on House MD)
3. Neurocysticercosis – The Worm That Attacks Your Brain (As Seen on House MD)

This is part of our House MD Project series.

Click here to read the connection to the episode (spoiler alert!)


On episode 2 of season 1, also known as Paternity, Dan, a 16 year old gets hit in the head during a lacrosse game. He also has night terrors and double vision. After a few mis-diagnoses (including sexual abuse and multiple sclerosis) the team (or, rather, Dr. House) arrive at the correct diagnosis of subacute sclerosing panencephalitis.

Dr. House asking his team to run unethical DNA tests on episode 2 of season 1. Photo by Fox Broadcasting Company. Credit: Danny Feld/FOX.

Danger level: High

What is it?

Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurological disorder characterized by inflammation of the brain (encephalitis = brain inflammation). It’s associated with infection of the brain with the measles virus.

Who gets it?

SSPE is rare. Before the measles vaccine was used, in the 1960’s, it was more common (and even then pretty rare – 0.61 cases per million people). In the early 1990’s only 2-3 cases per year were discovered in the US.

SSPE usually happens when people are infected by the measles virus at an early age, before the age of 4, and mostly before age 2. It then affects the infected person 7-13 years after the infection.

SSPE is twice as common in males as it is in females. It also tends to happen less in people living in cities, and more in rural areas. It’s also more common in children of Hispanic origin.

What causes it?

Usually, an infection by the measles virus tends to subside and the virus goes away. In SSPE, there appears to be a persistent infection with a virus that had somehow changed. That virus stays inside the cells in the brain for several years. After 7-10 years it starts attacking the cells in the brain that previously protected it.

This causes an inflammation in the cells which eventually leads to their death.

The measles virus. In SSPE it destroys brain cells.

How does it feel?

The disease can appear anywhere between age 1 and 30, but is more common in children and adolescents, as it usually begins 7-13 years after the infection with the measles virus occurred.

The disease has 4 stages:

In stage 1 subtle changes in behavior or school performance appear – including irritability, reduced attention span, or temper outbursts. This stage may be missed since the symptoms are mild.

In stage 2, a phenomenon called myoclonus is observed (which was also seen in the House episode). This is a brief, involuntary twitch of a muscle or a group of muscles.

In stage 3 there are no more involuntary movements. Instead, other, more severe types of movement problems appear, including something called choreathetosis (dancing movements), immobility, rigidity of muscles. These result from the destruction of areas in the brain responsible for movement.

In this stage, the infected person’s consciousness also deteriorates and can lead to a coma.

In Stage 4 brain areas that control our breathing, heart rate and blood pressure are destroyed, leading to death.

How is it discovered?

If the clinical stages above are seen by a doctor this might give a clue to SSPE. Also, at least one of these findings has to exist in order to diagnose SSPE -

1. Detection of antibodies – Antibodies are molecules the body produces to fight infections. Once we are infected, they may be found in the blood. Here, we actually look for antibodies not in the blood but in the spinal fluid, which runs throughout our brain and spinal cord. This is done by taking a sample from the spine, usually by inserting a needle to the lower back.
2. Findings on EEG – EEG is a tracing of our brain’s electrical activity, much like an ECG can show the electrical activity in our heart. In SSPE, the EEG has a certain pattern that can be seen in stage 2 of the disease.
3. Brain biopsy – This used to be more common. A part of the brain was taken to examine it under the microscope and see if the virus is there. Today it’s no longer done routinely.

Example of an EEG. Photo by Der Lange.

How is it treated?

Usually no specific treatment can be offered to people with SSPE, in contrast to what was seen on the House episode. On that episode, treatment with a drug called interferon was given to the kid, which cured him. Studies made on such treatment showed that only about 30% of people treated with it improved.

What happens after treatment?

Most people, unless rarely cured by the treatment, die within 1-3 years.

SSPE can be prevented if the initial infection by the measles virus is prevented. This is done by taking the measles vaccine.

Related posts:

1. Echoviruses (As Seen on House MD)
2. Rabies – All You Need To Know (As Seen on House MD)
3. AIDS (acquired immunodeficiency syndrome) – All You Need To Know

Turns out China is going to become the first country to provide vaccines for its population for swine flu, starting soon (a matter of weeks, it seems).

Who will get priority for being the first to receive the vaccine?

• About 200,000 people taking part in the 60th anniversary of the founding of the People’s Republic of China.
• Students aged 5-19
• People with medical conditions
• Pregnant women

The only problem? No mass vaccinations have been done with this vaccine yet, so the side effects it might cause are still unknown.

Another problem is that this vaccine is only suitable for people aged 3-60. On the other hand, most casualties from the disease so far have been of relatively young people.

Now one question remains: When will this vaccine reach the rest of us…

China set to provide first swine flu vaccines (via CNN)

Related posts:

1. The Swine Flu Poll – Results
2. In The News – Swine Flu (Influenza) – All You Wanted To Know
3. Swine Flu – 7 New Facts

Summer’s going away, at least around these parts of the woods. Many of you may be going to the pool to enjoy what’s left of it. Read on to find out about otitis externa – an ear infection you can catch while swimming there.

Danger level: Medium

What is it?

Otitis externa is an inflammation of the outer part of the ear causing earache.

Who gets it?

In the US, otitis externa happens to 4 out of every 1000 people each year.

It’s most common in swimmers, divers, and others whose ears are exposed to water for a long period of time.

It can be seen in all ages, but is most common around 7-12 years.

What causes it?

Our ear has an inner and an outer part. The outer part is the one spanning from the ear you can see, inside until the eardrum. The inner part is the part which comes after the eardrum. When your outer ear gets inflamed, the condition is called otitis externa. When the inner part gets inflamed, it is called otitis media, which we will cover in a future article.

Our ear is built so that infections will not occur in it. To prevent infections from happening, it has a few things going for it:

1. Cerumen (earwax) – This is a substance which created an acid environment in our ear. This repels bacteria and prevents infection. It also repels water, and collects debris in the ear, moving it out of the ear.
2. The ear’s shape – Our ear canal has a downward direction. This helps us get rid of water accumulating in the ear.

In swimmer’s ear, bacteria overcome these defenses and cause an infection and inflammation in our ear. How can they do that?

1. Swimming a lot (or getting a lot of water in your ears for other reasons) thins out the earwax, making it less protective.
2. A breakage of the skin can happen – This can happen when using a cotton swab (Q-tip) to clean the ear. It is recommended that you don’t clean your ears using a cotton swab, as this can expose you to an infection. Believe it or not, our body gets rid of the excess earwax by itself, and you really don’t need to mess with it.

How does it feel?

Swimmer’s ear can cause pain. The pain may get worse by touching the earlobe or when chewing.

Other things which can be felt include itching, a feeling of fullness in the ear, a yellow discharge from the ear, redness in the ear canal or skin of the ear.

Otitis externa (swimmer’s ear). Photo by Dale Miller.

How is it discovered?

Usually, a physical exam in which the doctor will look at your ear canal with an otoscope to see that it’s red and swollen.

How is it treated?

Otitis externa is treated using eardrops which contain antibiotics (which fight the germs causing the infection) and sometimes also steroids (which lessen the inflammation in the ear).

What happens after treatment?

Most people improve within 48-72 hours of starting the antibiotics.

If not treated properly, two things can happen:

1. Chronic otitis externa – This is defined as an infection which lasts more than 4 weeks or happens more than 4 times a year.
2. Necrotizing otitis externa – This usually happens to diabetics and older people. In this case, the infection spreads to the bones around the ear, which can also damage nerves in the area and may lead to death.

The bottom line – How do I avoid it?

1. Keep your ears dry – Dry them after swimming or showering. You can do this by shaking your head to remove water from the ear canal, or using the corner of a towel.
2. Don’t use any foreign objects in your ear – And yes, this includes cotton swabs. Also fingernails may damage the ear canal, so don’t poke fingers inside to clean the ear.

This video, featuring Dr. John Hong of NBC, sums it all up:

Related posts:

1. Labyrinthitis – An Ear Infection Causing Loss of Balance
2. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)
3. 8 Home Remedies for Summer’s Problems

A few days ago it was announced that Scientists were able to isolate two antibodies responsible for resistance to the disease in an African patient. What does this mean, exactly?

We will cover the new discovery in an article here in a couple of days, but first, what is AIDS and what causes it?

Danger level: High

What is it?

AIDS is a disease caused by the human immunodeficiency virus (HIV), causing your body to be susceptible to infections.

Who gets it?

In the US, there are about 1.1 million people living with an HIV infection, with 250,000 more infected and not knowing about it. About 56,000 new infections occur each year.

Around the world, more than 33 million people are infected, most of them in developing countries, mainly in Africa and Southeast Asia. More than 20 million people have died of AIDS worldwide.

In terms of sex, most infections occur in men through homosexual contact, but the frequency of infection in women is rising (worldwide 50% of infected people are women, while in the US only 25%).

Age-wise, most cases occur between the ages 25-49.

There are certain risk factors which put you at a greater risk of getting infected. They include:

1. Having unprotected sex with multiple partners – This means not using a condom every time. This is because the HIV virus is transmitted through semen.

2. Having unprotected sex with someone who’s HIV-positive – Meaning they are infected with the virus.

3. Having another sexually transmitted disease – These tend to raise your risk of acquiring HIV.

4. Sharing needles during intravenous drug use – Since the virus can also be transmitted through the blood.

What causes it?

As mentioned above, AIDS is caused by an infection with a virus called HIV (or by its long name, human immunodeficiency virus), shown in this picture:

HIV – This is how the virus looks

The process of infection with the virus goes like this:

1. The virus is transmitted from person to person – As mentioned above, this can happen when having sex, when sharing needles while using IV drugs, when getting blood transfusions, and from a mother carrying the virus to her child during pregnancy (there are 15-40% chances of that happening).

2. The virus sticks to cells in our body – Our immune system (the system that protects us from infections) has many types of cells. One of these types is called T cells or CD4 cells. The HIV virus recognizes these cells and sticks to them and then enters the cells.

After entering the cells, the virus combines its own DNA with the human DNA in the cells. That’s actually the main problem with HIV infection – Once the DNA is inside our own DNA, the virus can rest there undetected, with no way of destroying it.

3. The virus replicated itself within the cells -- This causes both a larger number of viruses in the body, and also destroys the cells the virus was in.

Soon after infection, the virus replicates itself rapidly, but the body usually can fight this. Unfortunately, this fighting isn’t very effective, and leaves enough viruses to continue replicate in the body. During the following years, over 100 billion new viruses may be produced daily, and the body may remove them all.

With time, the number of CD4 cells goes down. After a few years, the number of viruses in the body rises without the body being able to control it, while the number of CD4 cells goes further down. This condition is now called AIDS (while up until now it was called an HIV infection).

Since CD4 cells are important in fighting many forms of infections, when their numbers go down, infections start appearing and without treatment usually lead to death.

How does it feel?

Infections with HIV have two phases along the way:

1. Acute retroviral syndrome – Over 50% of people who get infected by HIV experience this. It happens 2-6 weeks after the infection, and may feel just like the flu, including fever, sore throat, rash, joint pain and headache. It lasts for several days to 3 weeks. A rash can also appear.

Unfortunately, since all of this resembles the common cold or flu, usually infection by HIV isn’t suspected.

2. AIDS – Once the number of CD4 cells goes down (usually after a few years), the infected person starts getting infected with opportunistic infections. These are infections that may reside in our body but that don’t do anything when our immune system is normal. When it’s damaged, like in this case, they start acting up.

There are many infections that can occur here into which we won’t go into detail.

There are, though, a few symptoms which are common in this stage:

- Diarrhea

- Weight loss

- Fever

- Cough and shortness of breath

- Swollen lymph nodes

This video should sum up what you’ve read above:

www.youtube.com/watch?v=68I7JlVhuhY

How is it discovered?

An infection with HIV is detected by a blood or saliva test called ELISA, in which the test tries to discover antibodies our body produces to fight against the virus. Antibodies are molecules created to fight infections.

These tests aren’t very useful during the first 1-2 weeks of infection. At this time, a special test can detect the virus’ DNA. This time is called the "window period".

How is it treated?

Today there are drugs which can fight the virus. They don’t eliminate it from the body, which means it will still lie within our cells and continue replicating. But they can prevent opportunistic infections from occurring for many years, even indefinitely.

During the lifetime of the disease, blood tests are taken to test the level of CD4 cells and the number of viruses in the blood. Usually, treatment doesn’t start until the disease progresses enough to justify it.

What happens after treatment?

When not treated, the life expectancy of someone suffering from AIDS ranges between 2-3 years. When treated, though, people can live for many years with the disease.

The bottom line – How do I avoid it?

1. Know the HIV state of your sexual partner – And don’t engage in unprotected sex unless you’re certain they are not infected.
2. Use a latex or polyurethane condom every time you have sex – If you don’t know the HIV status of your partner. Avoid lambskin condoms, as they don’t protect from HIV. When using lubricants, only use water-based lubricants, as others (such as petroleum jelly) may cause the condom to break.
3. Consider male circumcision – A large study in 2006 by the National Institutes of Health (NIH) showed that it significantly reduces your risk when having heterosexual intercourse.

Related posts:

1. The New HIV Discovery – What Does It Mean?
2. Echoviruses (As Seen on House MD)
3. Subacute Sclerosing Panencephalitis (As Seen on House MD)

A few days ago we have learned that an outbreak of pneumonic plague has killed two people in China, and forced the quarantining of a town of 10,000 to halt its spread. Today the news is that a fourth victim may be on the way.

Is this a sign of things to come? Is there a reason for panic outside China? Read on to find out.

(To stay up-to-date about recent developments, follow us on Twitter).

What is it?

Plague, first described in the Old Testament, is a deadly infectious disease affecting the lymph nodes, the lungs or the blood. It is also known by the names “The Black Plague” and “The Black Death”.

Who gets it?

In the United States, about 10 cases of plague are reported each year. Around the world it’s mostly encountered in developing countries in Africa and Asia. During 1990-1995, 12,998 cases of plague were reported.

Most cases of infection occur in people younger than 20 years.

What causes it?

Plague is caused by a type of bacteria called Yersinia Pestis. This is how it looks under a microscope:

How does this germ infect people?

Rats are the most common animals carrying the disease. A rat flea by the exotic name of Xenopsylla cheopis is the link between rats and humans. When the flea feeds on the blood of an infected rat, it carries the germ in its blood. When the flea then bites a human, it transfers the germ to their blood.

The process. Rat drawing by opk.

How does it feel?

There are 3 types of plague:

1. Bubonic plague – This is the most common type of plague – responsible for 80-95% of plague cases. (It was also featured on a Grey’s Anatomy episode). The germs enter the lymphatic system (the system responsible for killing infections from the outside, although here not successfully). The lymphatic system is made of lymph nodes, which are sort of stations along the system. The bacteria infect the nodes, causing inflammation in them. The nodes get swollen, a finding called bubo, which characterizes the disease.

   
   An example of buboes.

2. Septicemic plague – This happens when the germs enter the bloodstream, and from there travel to any area in the body, wreaking havoc on its way, including bleeding in various sites in the body.
3. Pneumonic plague – This is the form which has now started in China. It infects the lungs. Once it does, people can infect one another by coughing. Since it resembles pneumonia, doctors may confuse it for something less severe. This is a mistake, of course, since without proper treatment, 50-90% of people die of it.

How is it discovered?

To find out if you have been infected, the doctor can take a sample from a bubo or from your blood or sputum. These samples are then looked at under a microscope to discover the germ.

How is it treated?

If treated immediately, mortality can be reduced to 5% or less. The treatment includes antibiotics which kill the germ.

Another important issue in treatment is isolation of patients, so that other people don’t get infected.

What happens after treatment?

Like mentioned above, mortality is reduced to 5% or less if the disease is treated on time. It doesn’t tend to return afterwards. If not treated, though, there is a high chance of dying from it.

If you have been in contact with a person or animal whom you know are infected, if you have been bitten by a flea in an area known to have plague cases, or if you plan to travel to a region with plague outbreak, you can take preventive antibiotics. Consult your doctor about those.

If you live in an area where plague has been discovered, take the following precautions:

1. Avoid contact with sick or dead animals – Such as when hunting. Even though rats are the main culprits to avoid, field mice, cats, camels, chipmunks, prairie dogs, rabbits, and squirrels can carry the germ as well.
2. Rodent-proof your home – This includes removing potential nesting areas, such as piles of brush, rock, firewood and junk. Avoid leaving pet or bird food or any other foods in areas that rodents can easily access.
3. Prevent your pets from contracting fleas – You can use flea-control products (consult with your veterinarian about those).
4. Take precautions when outdoors – Such as using insect repellents.

What do you think? Will the disease leave the boundaries of China and become the next Swine Flu?

Related posts:

1. In The News – Swine Flu (Influenza) – All You Wanted To Know
2. China to Provide First Swine Flu Vaccines
3. Swine Flu – Get All The Latest News On Twitter