This is part of our House MD Project series.

Make sure to tune in tomorrow for a medical recap of tonight’s finale!

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


On episode 22 of season 7, named “After Hours”, a woman named Darrien is bleeding after a stabbing to her body. Her blood pressure and heart rate are almost missing on one side of her body, meaning something is blocking one of the arteries there. She then starts hallucinating due to an interruption of blood flow to her brain. Fever also develops, hinting at an infection. Turns out her symptoms were due to an infection with entamoeba, a parasite, which was released to her bloodstream by the stabbing.

Photo by NBCUniversal

Danger level: Medium

What is it?

Entamoeba histolytica is a parasite which can infect humans. It can infect the large intestine and sometimes the liver and other organs, causing a condition called amebiasis.

Who gets it?

It’s estimated that about 10% of the world’s population are infected with Entamoeba histolytica. It’s more common in some areas of the world where sanitation is poor, such as Central and South America, Africa, and Asia. In the United States it is estimated that about 4% of the population are infected – most of them are immigrants or people who have traveled to countries where it’s more common.

What causes it?

The infection, as mentioned above, is caused by a parasite – an ameba named Entamoeba histolytica, seen under a microscope in this photo:

The parasite can exist in 2 forms: One active (called a trophozoite) and one dormant – called a cyst. Infection occurs when a person swallows cysts. They hatch in the body, releasing trophozoites. These in turn start multiplying and can cause wounds in the lining of the intestines. They can also spread to the liver and other places.

Some trophozoites become cysts again, and are excreted in the feces, helping the infection spread.

Now how do people actually get to swallowing the parasite, or how do they infect themselves? The cysts can spread from person to person or through food or water. In places where there is poor sanitation, food and water can be contaminated with feces containing the ameba. If soil is polluted by human feces, fruits and vegetables growing in it will be infected as well. If someone doesn’t wash hands properly after going to the toilet, the infection can spread. You’re getting the idea…

How does it feel?

In many people (about 80%), the infection isn’t felt at all. When it is felt, symptoms start within about 2-4 weeks of ingesting the parasite, and can include flatulence, abdominal pain, diarrhea, or constipation. In some cases a dysentery may be caused, meaning there is blood and mucus in the feces. Fever may also develop. Blockage as well as perforation of the intestines can occur.

Sometimes the ameba may spread to the liver, causing an abscess (a localized collection of pus). The person would feel fever and chills, sweating, nausea and vomiting, and weight loss. Rarely, the ameba can spread to other areas of the body (even the brain).

This vivid video sums it up:

How is it discovered?

A stool sample has to be examined to find the ameba. Sometimes a tube with a camera (colonoscope) can be inserted to the colon to collect a sample from a wound caused by the ameba, to look at under a microscope.

To find a liver abscess, an imaging method such as an ultrasound, CT or MRI can be used. Blood tests can also help with the discovery of the parasite.

How is it treated?

An antibiotic is given that can kill the ameba. An example of such a drug is metronidazole (which was mentioned on House).

The bottom line – How do I avoid it?

When travelling to an area known to have poor sanitary conditions, make sure to drink only bottled water, tap water that’s been boiled for at least 1 minute, or bubbly water or soda drinks from sealed cans.

Do not drink fountain drinks or any drinks with ice cubes. Do not eat fresh fruit or vegetables you didn’t peel yourself. Do not eat dairy products that may not have been pasteurized. And don’t eat anything sold by street vendors.

If you have been infected, you can minimize risk of infection to others by washing your hands with soap and water after using the toilet, after changing diapers, and before handling food.

Related posts:

1. Malaria – A Deadly Infection Passed On By Mosquitoes (As Seen on House MD)
2. Gas Gangrene – An Infection That Can Rapidly Kill Your Muscles (As Seen on House MD)
3. Common Variable Immunodeficiency (CVID)–When a Cold Can Threaten Your Life (As Seen on House MD)

This is a guest post by Ashley Warner. Ashley is a graduate student working toward her Masters in Conservation Biology. She currently resides in Washington state and is a part-time content creator for Online Biology Degree.

Danger level: High

What is it?

Chagas disease (also called “American trypanosomiasis”) is an infection that eventually causes potentially fatal heart and digestive problems in 20-40 percent of infected humans.

Who gets it?

The parasite responsible for the disease, Trypanosoma cruzi (T. cruzi), exists mostly in central and south America and in Mexico, although a small number of infections documented in the southern United States indicate that the disease has spread into the north. Similarly, recent population movements have led to cases as far afield as Europe. Anyone living in one of these regions, particularly in a rural area, could potentially become infected.

What causes it?

T. cruzi lives in wild mammals such as opossums, armadillos, rats and raccoons and may inhabit domestic animals as well. The disease is transmitted to humans by triatomines (also called reduviid bugs), insects that feed on the blood of vertebrate animals. Often biting the faces of human victims, triatomines are commonly called “kissing bugs.”

A kissing bug. Photo by Fernando Otálora Luna

These insects defecate while feeding, and if one is carrying T. cruzi from a previous meal, the parasites will be in the feces. When human victims scratch at the bite, the infected feces enter the blood through the bite wound itself. The parasites can also pass through other places, such as the eye.

T. cruzi can also be transmitted by consumption of contaminated food (including breast milk), through transfusion of infected blood or transplantation of infected organs, and from an infected mother to her unborn child.

How does it feel?

Chagas disease proceeds in two phases.

The initial, acute phase, lasts for weeks or months. It usually brings about mild symptoms, if any, beyond swelling at the site of infection. The most recognizable symptom of acute infection, called Romaña’s sign, is swelling around the eye where the parasites reside.

A child with a Romana’s sign.

After several weeks, the infection proceeds to the chronic phase. In most cases, the parasites’ presence will cause no symptoms. This is known as indeterminate chronic Chagas disease. However, when symptoms do develop, they severely affect the heart and digestive system.

Cardiomyopathy (damage to the heart muscle) can lead to sudden death, while megacolon and megaesophagus (dilation and enlargement of the intestines and throat) cause difficulty swallowing, loss of weight and malnutrition and other life-threatening complications. In some cases chronic Chagas disease also affects the nervous system, impairing reflexes and sense perception.

How is it discovered?

Because it often presents no distinct symptoms (or no symptoms at all), Chagas disease can be difficult to detect. Diagnosis depend on detecting T. cruzi in the blood or the presence of antibodies specific to the parasite (antibodies are molecules the body produces to fight an infection).

How is it treated?

Acute cases respond well to antiparasitic drugs, and are often completely curable. In general, the younger the patient and the sooner treatment is received, the better the odds that the parasites can be eliminated.

However, in its chronic phase, Chagas disease becomes more and more incurable. In determinate chronic cases (where symptoms do appear), currently available antiparasitic treatments are not effective.

What happens after treatment?

If the disease is effectively treated with antiparasitic drugs, the parasite infection has been completely cured and the patient should suffer no further ill effects. Damage to the body in chronic cases may be irreversible even if a the parasites have been eliminated.

The bottom line — How do I avoid it?

Although research to develop one is underway, there is no vaccine for Chagas disease. The surest way to avoid infection is to avoid travel in regions where the disease is common. If you do spend any time in areas known to harbor T. cruzi and the kissing bugs that transmit it, avoid sleeping outdoors or in rural areas where the insects may inhabit buildings. Sleeping under a mosquito net is also advisable.

Related posts:

1. Leprosy – The Biblical Disease is Still With Us (As Seen On House MD)
2. Malaria – A Deadly Infection Passed On By Mosquitoes (As Seen on House MD)
3. Syphilis – The 4 Stage Disease That Will Make You Want To Wear A Condom

This is part of our House MD Project series.

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


On episode 10 of season 2, named “Failure To Communicate”, a reporter named Fltecher Stone collapses and hits his head on a desk. After that he has aphasia – a condition in which a person speaks but doesn’t know they speak the wrong words. He also can’t write properly (a condition called dysgraphia). After trial and error (lots of it, as usual), it’s discovered the patient has cerebral malaria, meaning he has an infection called malaria, that has also reached his brain, causing his symptoms. He got that when going to an exotic place in order to get a brain surgery for a different disease he has.

Danger level: High

What is it?

Malaria is an infection of red blood cells caused by a parasite that’s transmitted by mosquitoes. It kills about 1 million people each year worldwide.

Who gets it?

Modern medicine has made malaria quite rare in the United States and most other developed countries. In other places, though, it still remains common. Worldwide, about 300-500 million people are infected with malaria, with 1-2 million dying of it each year (most of them African children under 5 years of age).

This doesn’t mean you can’t see malaria in your neighborhood if you live elsewhere. Visitors from other places, immigrants, and even plain travelers (like the one on the House episode) can have the disease.

Map of malaria spread around the world (from the WHO website). Areas in shades of blue are those with active malaria spread.

If you visit these areas, you’re naturally more prone to get infected. Some people are at risk of having a severe case of malaria:

• Young children and infants
• Travelers from a place where there is no malaria (that’s because there is some immunity to malaria in people living in malaria-infected places)
• Pregnant women and their fetus

What causes it?

Malaria is caused by a bite from a female mosquito infected with germs (or, more correctly, parasites).

There are 4 types of parasites that can cause malaria. They are called: Plasmodium falciparum (the most common one – accounting for 80% of cases), plasmodium vivax, plasmodium ovale, and plasmodium malariae.

Image by the country of Los Angeles public health website

Once a female mosquito bites a person with malaria, the parasite gets into its blood stream. Once inside the mosquito, the parasite reproduces and migrates to its salivary glands. Now, when the mosquito bites another person, parasites are injected along with its saliva.

Inside the infected person, the parasites move to the liver, where they multiply and mature. This takes about 1-3 weeks. Then they leave the liver and get into the infected person’s blood cells, where they multiply again, causing the cells’ rupture. The parasite is then free to infect more red blood cells.

This video shows the process using beautiful animation:

In rare cases, there’s no need for a mosquito in order for the infection to pass form one person to another. Examples of such rare cases are transmission of the infection from a mother to her fetus, transfusion of blood contaminated with malaria, or injection with a needle that was used by a malaria infected person.

How does it feel?

Symptoms usually take a few weeks to a few months to appear after the infection, but they may also appear after years.

Once red blood cells begin to rupture and release parasites into the blood stream, a shaking chill appears, followed by high fever. Once body temperature falls again, the person sweats profusely. This ritual of shaking, fever, and sweating repeats in attacks.

Other things that can be felt are fatigue, headaches, body aches, and nausea.

If you’re infected with the plasmodium falciparum type of parasite, the infection can be more dangerous. Since here the infected red blood cells stick to the walls of small blood vessels and clog them, blood supply to organs in the body is interrupted, causing damage to these organs. Examples of such organs include the brain (causing cerebral malaria – like was seen on House), lungs, kidneys, and gastrointestinal tract.

How is it discovered?

When a doctor suspects a person has malaria, a blood sample is taken from them and looked at under a microscope to see the parasites, like can be seen in this picture:

How is it treated?

There are drugs that when taken kill the plasmodium parasites. The type of drug given depends on which of the four types of plasmodium parasites the person got infected with. An example of such a drug is chloroquine.

What happens after treatment?

Most people improve within 24-48 hours of starting taking the drugs, although with plasmodium falciparum, fever can persist for 5 days. Without treatment, malaria can be deadly.

The bottom line – How do I avoid it?

If you know you’ll be travelling to a place where there’s malaria, consult your doctor a few months ahead about drugs you can take before, during and after your trip, that can help protect you.

When you are in one of those countries, you should take measures to avoid contact with mosquitoes. This includes sleeping under a net (preferably sprayed with permethrin, an insecticide), covering your skin (especially from dusk till dawn, the most active mosquito times), spraying your clothing and skin with permethrin, and treating the home you live in with insecticides and with screens on the doors and windows.

Related posts:

1. Amebiasis– A Very Common Infection You May Not Even Have Heard of (As Seen on House MD)
2. Gas Gangrene – An Infection That Can Rapidly Kill Your Muscles (As Seen on House MD)
3. Meningitis – The Brain Infection That Could Kill You, and How To Recognize It

When taken within 24 hours of the first runny nose or sore throat, zinc can cut colds short by a day or more and sharply reduce the severity of symptoms, according to the New York Times.

The Cochrane Database of Systematic Reviews summarizes and interprets the results of medical researches. They combined the results of 15 different scientific studies and found that zinc can be effective in fighting colds. So effective, in fact, that it can cut the duration of colds to 4 days from 7 days, and reduce coughing to 2 days from 5.

The problem? No dose, type of zinc (lozenges, tablets, or syrup), or duration is recommended yet, as more research is needed.

Photo by sgrace

How does it work, you ask? It appears that zinc has antiviral properties that prevent the cold virus from replicating or attaching to nasal membranes.

And the real kicker: Regular zinc may also help prevent colds, leading to fewer school absences and less antibiotic use in children. People who took zinc regularly were also far less likely to have a cold that lasted more than 7 days. A word of warning, though – nasal zinc (the one you spray into your nose) may harm your sense of smell.

Our recommendation? You can try and visit your pharmacy and buy zinc as soon as you feel the cold coming. We can’t recommend any brand or dosage, but you can experiment and let us know in the comments if it worked for you. In any case, we wouldn’t recommend taking zinc to prevent a cold – you never know what long time treatment can do to you.

For Cold Virus, Zinc May Edge Out Even Chicken Soup [NYTimes.com]

Related posts:

1. Which Humidifier Should You Get for A Cold
2. Chilblains (Pernio)–How Exposure To Cold Can Cause Lesions on Your Toes
3. Muckle-Wells Syndrome – When Being Cold Gets You Warm (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 9 of season 2, called “Deception”, A woman named Anica has a seizure and arrives at the hospital. She also has a bruise on her stomach. She has had Cushing’s syndrome in the past, caused because she was faking it (she has Munchausen syndrome – a condition in which people fake diseases to get attention). After House smells a fruity smell in her bed, he arrives at the conclusion that she has an infection with a bacteria called clostridium perfringens, that used her stomach bruises as a safe house in which to grow.

Danger level: High

What is it?

Gas gangrene is a life-threatening infection of muscle. It’s usually caused by a germ called clostridium perfringens.

Who gets it?

In the US, about 3000 of these infections occur each year. Estimates are that outside the US it is more common.

What causes it?

Gas gangrene is an infection of the muscle caused by a germ named clostridium perfringens (although it may be caused by other bacteria as well).

It usually occurs at the site of an injury in the body, or in a surgical wound. Clostridium perfringens is a type of bacteria that belongs to the anaerobic type, which means it lives best when the level of oxygen is low. This makes deep wounds, in which there isn’t much oxygen, an excellent area for them to grow and prosper.

Clostridium perfringens. These guys cause all the trouble.

The bacteria then produce toxins. These eventually cause the death of the tissue (hence the name gangrene = tissue death). As a result of the toxins gas is produced, and it becomes trapped in the infected tissue.

The time between the infection and the symptoms is very short, since these bacteria grow very fast. The average time is less than 24 hours.

As a result of this process, tissue destruction occurs rapidly – muscle and fat in the area are destroyed, and blood vessels get clogged. The whole process affects the whole body pretty fast, causing destruction of blood cells, possible kidney failure, and then shock. Eventually, death can occur if the condition isn’t treated.

How does it feel?

The infected area will be very painful. At the beginning it may be swollen and pale, but it then turns red, then bronze, and then a blackish green. Large blisters also appear in the area.

Gas bubbles may be felt under the skin, as a result of the gas produced by the bacteria.

As mentioned above, without treatment death can occur pretty fast, usually within 48 hours.

Behind this link is an image showing a leg with gas gangrene. Please be warned – the image is very graphic. (photo by Engelbert Schröpfer, Stephan Rauthe and Thomas Meyer).

How is it discovered?

Usually a doctor suspects the condition just by seeing the patient and the infected area. X-rays can be used to confirm the suspicion, as well as CT or MRI images. The images will show gas inside the muscle tissue.

To make sure this is gas gangrene, though, fluids from the wound have to be examined under a microscope to show the bacteria there (like in the picture above). Most times, when the condition is suspected, there isn’t much time for that, and sometimes the diagnosis is done in surgery.

How is it treated?

When gas gangrene is suspected, high doses of antibiotics are immediately given.

Then a procedure called debridement is performed, in which all dead and infected tissue is removed surgically. About 1/5 of people with the infection in a limb will have to undergo amputation.

What happens after treatment?

Even with treatment, about 1/8 of people with an infected limb, and about 2/3 of those with infection in the torso will die.

Any skin injury should be cleaned thoroughly. If you see any signs of infection (such as redness, pain, drainage, or swelling around a wound) consult your health care provider promptly.

Related posts:

1. Meningitis – The Brain Infection That Could Kill You, and How To Recognize It
2. Amebiasis– A Very Common Infection You May Not Even Have Heard of (As Seen on House MD)
3. Malaria – A Deadly Infection Passed On By Mosquitoes (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 7 of season 2, called “Hunting”, a guy named Kalvin Ryan wants House to treat him after he has lost weight, has fever and shortness of breath. He also has HIV, which House believes is the source for all his problems. He then passes into anaphylactic shock after a brief struggle with House. Later his dad comes to the hospital with the same symptoms. With them both being from Montana and used to hunting foxes together, House deduces they are both ill with echinococcosis (a parasite native to Montana that infects foxes).

Danger level: High

What is it?

Echinococcosis is an infection caused by a worm, which settles in different organs and can lead to organ damage and death.

Who gets it?

Echinococcosis is caused by infection with a certain worm (more about that later). The worm is found mainly in foxes, coyotes, dogs, and cats.

A red fox. Is it carrying the worm? Photo by Eric Bégin

The disease can happen to people throughout the world, especially in the northern hemisphere. In the US, it’s more common in the north central region from eastern Montana to central Ohio, as well as Alaska. It has also been reported in Canada, central Europe, Russia, China, Central Asia, and Japan.

People at high risk of getting infected include trappers, hunters, veterinarians, or others who contact wild foxes, coyotes, or their feces, or household cats and dogs who have the opportunity to eat infected animals (more on that ahead).

How is it caused?

The disease, as stated above, is caused by infection with a worm. That worm is called echinococcus multilocularis.

The animals listed above get infected when they eat the worm’s larva in infected rodents, mice, etc. that they eat. The worm then infects the animal. Once it’s infected, the worm matures in its intestines and produces eggs. The animal then passes eggs in their feces. These eggs are too tiny to be seen.

It’s important to note that the worms only mature in those animals – the animals don’t feel anything.

Humans are infected by accidentally swallowing the eggs. How can you be exposed to the eggs?

1. By eating food contaminated with feces from foxes or coyotes (such as grass, herbs, greens, or berries gathered from fields).
2. By petting or handling infected household cats and dogs. The fur may be contaminated with the eggs.

It’s important to note that the disease doesn’t only occur in the geographic regions listed above. Animals are being trapped and transported to other places, bringing with them the risk for infection.

How does it feel?

The larvae grow in the body like a tumor or cyst. They usually involve the liver (like was seen in the father on the House episode), but they can spread to other organs (like the lungs and brain).

They grow slowly, and so symptoms may not happen for many years. When symptoms appear, they may contain pain or discomfort in the upper abdomen, weakness, and weight loss. The symptoms may mimic the symptoms of liver cancer and cirrhosis (like was seen on the House episode).

When they involve other organs, they can cause other symptoms, depending on the organ (like shortness of breath if it involves the lungs, like was seen on the House episode).

How is it discovered?

The worm can be discovered by a blood test. The cysts may also be seen on X-ray or on a CT scan or an MRI.

How is it treated?

Surgery is the most common treatment, in which the mass caused by the worm in the body is removed.

Medications may also be necessary to keep the cyst from growing back.

The bottom line – How do I avoid it?

If you live in an area where the worm is found, you should take the following precautions to avoid getting infected:

• Don’t touch animals listed above (like foxes, coyotes…), dead or alive, unless you are wearing gloves.
• Don’t keep wild animals as pets or encourage them to approach your home.
• Don’t allow your cats and dogs to wander freely or capture and eat rodents. If you think they did, contact your veterinarian.
• After handling pets, always wash your hands with soap and warm water.
• Fence in gardens to keep out wild animals.
• Don’t collect or eat wild fruits or vegetables picked directly from the ground. If you do pick wild foods, they should be washed carefully or cooked before eating.

Related posts:

1. Neurocysticercosis – The Worm That Attacks Your Brain (As Seen on House MD)
2. Rabies – All You Need To Know (As Seen on House MD)
3. Echoviruses (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 3 of season 2, called “Humpty Dumpty”, Alfredo, a construction worker at Dr. Cuddy’s house, falls off her roof. On the way to the hospital Cuddy notices two of his fingers turned blue. His lungs also have a sort of pneumonia. Later, his kidneys shut off and his other hand is getting blue (after the first one had to be cut off). Turns out all of this was caused by an infection of the heart (called endocarditis) caused by a bacterium called chlamidophila psittaci, causing a disease named psittacosis

Photo by Fox

Danger level: High

What is it?

Pstittacosis is an infectious disease that primarily affects birds. It can be transferred from birds to humans, causing inflammation of the lungs and other things.

Who gets it?

Almost any bird type can carry the germ responsible for psittacosis. Parrots are most commonly infected and transfer the disease to humans, but human cases have been traced to contact with other bird types, such pigeons, ducks, turkeys, chickens, and many others.

Be careful there… Photo by gwen

People in contact with birds are, therefore, at a higher risk of developing the disease. (On the house episode, for example, it turned out the patient used to work the cockfights, which exposed him to infected chickens.

Examples of people in higher risk groups include pet-shop owners, poultry workers, pigeon fanciers, taxidermists, veterinarians, and zoo attendants.

What causes it?

The infection is caused by a germ with the long name chlamydophila psittaci.

It doesn’t take a prolonged contact with the bird to catch the disease – a few minutes spent in an environment previously occupied by an infected bird can be enough.

Humans usually catch the disease through respiration. It then spreads via the bloodstream, and eventually localizes in the lungs, spleen and liver.

How does it feel?

Usually the disease presents as fever that starts suddenly, headache, and dry cough. Sometimes symptoms can include chest pain,shortness of breath, a sore throat, diarrhea, and a change in your mental status.

What’s important is that the disease can have complications, one of them featured on the House episode. Complications can happen in any of these organs:

1. Heart – Inflammation of the heart, or specifically its valves, is rare, but was featured on the House episode. Such inflammation is called endocarditis. We will cover endocarditis in extent on A Disease A Day, but in short we’ll say that it can send pieces of infection from the heart to various organs through the blood, blocking blood transport to them. That was the case on House, and that is why the patient had organs dying (his hands and kidneys).
2. Kidneys
3. Liver
4. Neurological system
5. Joints
6. Skin

And other organs…

How is it discovered?

A blood test can be done to show if a person is infected.

A sample of sputum, lung fluid and the likes can also be used to grow the germ and see if it’s indeed the one that causes psittacosis, but it’s usually not done.

How is it treated?

Psittacosis is treated with antibiotics. (On the House episode, an antibiotic called doxycycline was used, although others can be used as well).

What happens after treatment?

With appropriate antibiotics, people usually recover from the disease. Untreated, up to 20% of people can die.

Related posts:

1. TTP Explained Again (As Seen on House MD)
2. Acute Intermittent Porphyria Revisited (As Seen on House MD)
3. Why Sitting is Bad for You [Infographic]

This is part of our House MD Project series.

Episode 21 of season 1, named “Three Stories” is not a usual episode. Instead of the usual one patient story (and the occasional clinic patients), this episode tells 3 short stories (as its name implies). Each patient presented with a different disease. Since this episode was presented differently, so will this article digress from the usual presentation. The 3 diseases on that episode will be covered here in brief.

Disease 1 – Necrotizing Fasciitis

This long name means simply an infection by what is known as the “flesh eating bacteria”.

On the House episode, a 40 year-old farmer arrives at the hospital claiming he was bit by a snake. After an anti-venom doesn’t help him and his leg’s muscles begin to rot, it is found out he was actually bitten by a dog, a bite that infected him with a germ called streptococcus.

We already covered necrotizing fasciitis in the past and you can read all about this disease here:

Necrotizing Fasciitis (Flesh Eating Bacteria) – Are You at Risk, and How You Can Avoid It

Disease 2 – Osteosarcoma

update: We now have a complete article about osteosarcoma, if you’re interested to know more details

The 2nd patient is a 16 year-old volleyball player arriving at the hospital after what seems like a strained ankle. After some trial and error it is found she has osteosarcoma, a cancer in the leg of thigh.

Osteosarcomas are the most common malignant bone cancer in children (along with a cancer named Ewing sarcoma). The cause is unknown. In the US, about 400 children and adolescents younger than 20 years old are diagnosed with osteosarcoma each year. It most commonly affects adolescents.

The disease presents with pain in a bony site. A mass may be palpable in the area as well. X-ray image of the area can discover the tumor. A biopsy from the area is needed to make sure it’s osteosarcoma.

An x-ray picture of an osteosarcoma of the arm. Photo by bc the path

Before chemotherapy, osteosarcoma used to be treated with amputation alone. Today chemotherapy is used along with surgery which can cut the tumor. Sometimes amputation is still needed, as was seen on House.

Disease 3 – Aneurysm

The 3rd patient is actually Dr. House himself, telling the story of how he got his leg pain to begin with. Turns out he had an aneurysm in the artery of his leg which wasn’t diagnosed on time, leading to blockage of blood to his leg’s muscles, which led to muscle death.

An aneurysm is a dilatation of an artery. The chances of getting it increase with age (it happens to at least 3% of people older than 50). Most aneurysms don’t cause any symptoms and go unnoticed. As they progressively enlarge, though, they may cause symptoms as a result of compression of the surrounding area, of clogging, sending a blood clot, or rupturing.

In the case of the House episode, his leg aneurysm clogged with a blood clot. This led to blood not arriving to his leg muscles, causing muscle death.

Related posts:

1. Osteosarcoma–The Most Common Bone Cancer in Children (As Seen on House MD)
2. Necrotizing Fasciitis (Flesh Eating Bacteria) – Are You At Risk, and How Can You Avoid It
3. Acute Intermittent Porphyria Revisited (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 20 of season 1 (called “Love Hurts”)  a guy named Harvey Park comes to the clinic and suffers a stroke after House yells at him. His CT scan shows death of brain tissue. Deciding the stroke (which caused the brain death) was due to a blood clot, the team start to make assumptions as to where that clot came from . Turns out it came from an infection in his jaw, called osteomyelitis. Infected tissue from the jaw broke off, clogged an artery, and thereby blocked blood supply to the brain.

Danger level: High

What is it?

Osteomyelitis (OM) is an infection of the bone.

Who gets it?

Osteomyelitis isn’t very common: it happens to about 2 out of every 10,000 people.

It occurs mostly in young children and older adults, but it can affect anyone.

Osteomyelitis is an infection of bone. Photo by an untrained eye.

It’s more likely to occur in these people:

1. People with diabetes, sickle cell disease, HIV or AIDS, Rheumatoid arhritis

2. People who abuse alcohol or IV drugs

3. People who use steroids for a long time

4. People who are after a severe bone fracture or bone surgery

What causes it?

When a bone becomes infected, its inner part (the bone marrow) becomes swollen and presses against the rigid outer wall of the bone. That also presses the blood vessels in the bone, cutting the blood supply to the bone. Without it, bone simply dies.

The dead bone (called sequestra) is difficult for the body to cure, since its protective cells usually use the blood to reach places of infection.

How does it feel?

Acute osteomyelitis (acute because it can also become a long term condition, called chronic osteomyelitis) develops rapidly over a period of 7-10 days. Symptoms include:

• Fever, fatigue, irritability
• Nausea
• Tenderness, swelling, warmth and redness around the area of infection
• Lost range of motion of the involved extremity

If it happens in the vertebrae it can cause back pain.

How is it discovered?

On X-ray changes typical for osteomyelitis may show, but it may take them a few weeks to show up. CT and MRI can also be used, but they can’t make the diagnosis since what you see there may be seen in other types of bone problems.

An image showing osteomyellitis in the vertebral column. Photo by Nuclear Fire

Bone scans (images of bone taken after injecting a radioactive substance into the body) will almost always show a problem.

The doctor may take a sample of blood, pus, joint fluid, or the bone itself to diagnose infection to the bone and the germs causing it.

How is it treated?

Antibiotics are usually used to treat OM. Depending on the severity of the infection, they may be given directly to the vein at first but can be given by mouth later. Usually treatment takes weeks (between 4-8).

Sometimes surgery is needed to clear the infected area.

What happens after treatment?

With early and proper treatment, the condition usually goes away. There can be complications, though, such as an abscess (like the one on the House episode, causing the foul breath in the patient).

In some cases, the disease can spread to a nearby joint, causing an infection in the joint. If OM happens in children, it may impair their growth afterwards. The condition may also lead to skin cancer in the area of the infection.

People with artificial joints or metal components attached to a bone should take preventive antibiotics before surgery since they may be at increased risk of infection from bacteria normally present in the mouth and other parts of the body (In the House episode the patient had an artificial jaw that got infected).

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According to a new report in the journal The Lancet, a dangerous type of bacteria that’s resistant to nearly all known antibiotics was found. 37 patients in the UK with the new infection were found, and it’s believed that medical tourism is what’s brought this infection. Most of the people with the new resistant superbug had traveled to India, Pakistan or Bangladesh for medical procedures, including cosmetic surgeries. The infection was also found in dozens of patients from Asia.

Photo by kaibara87

The bacteria in question aren’t new. Their names are E. coli (a germ known to cause gastrointestinal infections and urinary tract infections), and Klebsiella pneumoniae (also known to cause urinary tract infections). What is new is the fact that these bacteria have a new gene making them resistant to almost all antibiotics. That gene was named NDM-1 (or, by its long name, New Delhi metallo-beta-lactamase) and it lets the bacteria create an enzyme (a sort of machinery) that destroys antibiotics.

What’s important to understand is that once antibiotics were invented they were considered “wonder drugs” and doctors started using them like water years ago. With time it was found that bacteria can develop resistance to antibiotics, a fact which led doctors to use them more sparingly. That is, if they know what they’re doing. Probably, the centers in India, Pakistan and Bangladesh were less developed in that area.
Now, with globalization, the superbugs have begun spreading. They are widespread in south Asian medical centers, and have also been spotted in Canada, Australia, the Netherlands, Sweden and the US.

A hope?
It turns out there is hope, after all. The bacteria do respond to an old antibiotic called colistin, which has a lot of side effects, and so hasn’t been used much in the last 30 years or so.
Now what?
The Center for Disease Control and Prevention (CDC) instructed doctors to isolate patients found to be infected with the new strain from other patients.
Experts in the area don’t recommend on panicking just yet. They claim that since those germs devote so much energy to develop their drug resistance, not much is left to prosper and cause significant diseases.
Now it’s just left to see how things develop, and if these superbugs turn to be a worldwide pandemic, or just a minor threat, like swine flu turned out to be.

Here’s a news video summing it up:

httpv://www.youtube.com/watch?v=K1axIgJ1VC0

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