| abstract | - Baby Girl Hartig was born full term and was healthy at birth. Her parents noticed that she was spitting up a lot and called their obstetrician, Dr. Lim. Dr. Lim examined the infant and noticed she was lethargic. The baby then had a seizure. Dr. Lim diagnosed a small bowel obstruction and put her in intensive care. However, Dr. House overheard the diagnosis of Baby Girl Hartig and about a fever being suffered by Baby Boy Howson and went to review their charts himself. He convinced himself that an infection was spreading in the hospital as Baby Girl Hartig's bowel x-ray appeared clear. He reported it to Dr. Cuddy who dismissed his concerns. Dr. House and his team search for more infants that might have infections. However, no further infections were found in the regular maternity rooms. However, they searched the overflow rooms and found a new infected infant, Baby Boy Chen. Dr. Cuddy was convinced and shut down the maternity ward and directed patients to other hospitals. Soon, there were a total of four sick infants including Baby Girl Perry. All were showing a fever and low blood pressure. However, they could not find a source of the infection as the infants did not appear to have anything in common. Dr. Cuddy enlisted the medical students to look for the source of the infection. The team ruled out parasites because the infection was spreading too quickly. A virus was a possibility, but the infants were not responding to common anti-viral medications. Dr. Foreman pointed out that if it were an uncommon virus, they would never find it in time. As the infants were not responding to common antibiotics, Dr. House thought it might be a resistant strain. Dr. House ordered vancomycin and astreanam to cover the most common resistant bacteria. Dr. House ordered an MRI to check for an abcess or an occult infection. However, all the patients were given an MRI and nothing unusual was found. As the treatment progressed, the patient's kidneys started to shut down and the urine test showed no casts. It was clear the antibiotics were toxic to the kidneys. Both the antibiotics being used could have had this effect, and it was most likely a combination of both. Dr. House suggested that they take one patient of off vancomycin and the other of astreanam as it was impossible to determine which disease the infants had. The patient who improved would guide the treatment for the other patients. As two more infants became symptomatic, Dr. House managed to get administrative approval for his treatment plan. Baby Hartig was taken off astreanam. When Baby Chen died, House ordered all the patients to be given extra doses of vancomycin. However, the patient soon started to deteriorate as well, showing that the vancomycin was not working either. Dr. Chase suggested Vancomycin resistant Staphylococcus, but this was very rare. Dr. Chase noted that another patient had a rash which would be consistent with this diagnosis. However, an autopsy of the Chen baby showed that the most likely culprit was a virus. Dr. Foreman noted that this made diagnosis almost impossible. Although they could run tests for antibodies, the patients did not have enough blood to test for all the possibilities. Dr. Chase was of the opinion that each patient could give enough blood for six tests, and the team set out to narrow down the possibilities. Herpes was ruled out because it would have responded to previous treatment. Toxoplasmosis and rubella were ruled out because none of the adults were sick. CMV was a possibility because it does cause cardiac scarring. Echovirus would also cause that symptom, as would influenza, coxsackie, a rotovirus, Epstein-Barr virus, parvovirus and RSV. Dr. Wilson looked for treatment for the possibilities. Dr. House also ordered blood tests on one of the healthy babies. The sick babies tested positive for echovirus 11, parvovirus BIT and CMV. The healthy baby tested positive for echovirus and CMV as well. Dr. House realized that the infants would test positive for any disease their mothers have had because they still share their mother's antibodies. The healthy infant was healthy because his mother had had the disease and passed her immunity on tho him. Dr. House ordered the patients' mothers to be tested for echovirus 11, parvovirus BIT and CMV. After testing the mothers, none of them had antibodies against echovirus. Dr. Foreman obtained the parent's consent to use an experimental anti-viral drug that had shown promise against echovirus. Eventually, she and the other patients started to improve. The patient was eventually released.
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