Aletheia with core exposed

"The new age is just over the horizon... and I'll bring about the new dawn of mankind! Don't we all want to be smarter, stronger, and more beautiful? The world will be populated by those who are superior. My beloved GUILT will eliminate all else..." -Reina Mayuzumi
"Don't give me that! GUILT won't bring happiness to anyone!!" -Derek Stiles

Aletheia (Greek for "truth") is the fourth and final strain of Neo-GUILT, also known as "the Omniscient Eye of Truth".

Aletheia halts the host's aging process while inactive, and, when activated, it starts to control the host's body. Aletheia can't attack the body itself; it summons Aletheia GUILT and Neo-GUILT to attack for it.


Stage Information
Attacking Aletheia Aletheia uses GUILT and Neo-GUILT (some with little differences) to attack the body. Each time a GUILT/Neo-GUILT is defeated, Aletheia will be vulnerable for a second, so you have to be quick and inject the black antibiotic. Each time you defeat a wave of GUILT/Neo-GUILT Aletheia will "open" and will take several seconds to summon more GUILT/Neo-GUILT, so you can use this time to either attack Aletheia or to treat remaining wounds (like lacerations or pus).

Warning: You must not use the Healing Touch until the end of the operation!

Stage 1

Aletheia Kyriaki

Aletheia Nous

Aletheia Pempti


Aletheia with core semi-exposed

When starting the operation, four Aletheia Kyriaki will appear, and start to make lacerations; however, they won't be inside the heart, so you can treat them with the laser right away. Is recommended to treat the lacerations as well, since four lacerations at once will deal some vitals damage.If you can't go to stage 2 after finishing the four Aletheia Kyriaki, four Aletheia Nous will appear. Treat as normal: drain the cytoplasm and excise (in any order). If you take too long, the remaining Aletheia Nous will disappear and make some tumors, which have to be treated in the exact order they appeared, and then you can continue treating Aletheia Nous. If you are unable to remove the green tumors and an Aletheia Nous in one go, they will resubmerge and you will have to repeat the excision. A way to avoid this is to drain and cut the Nous tumor, but not remove it until the Aletheia Nous begin to submerge. If you time it right and you remove the green tumor right before a second green tumor appears, Aletheia Nous will not create another tumor. If you failed, you can wait and try again.

After the Aletheia Nous, Aletheia summons Aletheia Pempti. After defeating them, the order will restart. It is okay to inject Aletheia with the black antibiotic while tumors are up - just make sure to put antibiotic gel on the wounds fast.

After dealing enough damage to Aletheia, 8 blood veins will appear linked to its "eye". You have to use the scalpel to sever them, and you have to take care to not touch the red vein, or the patient's vitals will drop by 30 and you'll come back to the last stage you were. Keep in mind that when you are severing them. If either you sever a red vein or you take too long, Aletheia will recover and resume the current stage and send the next wave of GUILT/Neo-GUILT.

Stage 2

Aletheia Sige

Aletheia Tetarti

Aletheia Kyriaki

Aletheia will recover a bit and start the next stage, firstly summoning six Aletheia Sige. They won't be inside the heart, so the treatment is almost the same: apply Antibiotic Gel to stop it from moving and cut it. Aletheia Sige creates pus as well, and these will form inflammations if not treated for too long. To add to your troubles, if you try to attack Aletheia Sige with the scalpel while it moves or if the gel wears off while you attack, pus will form. The only difference is moving pattern, they stay in a hexagon-like form, and they will change places from time to time.

After treating Aletheia Sige, Aletheia will summon Aletheia Tetarti, with the default colors: green, yellow and purple; the only difference is that is very difficult to see each colors. If you take too long or inject the medication into the wrong Aletheia Tetarti, they will move around the heart and form diverticula. If you are quick, you can inject the Aletheia Tetarti before they can. If diverticulum is created, you may have trouble defeating Aletheia Tetarti because of the vital drop.

After treating Aletheia Tetarti, Aletheia will summon six Aletheia Kyriaki, making lacerations around Aletheia, so treating them as soon as possible is recommended since vitals drop very fast. After treating Aletheia Kyriaki, the order will restart. If the vitals are low, wait for the next Aletheia Sige round to raise vitals before moving on.

Doing enough damage to Aletheia will cause it to expose its vessels again. Sever them using the same method as before.

Stage 3

Aletheia Bythos

Aletheia Sige

Aletheia Pempti

Aletheia Bythos will appear. They will appear to do nothing, but they'll be creating hematoceles. A good strategy is to laser two cores at a time and remove them two at a time, injecting the antibiotic into Aletheia twice (taking out two Aletheia Bythos at a time should allow enough time for two injections), and then repeating that process until all of the cores are extracted, treating any ruptured hematoceles on the way. Another strategy is to laser them all in the same place, so checking for hemorrhages isn't as much of a pain. Using the ultrasound all over will take up a lot of your time, and by the time you've scanned the area, there might be another hemorrhage that formed when you were checking other areas.Another way to deal with the hemorrhages is to draw a circle around Aletheia with the scalpel before placing the core on the tray, to open up any hematoceles. This way the hematoceles will not break your chain.

Aletheia Sige and Aletheia Pempti are the same, except that the maximum number of polyps Aletheia Pempti can make has increased, so vitals will drop very fast.

Doing enough damage to Aletheia will cause it to expose its vessels again. Sever them using the same method as before.

Last Stand At this point, Aletheia will drop the patient's vitals to 30 if they are any higher than that amount. Aletheia will have 8 blood veins and will be rapidly switching its red vein. You have to use the Healing Touch as soon as this stage starts to slow the switching down (as well as slowing down the vitals it drops) and then sever the veins. If at any time a red vein is touched, the patient's vitals will drop to 0, resulting in an instant Game Over. Take care since each time a vein is severed Aletheia will "blink" and the red vein will be 2 or 3 veins before (clockwise). Also while its blinking, take a quick glance at the patients vitals as vitals will continue to drop as you continue to sever the veins.

Aletheia will not go back to any previous stages if you take too long so you have from the point this stage starts until the time runs out in order to eliminate Aletheia and by this time you should have enough time, if not more time due to the Healing Touch slowing down the timer, to finish off Aletheia and close up the patient. So be patient and pay extreme attention to what you're cutting.

Aletheia OperationsEdit

Game Episode Host Organ
Under the Knife 2 7-7: Mother of Sins Reina Mayuzumi Heart
X-7: Aletheia Unnamed woman Heart


  • You can inject the black antibiotic into Aletheia every time an Aletheia GUILT is defeated. Aletheia Pempti and Aletheia Kyriaki will not be seen if you inject the antibiotic every chance possible (once for every Aletheia GUILT, and at least 3 times after defeating a wave of Aletheia GUILT). If you are fast enough, it is possible to not see the second waves in each stage, Aletheia Nous, Aletheia Tetarti, and Aletheia Sige, but you MUST inject the full syringe's worth of anitibiotic into Aletheia for every Aletheia GUILT you defeat, and inject at least four syringe's worth of antibiotic after defeating a wave. Note that if you do work too quickly, you may miss out on the operation's chain bonus.
  • Once you defeat an Aletheia GUILT, and Aletheia is pink instead of green, it is a good indicator that you have injected enough antibiotic. If that is the case, take the time to either attack other Aletheia GUILT or raise vitals. Once you are done with the wave of GUILT, just inject more antibiotic to have Aletheia expose its veins.
  • During the final stage, while cutting Aletheia's veins for the last time, right after you cut a vein, Aletheia will blink, and be invulnerable for a while as Dr. Stiles and Nurse Angie say their prayers. Be cautious because the red blood vessel will vary depending on how long it takes you to read these prayers. These prayers only apply for the first time you encounter Aletheia. In the extreme mode, you can raise the vitals while it's eye is closed.
  • After defeating Aletheia, all lacerations, pus, tumors etc. disappear along with it.


  • Aletheia is the only seen pathogen that actually merges with the heart.
  • If one looks closely when the heart first comes into view, a slight discoloration can be observed. The discoloration takes the distinct shape of a human hand, which seems to be holding the heart. This is a direct reference to Aletheia's attempt to "take hold" of the host's body.
  • Aletheia is the only Neo-GUILT that can affect the heart.
  • When you reach the fast changing blood veins stage, pause the game and you will see that rather than one, there are actually two red veins at the same time to make it look like it is rotating faster.
  • When the Healing Touch is activated during the final stage, it does not act on a timer, and will not run out until the final vein is cut.
    vde Diseases and Conditions
Common Conditions AneurysmAppendicitisBurnCardiac ArrestCholelithiasisForeign ObjectHemorrhageInflammationLacerationTumor
GUILT KyriakiDefteraTritiTetarti (Diverticulum) • PemptiParaskeviSavatoBliss
Stigma CheirSomaOpsOnyxBrachionCardia
Post-GUILT Syndrome Post-KyriakiPost-TritiPost-PemptiPost-Savato
Neo-GUILT NousBythosSigeAletheia
Other Rosalia Virus (Twisted Rosalia) • Costigar DiseaseVaimahse Fever
Community content is available under CC-BY-SA unless otherwise noted.