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Kemperman PMJH, Vulink NCC, Smit C, Hovius JW, de Rie MA. Review of literature and clinical practice experience for the therapeutic management of Morgellons disease. J Eur Acad Dermatol Venereol 2024; 38:1300-1304. [PMID: 38308572 DOI: 10.1111/jdv.19831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/19/2024] [Indexed: 02/05/2024]
Abstract
Morgellons disease (MD) is a rare and contentious health condition characterized by dermatological symptoms including slow-healing skin lesions 'attributed' to fibres emerging from or under the skin. Patients also report sensations of crawling, biting and infestation with inanimate objects. This review examines the aetiology, patient characteristics, epidemiology, historical context, correlation with Lyme disease, role of internet, impact on quality of life and treatment approaches for MD. Despite ongoing debate, MD is not officially recognized in medical classifications, with differing views on its aetiology. Some link MD to Lyme disease, while others view it as a variant of delusional infestation. The literature suggests both psychiatric and environmental factors may contribute. The manuscript explores the association with substance abuse, psychiatric comorbidities, infectious agents and the role of internet communities in shaping perceptions. MD's impact on quality of life is significant, yet often overlooked. Treatment approaches are varied due to limited evidence, with low-dose antipsychotics being considered effective, but patient beliefs may influence adherence. A patient-centred, multidisciplinary approach is emphasized, considering both the physical and psychological dimensions of MD. Addressing the controversies surrounding MD while focusing on patient well-being remains a critical challenge for healthcare professionals.
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Affiliation(s)
- P M J H Kemperman
- Department of Dermatology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
- Department of Dermatology, Dijklander Ziekenhuis location Purmerend, Hoorn, The Netherlands
| | - N C C Vulink
- Department of Psychiatry, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - C Smit
- Department of Dermatology, Dijklander Ziekenhuis location Purmerend, Hoorn, The Netherlands
| | - J W Hovius
- Section of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | - M A de Rie
- Department of Dermatology, Amsterdam UMC location AMC, Amsterdam, The Netherlands
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2
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Singh N, Conner A, Nahmias Z. Dupilumab as a novel therapy for management of delusions of parasitosis: A case series. JAAD Int 2024; 15:3-4. [PMID: 38371665 PMCID: PMC10869274 DOI: 10.1016/j.jdin.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Affiliation(s)
- Nupur Singh
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Anna Conner
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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3
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Dib El Jalbout J, Sati H, Ghalloub P, El Bejjani G, Karam R, Mago A, Salame M, Saoudi L, Desangles AB, Emmanuel N. Morgellons disease: a narrative review. Neurol Sci 2024; 45:2579-2591. [PMID: 38319480 DOI: 10.1007/s10072-024-07361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
Morgellons disease is characterized by the persistent delusion of skin infestation, ultimately inflicting wounds and impairing quality of life. There is insufficient and conflicting research pertaining to this condition, imposing challenges on clinicians in understanding, diagnosing, and treating it. In this review, we summarize the available literature on Morgellons disease including its historical evolution, epidemiology, proposed pathophysiology, underlying structural and functional brain pathologies, typical and atypical clinical presentations, diagnosis, and treatment. A comprehensive review of the literature was conducted on PubMed, Embase, and Scopus using specified keywords. Selected articles were screened by two independent reviewers based on set inclusion and exclusion criteria. Conflicts were resolved by a third reviewer as needed. No limit to the date of selected articles was set due to the scarce literature available on the subject. Morgellons disease is an underdiagnosed entity, owing mostly to the lack of an established pathophysiology and treatment guidelines. While many authors classify it as a type of delusional infestation (DI), others correlate MD with an underlying spirochetal infection, namely Lyme disease. Neuroimaging studies have revealed abnormalities in the "fronto-striato-thalamo-parietal network", a finding common to patients with DI, in addition to alterations in structures related to the "Itch Processing Pathway". Patients tend to extract fibers from their skin lesions and place them in a match box hence the term "match box sign". The diagnosis is that of exclusion, requiring extensive work up to rule out secondary causes and differential diagnoses. Treatment is largely based on the use of antipsychotics, with or without cognitive behavioral therapy. Despite being a diagnosis of exclusion, clinicians must be aware of this entity and have a profound understanding of the pathogenesis underlying it. Upon clinical suspicion, secondary Morgellons should always be ruled out through a thorough history taking, physical examination, and laboratory exams. Despite the challenges brought by the heterogeneous presentation of the condition and the paucity of research revolving around it, the great impact that Morgellons disease has on patients' quality of life forms a pressing need for its adequate detection, diagnosis, and treatment.
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Affiliation(s)
- Jana Dib El Jalbout
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Heba Sati
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
| | - Perla Ghalloub
- Faculty of Medicine and Medical Sciences, University of Balamand, Koura, Lebanon
| | - Grace El Bejjani
- Department of Internal Medicine, Lebanese American University Medical Center Rizk Hospital, Beirut, Lebanon
| | - Rim Karam
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Arpit Mago
- Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Marita Salame
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Lara Saoudi
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | | | - Nancy Emmanuel
- Department of Dermatology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil.
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Ghiam S, Sojitra B, Reiff C, M. Sears C, N. Karlin J. Perceived Conjunctival Foreign Material Egress in Morgellons Disease: A Case Study. Case Rep Psychiatry 2024; 2024:9952722. [PMID: 38764875 PMCID: PMC11101242 DOI: 10.1155/2024/9952722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/21/2024] Open
Abstract
The purpose of this report is to present a case of a 63-year-old man with orbital Morgellons disease. A 63-year-old man presented reporting 15 years of daily egress of different foreign bodies apparently found in the superior fornices of both eyes, exhibiting a classic manifestation known as the matchbox sign. He described the symptoms starting after a facial trauma. The patient stated that at several points over the 15-year course of his condition, he was so distressed that he had contemplated suicide. On multiple exams by a range of ophthalmic professionals, there was no evidence of foreign body. Further investigation involving MRI and plain radiographs demonstrated similar lack of findings. A trial of gabapentin was performed without improvement in symptoms. He discontinued care 5 months later. Morgellons disease is a poorly understood condition, particularly ophthalmic presentations of the disease. Despite extensive investigation, the exact cause of Morgellons disease remains unclear, and there is no definitive treatment for the condition. We highlight the importance of empathetic listening in building trust, as a means of helping the patient to seek psychological help.
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Affiliation(s)
- Sean Ghiam
- Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Badal Sojitra
- Department of Ophthalmology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Collin Reiff
- Department of Psychiatry, Division of Addiction Psychiatry, New York University Langone Hospital, New York City, USA
| | - Connie M. Sears
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, USA
| | - Justin N. Karlin
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, USA
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Guedes NLKO, Dwan AJ, Gerlero P, Nico MMS. Delusional infestation treated with risperidone: a series of 27 patients. Clin Exp Dermatol 2024; 49:364-367. [PMID: 38001055 DOI: 10.1093/ced/llad411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Patients with delusional infestation (DI) frequently refuse to be treated with psychoactive drugs. In the past, pimozide was commonly used as a first-line agent but is now prescribed more rarely. Risperidone was first used to treat DI in 1995. A recent review identified 12 studies that evaluated the use of risperidone in 43 patients with DI. OBJECTIVES To study the characteristics of and therapeutic results in patients with DI treated with risperidone at a university medical centre in São Paulo, Brazil. METHODS We performed a retrospective study of patients with DI treated with risperidone at a dermatological university clinic since 2016. Records were reviewed for personal data and findings related to treatment. RESULTS Twenty-seven patients were studied (20 women and 7 men). The maintenance dose of risperidone varied from 1 mg three times weekly to 8 mg daily. Control of symptoms was achieved in the majority of patients. A reduction in dosage due to side-effects was seen in four patients; risperidone had to be switched to another antipsychotic in three cases, despite a good response. Only one patient did not respond to risperidone. CONCLUSIONS Risperidone is an effective, well-tolerated and safe treatment for delusional parasitosis. Adequate follow-up is mandatory in order to obtain long-term control of symptoms.
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Affiliation(s)
| | - Alexandre J Dwan
- Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
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Tausk F. Finally, successful interventions to ameliorate cutaneous infestations. J DERMATOL TREAT 2024; 35:2326655. [PMID: 38465790 DOI: 10.1080/09546634.2024.2326655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Francisco Tausk
- Department of Dermatology, Allergy, Immunology and Rheumatology University of Rochester, Rochester, NY, USA
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7
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Alsafwani Z, Aljishi M, Shiboski C, Jordan R, Villa A. Oral manifestations of delusional infestation: a case series. BMC Oral Health 2022; 22:652. [PMID: 36581857 PMCID: PMC9799679 DOI: 10.1186/s12903-022-02664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Delusional infestation (DI) is a rare psychotic disorder characterized by a patient's false belief that the body is infested with living or non-living organisms in the absence of clinical evidence of disease. Based on the underlying etiology, DI can be classified into primary and secondary forms based on the presence or absence of an underlying condition or previously diagnosed psychiatric disorder. This paper discusses a condition that is not commonly reported in the literature. CASE PRESENTATION Here, we describe four patients diagnosed with DI of the oral cavity. In each case, the patients' intraoral examinations revealed either traumatic lesions or no signs of mucosal disease. Management involved symptom management, medical therapy, and/or a referral to the primary care provider. CONCLUSION Because oral health care providers may encounter patients with DI, they should familiarize themselves with this unusual condition in order to recognize the condition and initiate prompt referral to a psychiatrist.
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Affiliation(s)
- Zahra Alsafwani
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Morooj Aljishi
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA ,grid.411975.f0000 0004 0607 035XDepartment of Biomedical Science, College of Dentistry, Imam Abdulrahman Bin Faisal University, IAU, Dammam, Saudi Arabia
| | - Caroline Shiboski
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Richard Jordan
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA
| | - Alessandro Villa
- grid.266102.10000 0001 2297 6811Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, 513 Parnassus Avenue, S- 722, San Francisco, CA 94143 USA ,grid.418212.c0000 0004 0465 0852Miami Cancer Institute, Baptist Health South Florida, Miami, FL USA
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8
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Caputo V, Bonoldi E, Citterio A, Rongioletti F. The challenge of Morgellons disease: A patient with clinicopathologic correlation. Clin Dermatol 2022; 40:686-690. [PMID: 35905899 DOI: 10.1016/j.clindermatol.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Morgellons disease is a rare condition characterized by patient-reported multicolored fibers and other nonorganic particles or organic particles embedded in and protruding from diffuse skin ulcerations. Although the scientific community is prone to believe that Morgellons disease is a psychiatric disorder, an infectious pathogenesis associated with Borrelia burgdorferi in the setting of Lyme disease has also been proposed. The histopathology is usually considered as nonspecific. To illustrate this condition, we present the case of an adult woman with significant ulcerative skin lesions and cicatricial changes on the face, trunk, and arms. After multiple biopsies and successful microscopic visualization of the fibers, she received a diagnosis of Morgellons disease in the setting of delusional infestation. No evidence of Borrelia infection was found. Treatment with antipsychotics was initiated, but the patient was lost to follow-up, as is often the case with patients with Morgellons disease.
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Affiliation(s)
- Valentina Caputo
- Department of Surgical Pathology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Emanuela Bonoldi
- Department of Surgical Pathology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonella Citterio
- Department of Plastic and Reconstructive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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9
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Turk T, Liu C, Straube S, Dytoc M, Hagtvedt R, Dennett L, Abba-Aji A, Fujiwara E. The Global Prevalence of Primary Psychodermatologic Disorders: A Systematic Review. J Eur Acad Dermatol Venereol 2022; 36:2267-2278. [PMID: 35924420 DOI: 10.1111/jdv.18478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
The management of primary psychodermatologic disorders (PPDs) (i.e., psychiatric disorders with dermatologic presentation) is challenging. The scarceness of reported prevalence hinders the development of coordinated interventions to improve healthcare delivery. This review aimed to explore the global prevalence of PPDs. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Of the 4632 identified publications, 60 were included. Five PPDs were investigated from the included studies: delusional parasitosis (n=9), skin picking disorder (n=26), trichotillomania (n=22), tanning dependence (n=5), and repetitive nail biting (n=6). Delusional parasitosis was rare in the general population (prevalence ranging from 0.0002% to 0.03%), with higher rates in the psychiatric settings (outpatient=0.5%; inpatient=0.1%). Other pathologic or subclinical forms of PPDs had a minimum prevalence of 0.3% (median=7.0%; mean=17.0%). The distribution of the prevalence rates was highly skewed, with large differences based on the study setting (e.g., dermatologic settings, psychiatric settings, and general population). The most common condition was pathologic skin picking (prevalence, 1.2%-11.2%) in the general population. Its rates were higher in the psychiatric settings (obsessive-compulsive disorder, 38.5%; Tourette syndrome, 13.0%; body dysmorphic disorder, 26.8%-64.7%). The prevalence of trichotillomania in the general population ranged from 0.6% to 2.9%, while that of pathologic tanning and nail biting could not be ascertained as the studies were mainly in students (range; 12.0%-39.3% and 3.0%-10.1%, respectively). In conclusion, PPDs are common, especially in the dermatologic and psychiatric settings. Further population-based studies are needed to determine more accurate prevalence rates.
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Affiliation(s)
- T Turk
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - C Liu
- Department of Dermatology and Skin Science, University of British Colombia, Vancouver, BC, Canada
| | - S Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Dytoc
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Hagtvedt
- ABA, Alberta School of Business, University of Alberta, Edmonton, AB, Canada
| | - L Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - A Abba-Aji
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - E Fujiwara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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10
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Romiti F, Magliano A, Del Lesto I, Filugelli L, Montarsi F, Carlin S, De Liberato C. Delusional parasitosis: an entomological perspective after a 20-years-experience in two public medical and veterinary entomology laboratories. Acta Trop 2022; 234:106614. [PMID: 35872007 DOI: 10.1016/j.actatropica.2022.106614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/01/2022]
Abstract
Delusional parasitosis (DP) is psychiatric disorder characterized by the unshakeable belief of being infested by endo- or ectoparasites, without any evidence of infestations. Hence, DP sufferers often consult medical entomologists or dermatologists, rather than seeking help from a mental health practitioner. Here we present 39 cases of suspected DP occurred in twenty years in two Italian public medical entomology laboratories, to highlight their common features and peculiarities, based on the interviews and material brought to our laboratories. Our results confirmed that DP affects both sexes, but is more frequent in females over the age of 50 years. Cases of psychological contagion, mostly affecting elderly people, were reported within seven family units. Some rare or unique features of DP sufferers involved: the fixed belief to be infested by endoparasites, olfactory hallucinations of unpleasant smell, self-harm to get rid of the imaginary parasite and suicidal thoughts. We suggest the term "Digital pics sign" to describe a modern derivative of the "Matchbox sign", where the DP sufferers showed pictures and videos, in person or sent by email, as proofs of being infested. Medical entomologists, being the most frequently contacted professionals by DP sufferers, may be crucial to raise awareness about this psychological disorder and to encourage a multidisciplinary approach amongst medical professionals and pest control operators.
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Affiliation(s)
- Federico Romiti
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy
| | - Adele Magliano
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy
| | - Irene Del Lesto
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy.
| | - Lorena Filugelli
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10, 35020 Legnaro (PD), Italy
| | - Fabrizio Montarsi
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10, 35020 Legnaro (PD), Italy
| | - Sara Carlin
- Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell'Università, 10, 35020 Legnaro (PD), Italy
| | - Claudio De Liberato
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana, M. Aleandri, Via Appia nuova, 1411, 00178 Rome (RM), Italy
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11
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Cutlip HA, Mogallapu R, Ang-Rabanes M. Morgellons Disease Treated as a Psychosomatic Condition. Cureus 2022; 14:e25236. [PMID: 35755571 PMCID: PMC9217663 DOI: 10.7759/cureus.25236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/05/2022] Open
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12
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Balogh EA, Beuerlein KG, Feldman SR. Choosing the appropriate pharmacotherapy for Morgellons disease: an expert perspective. Expert Opin Pharmacother 2022; 23:527-530. [DOI: 10.1080/14656566.2022.2029407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Esther A. Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katherine G. Beuerlein
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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13
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Zhang JF, Gopalakrishnan K, Molloy DJ. Treatment of Morgellons disease with doxycycline. Clin Case Rep 2021; 9:e05148. [PMID: 34917368 PMCID: PMC8643125 DOI: 10.1002/ccr3.5148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/10/2022] Open
Abstract
Morgellons disease (MD) is a rare dermatopathy characterized by nonspecific symptoms and the production of multicolored fibers and granular tissue from diffuse skin ulcerations which are described as being either pruritic or painful. The etiology of MD is currently unknown; previous studies have suggested both psychiatric and infectious causes, with increasing interest over the previous decade in elaborating a possible pathogenesis for the disease secondary to infection by Borrelia species. We report a middle-aged Caucasian female who developed symptoms of MD in the days following exposure to a tick bite after spending an afternoon hiking through a wooded area. She was subsequently treated with a course of Doxycycline and found on two-week follow-up to have complete remission of her symptoms. This case report further supports the theory for an infectious etiology of MD and encourages future studies into its pathophysiology.
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Affiliation(s)
- Jeff F. Zhang
- Jacobs School of Medicine and Biomedical SciencesUniversity at BuffaloBuffaloNew YorkUSA
| | | | - Daniel J. Molloy
- St. Vincent Health Center, Sisters of Charity HospitalBuffaloNew YorkUSA
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14
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Nunziato CA, Egeland BM, Gurman A, Henry SL. Morgellons Disease: The Spread of a Mass Psychogenic Illness via the Internet and Its Implications in Hand Surgery. Hand (N Y) 2021; 16:NP5-NP9. [PMID: 33435739 PMCID: PMC8647328 DOI: 10.1177/1558944720976648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Somatic manifestations of mental illness sometimes occur in patients presenting to hand specialists. These conversion disorders can also occur in groups, a phenomenon known as "mass psychogenic illness." The increasing penetrance of the Internet and social media in modern society has greatly facilitated the interaction of patients with others with similar disorders. One example relevant to hand surgery is "Morgellons disease," a disorder popularized in 2002 and characterized by a firm belief in foreign material extruding from the skin, leading to nonhealing, self-inflicted ulcerations and excoriations. A series of 4 patients collected through an informal survey of hand surgeons regarding experience with Morgellons disease is reviewed and discussed. All patients in the series presented with a chief complaint of foreign material extruding from the hand. In 1 case, the complaint was made by a young patient's mother. In none of the patients were foreign bodies identified, although 2 patients demonstrated significant ulcerations and scars from self-excoriation. Three patients had a somatic condition affecting the hand or upper extremity, 1 directly related to self-excoriation and 2 unrelated. Treatments, workups, and ultimate outcomes varied among patients. Patients presenting with Morgellons disease often undergo multiple unnecessary tests and are at risk of inappropriate procedures. It is therefore important that providers have a compassionate understanding of the involved psychology. Herein, we offer an approach to the recognition of and treatment strategies for these patients.
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Affiliation(s)
| | | | | | - Steven L. Henry
- Dell Medical School at the University of Texas at Austin, USA,Steven L. Henry, Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, 1601 Trinity Street, Austin, TX 78712, USA.
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15
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Lepping P. Cogito, ergo praedico (I think, therefore I predict). BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYI comment on a new overview of the treatment of delusional infestation. I focus on the challenges of communicating with a patient who has delusions and evaluate practical advice. I look at philosophical models to explain those communication problems as well as theories of delusional formation, and examine how these may help clinicians to understand and overcome those challenges.
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16
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Patel A, Jafferany M. Special Consideration for Patients With Morgellons Disease, Even Among Psychodermatology Patients?-Reply. JAMA Dermatol 2020; 156:1142-1143. [PMID: 32845295 DOI: 10.1001/jamadermatol.2020.2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Arsh Patel
- Wake Forest University, School of Medicine, Winston-Salem, North Carolina
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Middelveen MJ, Martinez RM, Fesler MC, Sapi E, Burke J, Shah JS, Nicolaus C, Stricker RB. Classification and Staging of Morgellons Disease: Lessons from Syphilis. Clin Cosmet Investig Dermatol 2020; 13:145-164. [PMID: 32104041 PMCID: PMC7012249 DOI: 10.2147/ccid.s239840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Morgellons disease (MD) is a contested dermopathy that is associated with Borrelia spirochetal infection. A simple classification system was previously established to help validate the disease based on clinical features (classes I-IV). METHODS Drawing on historical and pathological parallels with syphilis, we formulated a more detailed staging system based on clinical features as well as severity of skin lesions and corresponding histopathological infection patterns, as determined by anti-Borrelia immunohistochemical staining. RESULTS Clinical classes I-IV of MD are further categorized as mild, moderate and severe, or stages A, B and C, respectively, based on histopathological findings. Stage A lesions demonstrated little or no immune infiltrates and little or no disorganization of cells; macrophages were not present, and hemorrhage was negligible. Extracellular isolated spirochetes and intracellular staining of keratinocytes in the lower epidermis was occasionally seen. Stage C lesions demonstrated positive staining of keratinocytes in the stratum basale and stratum spinosum and positive intracellular staining of macrophages for Borrelia. Aggregate Borrelia colonies were frequently encountered, hemorrhage was frequent, and intracellularly stained fibroblasts were occasionally seen. Stage B lesions demonstrated a pattern intermediate between Stages A and C. CONCLUSION The enhanced staging system provides objective criteria to assess the severity of dermopathy in MD. Further studies are needed to determine the optimal treatment for MD based on this staging system related to Borrelia infection.
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Affiliation(s)
| | | | | | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA
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Ma J, Roelofs KA, Badilla J. Morgellons disease leading to corneal perforation and enucleation. Can J Ophthalmol 2019; 54:e285-e288. [PMID: 31836115 DOI: 10.1016/j.jcjo.2019.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Jingyi Ma
- University of Alberta, Edmonton, Alberta
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Moriarty N, Alam M, Kalus A, O'Connor K. Current Understanding and Approach to Delusional Infestation. Am J Med 2019; 132:1401-1409. [PMID: 31295443 DOI: 10.1016/j.amjmed.2019.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 01/06/2023]
Abstract
Delusional infestation is a psychiatric condition defined by a fixed belief of infestation despite contrary evidence. Diagnosis includes exclusion of organic etiologies. Treatment with antipsychotics is effective and safe in the majority of patients. Patients are characteristically reluctant to pursue psychiatric evaluation and may resist discussing their disease in psychiatric terms. Strategies to strengthen the provider-patient therapeutic alliance facilitate communication around appropriate treatment. Without antipsychotic medications, patients can become heavy utilizers of care and practice self-destructive behaviors in attempts to clear their perceived infestation.
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Katsoulis K, Rutledge KJ, Jafferany M. Delusional infestation: a prototype of psychodermatological disease. Int J Dermatol 2019; 59:551-560. [PMID: 31773724 DOI: 10.1111/ijd.14709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/09/2019] [Accepted: 10/19/2019] [Indexed: 01/10/2023]
Abstract
Delusional infestation (DI) is a disorder in which patients express a firm, unwavering belief that they are infested with some type of organism but otherwise have a typical grasp on reality with relatively normal cognitive functioning. Although classified as a somatic delusional disorder, DI requires special consideration due to its complicated clinical presentation, requiring attention to several possible explanations for the symptoms the patients describe. The purpose of the current review is to first summarize the clinical background and features of the diagnosis then explore treatment options. DI is a rare disorder though has reported cases dating back to the 19th century and spanning across the globe. Patients often experience the disorder as secondary to a medical condition, including substance use/withdrawal. However, there have also been many reported cases of primary DI, occurring in the absence of any other psychiatric or medical disorder. Clinically, DI is a diagnosis of exclusion, where the physician must rule out other medical conditions, including genuine dermatological disorders or infestations, or contributions from medications or substances. Patients with the disorder more commonly present to nonpsychiatric healthcare providers, making it essential for all clinicians to be able to identify the disease. Treatment can include either first or second generation antipsychotics, but it is important to proceed tactfully in discourse with the patient, being careful to address patients in a straightforward manner without reinforcing or questioning the delusion and focusing conversation on what can be done for the symptoms. Future research can continue to evaluate pathophysiology underlying primary DI, which historically has been an under-studied topic.
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Garcia-Mingo A, Dawood N, Watson J, Chiodini PL. Samples From Cases of Delusional Parasitosis as Seen in the UK Parasitology Reference Laboratory (2014-2015). Open Forum Infect Dis 2019; 6:ofz440. [PMID: 31660383 PMCID: PMC6810309 DOI: 10.1093/ofid/ofz440] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/06/2019] [Indexed: 11/13/2022] Open
Abstract
Delusional parasitosis is a common syndrome seen in Infectious Diseases clinics. These patients characteristically provide samples as evidence of their infestation. We prospectively catalogued and characterized 138 samples from these patients, processed in the UK Clinical Parasitology reference laboratory from January 2014 to April 2015. No human parasites were identified.
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Affiliation(s)
| | - N Dawood
- Brighton and Sussex University Hospital
| | - J Watson
- Hospital for Tropical Diseases, London, United Kingdom
| | - P L Chiodini
- Hospital for Tropical Diseases, London, United Kingdom
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Affiliation(s)
- Bernice Y Yan
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Joseph L Jorizzo
- Department of Dermatology, Weill Cornell Medical College, New York, New York
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Mixed Borrelia burgdorferi and Helicobacter pylori Biofilms in Morgellons Disease Dermatological Specimens. Healthcare (Basel) 2019; 7:healthcare7020070. [PMID: 31108976 PMCID: PMC6627092 DOI: 10.3390/healthcare7020070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/17/2019] [Accepted: 05/14/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Morgellons disease (MD) is a dermopathy that is associated with tick-borne illness. It is characterized by spontaneously developing skin lesions containing embedded or projecting filaments, and patients may also experience symptoms resembling those of Lyme disease (LD) including musculoskeletal, neurological and cardiovascular manifestations. Various species of Borrelia and co-infecting pathogens have been detected in body fluids and tissue specimens from MD patients. We sought to investigate the coexistence of Borrelia burgdorferi (Bb) and Helicobacter pylori (Hp) in skin specimens from MD subjects, and to characterize their association with mixed amyloid biofilm development. METHODS Testing for Bb and Hp was performed on dermatological specimens from 14 MD patients using tissue culture, immunohistochemical (IHC) staining, polymerase chain reaction (PCR) testing, fluorescent in situ hybridization (FISH) and confocal microscopy. Markers for amyloid and biofilm formation were investigated using histochemical and IHC staining. RESULTS Bb and Hp were detected in dermatological tissue taken from MD lesions. Bb and Hp tended to co-localize in foci within the epithelial tissue. Skin sections exhibiting foci of co-infecting Bb and Hp contained amyloid markers including β-amyloid protein, thioflavin and phosphorylated tau. The biofilm marker alginate was also found in the sections. CONCLUSIONS Mixed Bb and Hp biofilms containing β-amyloid and phosphorylated tau may play a role in the evolution of MD.
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Campbell EH, Elston DM, Hawthorne JD, Beckert DR. Diagnosis and management of delusional parasitosis. J Am Acad Dermatol 2019; 80:1428-1434. [DOI: 10.1016/j.jaad.2018.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/24/2023]
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Kupfer TR, Fessler DMT. Ectoparasite defence in humans: relationships to pathogen avoidance and clinical implications. Philos Trans R Soc Lond B Biol Sci 2019; 373:rstb.2017.0207. [PMID: 29866920 DOI: 10.1098/rstb.2017.0207] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2018] [Indexed: 11/12/2022] Open
Abstract
Currently, disgust is regarded as the main adaptation for defence against pathogens and parasites in humans. Disgust's motivational and behavioural features, including withdrawal, nausea, appetite suppression and the urge to vomit, defend effectively against ingesting or touching sources of pathogens. However, ectoparasites do not attack their hosts via ingestion, but rather actively attach themselves to the body surface. Accordingly, by itself, disgust offers limited defence against ectoparasites. We propose that, like non-human animals, humans have a distinct ectoparasite defence system that includes cutaneous sensory mechanisms, itch-generation mechanisms and grooming behaviours. The existence of adaptations for ectoparasite defence is supported by abundant evidence from non-human animals, as well as more recent evidence concerning human responses to ectoparasite cues. Several clinical disorders may be dysfunctions of the ectoparasite defence system, including some that are pathologies of grooming, such as skin picking and trichotillomania, and others, such as delusory parasitosis and trypophobia, which are pathologies of ectoparasite detection. We conclude that future research should explore both distinctions between, and overlap across, ectoparasite defence systems and pathogen avoidance systems, as doing so will not only illuminate proximate motivational systems, including disgust, but may also reveal important clinical and social consequences.This article is part of the Theo Murphy meeting issue 'Evolution of pathogen and parasite avoidance behaviours'.
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Affiliation(s)
- Tom R Kupfer
- School of Psychology, Keynes College, University of Kent, Canterbury, Kent CT2 7NP, UK
| | - Daniel M T Fessler
- Department of Anthropology and Center for Behavior, Evolution and Culture, University of California, Los Angeles, Los Angeles, CA 90095-1553, USA
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Middelveen MJ, Cruz ID, Fesler MC, Stricker RB, Shah JS. Detection of tick-borne infection in Morgellons disease patients by serological and molecular techniques. Clin Cosmet Investig Dermatol 2018; 11:561-569. [PMID: 30519067 PMCID: PMC6233863 DOI: 10.2147/ccid.s184521] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Morgellons disease (MD) is a skin condition associated with Lyme disease (LD) and tick-borne illness. Patients with this skin disorder experience ulcerative lesions that contain multicolored filamentous collagen and keratin inclusions. Infection with various species of Borrelia and other tick-borne pathogens has been detected in tissue and body fluid specimens from MD patients. We sought to explore this association further in a cohort of MD patients. Patients and methods Sera from 30 patients with MD were tested for antibody reactivity to antigens from the Borrelia burgdorferi (Bb) group and the relapsing fever Borrelia (RFB) group of spirochetes. Tissue and/or body fluid specimens from these patients were also tested for the presence of Bb and RFB infection using PCR technology. In addition, tissue and body fluid specimens were tested for the presence of Bartonella henselae using PCR, and formalin-fixed skin sections from a subset of patients were tested using fluorescent in situ hybridization (FISH) with B. henselae-specific DNA probes. Results Seroreactivity to Bb, RFB or both was detected in 63% of the cohort, while positive PCR testing for Bb, RFB or both was detected in 53% of the cohort. Overall, 90% of patients tested positive for exposure and/or infection with Borrelia spirochetes. B. henselae infection was detected by PCR in skin sections or body fluids from 20% of the subjects, and B. henselae FISH testing was positive in 30% of the dermatological specimens submitted for study. Conclusion The study demonstrates an association between MD and positive tests for both Bb and RFB spirochetes. In conjunction with previous studies, our study provides corroborative evidence linking MD to Borrelia infection and tick-borne illness.
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28
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Lai J, Xu Z, Xu Y, Hu S. Reframing delusional infestation: perspectives on unresolved puzzles. Psychol Res Behav Manag 2018; 11:425-432. [PMID: 30319296 PMCID: PMC6171510 DOI: 10.2147/prbm.s166720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Delusional infestation (DI), a debilitating psychocutaneous condition, featured as a false fixed belief of being infested accompanied by somatosensory abnormality, behavior alteration, and cognitive impairment. Although management of primary causes and pharmacotherapy with antipsychotics and/or antidepressants can help to alleviate symptoms in most patients, the underlying etiology of DI still remains unclear. Morgellons disease (MD), characterized by the presence of cutaneous filaments projected from or embedded in skin, is also a polemic issue because of its relationship with spirochetal infection. This review aims to discuss the following topics that currently confuse our understandings of DI: 1) the relationship of real/sham “infestation” with DI/MD; 2) behavior alterations, such as self-inflicted trauma; 3) neuroimaging abnormality and disturbance in neurotransmitter systems; and 4) impaired insight in patients with this disease. In discussion, we try to propose a multifactorial approach to the final diagnosis of DI/MD. Future studies exploring the neurobiological etiology of DI/MD are warranted.
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Affiliation(s)
- Jianbo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China, .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou 310003, China, .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China,
| | - Zhe Xu
- Zhejiang University School of Medicine, Hangzhou 310003, China.,Department of Psychiatry, Third People's Hospital of Huzhou, Hangzhou 313000, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China, .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou 310003, China, .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China,
| | - Shaohua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China, .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou 310003, China, .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China,
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Steinhoff M, Schmelz M, Szabó IL, Oaklander AL. Clinical presentation, management, and pathophysiology of neuropathic itch. Lancet Neurol 2018; 17:709-720. [PMID: 30033061 DOI: 10.1016/s1474-4422(18)30217-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 05/15/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
Unlike conventional itch, neuropathic itch develops in normal skin from excess peripheral firing or dampened central inhibition of itch pathway neurons. Neuropathic itch is a symptom of the same central and peripheral nervous system disorders that cause neuropathic pain, such as sensory polyneuropathy, radiculopathy, herpes zoster, stroke, or multiple sclerosis, and lesion location affects symptoms more than aetiology. The causes of neuropathic itch are heterogeneous, and thus diagnosis is based primarily on recognising characteristic, disease-specific clinical presentations. However, the diagnosis of neuropathic itch is challenging, different subforms exist (eg, focal vs widespread, peripheral vs central), and the mechanisms of neuropathic itch are poorly understood, resulting in reduced treatment availability. Currently available strategies include treating or preventing causal diseases, such as diabetes or herpes zoster, and topical or systemic medications that calm excess neuronal firing. Discovery of itch mediators such as gastrin releasing peptide, receptors (eg, neurokinin-1), and pathways (eg, Janus kinases) might encourage much needed new research into targeted treatments of neuropathic itch.
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Affiliation(s)
- Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar; HMC Translational Research Institute, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar; College of Medicine, Qatar University, Medical School, Doha, Qatar.
| | - Martin Schmelz
- Department of Experimental Pain Research, CBTM Mannheim, Heidelberg University, Mannheim, Germany
| | - Imre Lőrinc Szabó
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anne Louise Oaklander
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neuropathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Roncati L, Piscioli F. Morgellons Disease: Truth & Belief. Ann Dermatol 2018; 30:361-362. [PMID: 29853755 PMCID: PMC5929958 DOI: 10.5021/ad.2018.30.3.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/24/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Luca Roncati
- Department of Diagnostic and Clinical Medicine and of Public Health, Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Piscioli
- Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto, Italy
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Middelveen MJ, Fesler MC, Stricker RB. History of Morgellons disease: from delusion to definition. Clin Cosmet Investig Dermatol 2018; 11:71-90. [PMID: 29467580 PMCID: PMC5811176 DOI: 10.2147/ccid.s152343] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. Further studies of the genetics, pathogenesis, and treatment of MD are warranted.
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Krooks JA, Weatherall AG, Holland PJ. Review of epidemiology, clinical presentation, diagnosis, and treatment of common primary psychiatric causes of cutaneous disease. J DERMATOL TREAT 2017; 29:418-427. [DOI: 10.1080/09546634.2017.1395389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J. A. Krooks
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | - A. G. Weatherall
- Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
- ClearlyDerm Center for Dermatology, Boca Raton, FL, USA
| | - P. J. Holland
- Psychiatry and Neurology Department, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
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Mohandas P, Bewley A, Taylor R. Morgellons disease: experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes. J DERMATOL TREAT 2017; 29:208-213. [PMID: 28665169 DOI: 10.1080/09546634.2017.1349868] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In recent years, there has been a reported increase in affliction of the skin with small fibres or other particles. The condition has been referred to as Morgellons disease. Patients present with stinging, burning or crawling sensations of the skin, with perceived extrusion of inanimate material alongside fatigue and other systemic symptoms. Sufferers often experience significant morbidity and reduction in quality of life. OBJECTIVES We aimed to explore the various clinical presentations, management strategies and outcomes employed to treat this condition in our patients. METHODS We conducted a retrospective case notes review of 35 patients referred to our multidisciplinary psycho-dermatology clinic at the Royal London Hospital between January 2004 and January 2017. RESULTS The majority of patients were women (25) 71.4%, with a mean age of 54.6 years (26-80 years). Most (26) 74.2% were living alone. The average duration of illness prior to presentation was 3.8 years (4 months-20 years). Many patients had perceived precipitating factors (54.2%) and often self-diagnosed (28.5%). Psychiatric co-morbidities included 42.8% with depressive symptoms and 25.7% with anxiety. Substance misuse was elicited in five patients (14%). Management of patients included both the treatment of skin disease and psychosocial co-morbidities. Out of the 35 patients who attended (14) 40% cleared or showed significant improvement. Sixteen (45.7%) patients were stable and under review. One patient declined treatment and three did not attend review. One patient died from disease unrelated to her skin condition. CONCLUSIONS Morgellons disease is a condition, which is widely discussed on the internet and patients often self-diagnose. The course of the disease can be chronic and debilitating. For a positive outcome, it is important that a strong physican-patient relationship is cultivated. As demonstrated in this case series, managing patients holistically in an integrated multidisciplinary dermatology setting helps achieve positive outcomes.
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Affiliation(s)
- Padma Mohandas
- a Department of Dermatology , The Royal Derby Hospital , Derby , England.,b Department of Dermatology , The Royal London Hospital , London , England
| | - Anthony Bewley
- b Department of Dermatology , The Royal London Hospital , London , England
| | - Ruth Taylor
- b Department of Dermatology , The Royal London Hospital , London , England
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Tripathi SM, Singh P, Pandey NM. Postherpetic Neuralgia Presenting as Delusional Parasitosis: A Case Series. Indian J Psychol Med 2017; 39:347-349. [PMID: 28615772 PMCID: PMC5461848 DOI: 10.4103/0253-7176.207347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Delusional parasitosis (DP) or Ekbom's disease is a rare psychiatric condition where the sufferers have a firm-fixed belief of insects crawling over their skin. The condition may be primary monosymptomatic hypochrondrical delusion or secondary to an underlying psychiatric or organic condition. We present two cases of elderly men presenting with classical symptomatology of DP, which is found to be secondary to postherpetic neuralgia following an acute episode of shingles or herpes zoster infection. One patient responded to a combination of antipsychotic, olanzapine, and pregabalin, used for neuropathic pain, and the other patient responded completely with medications used for neuropathic pain only without any antipsychotic use.
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Affiliation(s)
| | - Priti Singh
- Department of Geriatric Mental Health, KG Medical University, Lucknow, Uttar Pradesh, India
| | - Nisha Mani Pandey
- Department of Geriatric Mental Health, KG Medical University, Lucknow, Uttar Pradesh, India
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Ohn J, Park SY, Moon J, Choe YS, Kim KH. Morgellons Disease. Ann Dermatol 2017; 29:223-225. [PMID: 28392653 PMCID: PMC5383751 DOI: 10.5021/ad.2017.29.2.223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 11/08/2022] Open
Abstract
Morgellons disease is a rare disease with unknown etiology. Herein, we report the first case of Morgellons disease in Korea. A 30-year-old woman presented with a 2-month history of pruritic erythematous patches and erosions on the arms, hands, and chin. She insisted that she had fiber-like materials under her skin, which she had observed through a magnifying device. We performed skin biopsy, and observed a fiber extruding from the dermal side of the specimen. Histopathological examination showed only mild lymphocytic infiltration, and failed to reveal evidence of any microorganism. The polymerase chain reaction for Borrelia burgdorferi was negative in her serum.
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Affiliation(s)
- Jungyoon Ohn
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Seon Yong Park
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Jungyoon Moon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Seon Choe
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Han Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Morgellons disease is characterized by complaints of uncomfortable skin sensations and fibers emanating from nonhealing skin lesions. Morgellons disease is well-known in the dermatology and psychiatry literature, where it is typically considered a subtype of delusional parasitosis, but it has not yet been described in the ophthalmology literature. A patient with self-reported Morgellons disease is presented, who was referred for evaluation of left lower eyelid ectropion. She reported that her skin was infested with fibers that were "trying to get down into the eyelid." On examination, she had ectropion of the left lower eyelid, broken cilia, and an ulcerated left upper eyelid lesion concerning for carcinoma. Biopsy of the lesion was consistent with excoriation. Treatment of her ectropion was deferred out of concern for wound dehiscence, given the patient's aggressive excoriation behavior. This case is presented to make the ophthalmologist aware of this disorder and to highlight the appropriate clinical management.
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Marshall CL, Williams V, Ellis C, Taylor RE, Bewley AP. Delusional infestation may be caused by recreational drug usage in some patients, but they may not disclose their habit. Clin Exp Dermatol 2016; 42:41-45. [DOI: 10.1111/ced.12999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - V. Williams
- Barts and the London School of Medicine and Dentistry; London UK
| | - C. Ellis
- Barts and the London School of Medicine and Dentistry; London UK
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Abstract
Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined.
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Ranka N, Godse K, Nadkarni N, Patil S, Agarwal S. Morgellons disease: A myth or reality? Indian Dermatol Online J 2016; 7:430-432. [PMID: 27730047 PMCID: PMC5038112 DOI: 10.4103/2229-5178.190500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nishita Ranka
- Department of Dermatology, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
| | - Kiran Godse
- Department of Dermatology, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
| | - Nitin Nadkarni
- Department of Dermatology, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
| | - Sharmila Patil
- Department of Dermatology, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
| | - Shweta Agarwal
- Department of Dermatology, D.Y. Patil University School of Medicine, Navi Mumbai, Maharashtra, India
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Fineberg SK, Leavitt JD, Deutsch-Link S, Dealy S, Landry CD, Pirruccio K, Shea S, Trent S, Cecchi G, Corlett PR. Self-reference in psychosis and depression: a language marker of illness. Psychol Med 2016; 46:2605-15. [PMID: 27353541 PMCID: PMC7944937 DOI: 10.1017/s0033291716001215] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Language use is of increasing interest in the study of mental illness. Analytical approaches range from phenomenological and qualitative to formal computational quantitative methods. Practically, the approach may have utility in predicting clinical outcomes. We harnessed a real-world sample (blog entries) from groups with psychosis, strong beliefs, odd beliefs, illness, mental illness and/or social isolation to validate and extend laboratory findings about lexical differences between psychosis and control subjects. METHOD We describe the results of two experiments using Linguistic Inquiry and Word Count software to assess word category frequencies. In experiment 1, we compared word use in psychosis and control subjects in the laboratory (23 per group), and related results to subject symptoms. In experiment 2, we examined lexical patterns in blog entries written by people with psychosis and eight comparison groups. In addition to between-group comparisons, we used factor analysis followed by clustering to discern the contributions of strong belief, odd belief and illness identity to lexical patterns. RESULTS Consistent with others' work, we found that first-person pronouns, biological process words and negative emotion words were more frequent in psychosis language. We tested lexical differences between bloggers with psychosis and multiple relevant comparison groups. Clustering analysis revealed that word use frequencies did not group individuals with strong or odd beliefs, but instead grouped individuals with any illness (mental or physical). CONCLUSIONS Pairing of laboratory and real-world samples reveals that lexical markers previously identified as specific language changes in depression and psychosis are probably markers of illness in general.
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Roncati L, Gatti AM, Pusiol T, Piscioli F, Barbolini G, Maiorana A. The first investigative science-based evidence of Morgellons psychogenesis. Ultrastruct Pathol 2016; 40:249-53. [DOI: 10.1080/01913123.2016.1190434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Delusional Infestation. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2016; 2016:9091838. [PMID: 27366186 PMCID: PMC4904590 DOI: 10.1155/2016/9091838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022]
Abstract
Although the practice of infectious diseases involves a broad range of surgical and medical disciplines, interactions with psychiatry are infrequent. Delusional infestation is a condition where an individual has a firmly fixed false belief that they have an infection. Delusional infestation challenges the infectious diseases specialist who must diligently rule out the presence of a true infection. However, perhaps, more importantly, we may need to initiate therapy with neuroleptic medications for which we may have little specific knowledge and experience. In this note we review the diagnosis and management of patients with delusional infestation.
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Feldman SR. Advances in and hope for the treatment of parasitosis. J DERMATOL TREAT 2016; 27:197. [PMID: 26979153 DOI: 10.3109/09546634.2016.1153254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Steven R Feldman
- a Department of Dermatology, Center for Dermatology Research , Wake Forest School of Medicine , Winston-Salem , NC , USA .,b Department of Pathology , Wake Forest School of Medicine , Winston-Salem , NC , USA .,c Department of Public Health Sciences , Wake Forest School of Medicine , Winston-Salem , NC , USA
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Medaglia JD, VanKirk KK, Oswald CB, Church LWP. Interdisciplinary Differential Diagnosis and Care of a Patient with Atypical Delusional Parasitosis due to early HIV-related Dementia. Clin Neuropsychol 2015; 29:559-69. [PMID: 25978635 DOI: 10.1080/13854046.2015.1042921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To provide a differential diagnosis and recommendations for care for an individual with suspected delusional parasitosis secondary to human immunodeficiency virus (HIV). METHOD A 62-year-old male with sexually acquired, chronic, and well-managed HIV infection was referred for neuropsychological evaluation and treatment recommendations following extensive self-manipulation of a sternoclavicular cystic mass and superficial skin lesions over most of his body. The patient reported that he had pulled long calcified tendrils out of the mass over a period of several weeks and that "encapsulated fat" was flowing beneath his skin. RESULTS Numerous lab panels were negative for any acute medical pathology. Clinical neuroimaging was unremarkable. Neuropsychological evaluation revealed a profile consistent with mild neurocognitive disorder due to HIV. Medical and behavioral recommendations were made for the management of delusional thought processes consistent with atypical delusional parasitosis and other symptoms. The patient was responsive to carefully crafted provider feedback and his delusional and somatic symptoms decreased significantly with risperidone. CONCLUSIONS This case illustrates the utility of neuropsychological assessment and provider feedback in the diagnosis and care of HIV-related neurocognitive disorder, the context of a delusional disorder.
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Affiliation(s)
- John D Medaglia
- a Moss Rehabilitation Research Institute , Elkins Park, PA , USA
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Middelveen MJ, Bandoski C, Burke J, Sapi E, Filush KR, Wang Y, Franco A, Mayne PJ, Stricker RB. Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients. BMC DERMATOLOGY 2015; 15:1. [PMID: 25879673 PMCID: PMC4328066 DOI: 10.1186/s12895-015-0023-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/28/2015] [Indexed: 11/10/2022]
Abstract
Background Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process. Methods & Results Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme serological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal infection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study patients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that the organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi were cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic infection. Based on these observations, a clinical classification system for MD is proposed. Conclusions Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.
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Affiliation(s)
| | - Cheryl Bandoski
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA.
| | | | - Eva Sapi
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA.
| | - Katherine R Filush
- Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA.
| | - Yean Wang
- Australian Biologics, Sydney, NSW, Australia.
| | | | - Peter J Mayne
- International Lyme and Associated Diseases Society, Bethesda, MD, USA.
| | - Raphael B Stricker
- International Lyme and Associated Diseases Society, Bethesda, MD, USA. .,, 450 Sutter Street, Suite 1504, San Francisco, CA, 94108, USA.
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Bailey CH, Andersen LK, Lowe GC, Pittelkow MR, Bostwick JM, Davis MDP. A population-based study of the incidence of delusional infestation in Olmsted County, Minnesota, 1976-2010. Br J Dermatol 2015; 170:1130-5. [PMID: 24472115 DOI: 10.1111/bjd.12848] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Delusional infestation (DI) is a well-recognized clinical entity but there is a paucity of reliable data concerning its epidemiology. Knowledge of the epidemiology is fundamental to an understanding of any disease and its implications. Epidemiology is most accurately assessed using population-based studies, which are most generalizable to the wider population in the U.S. and worldwide. To our knowledge, no population-based study of the epidemiology (particularly incidence) of DI has been reported to date. OBJECTIVES To determine the incidence of delusional infestation (DI) using a population-based study. METHODS Medical records of Olmsted County residents were reviewed using the resources of the Rochester Epidemiology Project to confirm the patient's status as a true incident case of DI and to gather demographic information. Patients with a first-time diagnosis of DI or synonymous conditions between 1 January 1976 and 31 December 2010 were considered incident cases. RESULTS Of 470 identified possible diagnoses, 64 were true incident cases of DI in this population-based study. The age- and sex-adjusted incidence was 1·9 [95% confidence interval (CI) 1·5-2·4] per 100 000 person-years. Mean age at diagnosis was 61·4 years (range 9-92 years). The incidence of DI increased over the four decades from 1·6 (95% CI 0·6-2·6) per 100 000 person-years in 1976-1985 to 2·6 (95% CI 1·4-3·8) per 100 000 person-years in 2006-2010. CONCLUSIONS Our data indicate that DI is a rare disease, with incidence increasing across the life span, especially after the age of 40 years.
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Affiliation(s)
- C H Bailey
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, MN, U.S.A
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Beach SR, Kroshinsky D, Kontos N. Case records of the Massachusetts General Hospital. Case 37-2014. A 35-year-old woman with suspected mite infestation. N Engl J Med 2014; 371:2115-23. [PMID: 25427115 DOI: 10.1056/nejmcpc1305989] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Söderfeldt Y, Groß D. Information, consent and treatment of patients with Morgellons disease: an ethical perspective. Am J Clin Dermatol 2014; 15:71-6. [PMID: 24671866 DOI: 10.1007/s40257-014-0071-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Morgellons is a medically contested diagnosis with foremost dermatological symptoms. Patients experience fibers emerging from the skin, together with a range of other somatic, psychiatric, and neurological complaints. Within the medical community, it is generally held to be a variation of delusional parasitosis/delusional infestation, which is usually treated with antipsychotics. Little attention has been paid in the literature to the ethical aspects of treating patients with Morgellons disease. The communicative strategies suggested in the literature display significant ethical issues, primarily the use of therapeutic privilege, i.e. withholding information from the patient. Since this limits patient autonomy, that approach is ethically problematic. Instead, the physician has an ethical obligation to respect the patient's autonomy, provide full information, and seek consent before initiating a psychiatric referral.
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Affiliation(s)
- Ylva Söderfeldt
- Institut für Geschichte, Theorie und Ethik der Medizin, Medizinische Fakultät der RWTH Aachen, Universitätsklinikum Aachen, Wendlingweg 2, 52074, Aachen, Germany,
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