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Morgellons (also called Morgellons disease or Morgellons syndrome) is a name given to a condition characterized by a range of cutaneous (skin) symptoms. Sufferers report crawling, biting, and stinging sensations; finding fibers on or under the skin; and persistent skin lesions (e.g. rashes or sores). In addition to skin manifestations, some sufferers also report fatigue, mental confusion, short term memory loss, joint pain, and changes in vision. A majority of health professionals, including most dermatologists, regard Morgellons as manifestations of other known medical conditions, including delusional parasitosis and believe any fibers found are from textiles such as clothing. The Morgellons Research Foundation, a non-profit advocacy organization, believes that it is a new infectious disease that will be confirmed by future research. "Other health professionals don't acknowledge Morgellons disease or are reserving judgment until more is known about the condition." Research into the condition is ongoing.

History

In 2002, biologist Mary Leitao's 2-year-old son developed sores under his lip and began to complain of "bugs." Leitao examined the sores and discovered "bundles of fibers" of various colors. She took her son to see at least eight different doctors, who were unable to find any disease, allergy, or other explanation for the symptoms. She named the condition Morgellons (with a hard g), after a condition from the monograph A Letter to a Friend by Sir Thomas Browne, in 1690, wherein he describes several medical conditions in his experience, including that endemial distemper of children in Languedoc, called the morgellons, wherein they critically break out with harsh hairs on their backs. In 2004, Leitao created the Morgellons Research Foundation and its associated web site to promote awareness of the disease and advocate for increased attention from the medical community.

The MRF began actively trying to raise public awareness of Morgellons. In May 2006, Morgellons was featured in a number of TV news segments on local Southern California stations. One report, titled, "Mysterious Disease Plagues More Southlanders" prompted the Los Angeles County Department of Health services to issue a statement stating that, "No credible medical or public health association has verified the existence or diagnosis of "Morgellons Disease."

This attention was followed in June and July by segments on CNN, ABC's Good Morning America, and NBC's The Today Show. In August 2006 a large segment of the ABC show Medical Mysteries was devoted to the subject of Morgellons. This resulted in a significant rise in the public awareness of the term Morgellons. The first scientific article to discuss Morgellons was co-authored by Leitao and R. B. Stricker, a member of the MRF's Medical Advisory Board and was published in July, 2006..

The MRF has since received reports of Morgellons from all 50 US states and 15 nations, including Canada, the UK, Australia, and the Netherlands, and states that they have been contacted by over 10,000 families.

CDC investigation

A Centers for Diease Control task force first met in June 2006 in order to develop a case definition of Morgellons. As of August, the task force consisted of 12 people, including two pathologists, a toxicologist, an ethicist, a mental health expert and specialists in infectious, parasitic, environmental and chronic diseases. In July of 2006, Dan Rutz, MPH, a communications specialist for the CDC, said "We're not ready to concede there's a new disease, but the volume of concern has stepped up because a lot of people are writing or calling their congressmen about it because they're frustrated that there's been no organized way to deal with their suffering." In May, 2007, KGW-TV Newschannel 8's Laural Porter asked Rutz "Do you have any idea what the fibers are?" Rutz said, "None. We don't know. We haven't studied them in a lab yet. There is nothing to imply there is , but our mind is open to everything, including that remote possibility."

In June 2007, the CDC opened a website on "Unexplained Dermopathy (aka "Morgellons")", stating, "CDC is working with public health and other medical professionals to identify potential sites for the epidemiologic investigation. CDC also is working with task force members to develop a scientific protocol, including an initial screening case definition for the epidemiologic investigation."

On August 1, 2007, the CDC issued a formal Request for Quotations for an epidemiologic investigation of Morgellons. The CDC plans to identify a database of potential cases (study cohort) by November 30, 2007.

Symptoms and diagnosis

There is currently no generally recognized list of symptoms or differential diagnosis for Morgellons. Patients usually self-diagnose based on media reports and information published by the Morgellons Research Foundation. Symptoms usually include:

• Disturbing sensations of insects crawling, stinging or biting on or under the skin
• Skin rashes and lesions that do not heal
• Fiber-like filaments, granules or crystals that appear on or under the skin or that can be extracted from lesions
• Joint, muscle and connective tissue pain, including fibromyalgia
• Chronic fatigue
• Cognitive dysfunction, including difficulty with concentration, short-term memory, and attention

Dr. William T. Harvey, a member of the MRF Medical Advisory Board, has reported that Morgellons patients also exhibit laboratory findings including increased levels of inflammatory cytokines, increased insulin, and antibodies to three bacterial pathogens. However, these findings have not been reported in the peer-reviewed medical literature. Many Morgellons patients have symptoms that are also consistent with Chronic Fatigue Syndrome, depression, obsessive-compulsive disorder, and attention deficit disorder.

The Morgellons Research Foundation has adopted a draft Case Definition developed by their Medical Advisory Board that is intended to be refined as new information is available.

The 2007 Atlas of Human Parasitology states:

Many dermatologists refute the suggestion that this is an actual disease but instead indicate that many of these patients have psychological problems or other common skin disorders. Given the large numbers of individuals who feel that they have this affliction, it will be most helpful over the coming years to have a valid scientific assessment of Morgellons diesease and its possible etiology (or etiologies). One of the chief criticisms by many patients has been that they feel the medical community and other scientists consulted have not been open to the idea that there is possibly an as yet undescribed infectious or physiologic causation for the disease. However it is certainly true that in fact many expert parasitologists, medical entomologists and other microbiologists have in fact carefully examined fibers and other materials expressed or extracted from such patients and found that biological organisms are not present. Although an apparent association of the condition with the presence of Lyme disease has been reported (Savely et al, 2006, Am J Clin Dermatol, 7:1-6), further research will be needed to help resolve the validity of Morgellons disease. Until then, whether Morgellons disease is another name for delusional parasitosis or a real disease entity with a biologic or physiologic basis will remain up in the air.

Proposed causes

Delusional parasitosis

A majority of dermatologists view Morgellons as a new name for an old condition, Delusional parasitosis. In delusional parasitosis, patients hold a delusional belief that they are infested with parasites. They may experience formication, the sensation that insects are crawling under the skin. Individuals suffering from this condition may develop elaborate rituals of inspection and cleansing to locate and remove parasites and fibers, resulting in a form of self-mutilation; they injure themselves in attempts to be rid of the "parasites" by picking at the skin, causing lesions, and then pick at the lesions, preventing them from healing. Patients with delusion parasitosis often present at the doctor's office with "matchbook sign," collections of fibers and other foreign objects supposedly retrieved from the skin. Delusional parasitosis, with symptoms that have "extraordinary similarities" to Morgellons, has been described in the medical literature for over 75 years. Dr. Noah Craft, a dermatologist at the Harbor-UCLA Medical Center, Torrance, CA, has seen a handful of Morgellons patients and biopsied their skin lesions, but found only normal skin and inflammation, as one would find in a bump that has been picked at.

Some cases of delusional parasitosis may have organic causes. For example, formication, the sensation that bugs are crawling under ones' skin, can be caused by allergies, diabetic neuropathy, menopause, skin cancer, or herpes zoster. Formication is also a common side-effect of many prescription drugs such as Ritalin, Adderall and Lunesta. The sensations are real, but the attribution of the sensations to unknown parasites and the collection of fibers is part of the delusion.

Advocates from the MRF counter that non-healing Morgellons lesions have been found on infants' bodies in locations that the infants can not themselves reach to scratch.. The symptoms of Morgellons are broader than those reported for delusional parasitosis, including chronic fatigue and muscle pain and cognitive disfunction. In a letter to the MRF dated June 11, 2003, the California Department of Health and Human Services stated that, "After reviewing your website to gain some information about the patients...the patients appear to have a constellation of symptoms that do not fit any currently definable disease, infectious or otherwise."

Other skin conditions

It has been hypothesized that some cases of (self-diagnosed) Morgellons disease are actually other recognized skin disorders, including allergic dermatitis, contact dermatitis, and the parasite scabies. In these cases, there is still a delusional component (the fixation on bugs crawling under the skin, the production and collection of fibers, and self-mutilation), there is also an organic component that can be treated by conventional means. There are reports of cases diagnosed as delusional parasitosis in which an underlying organic cause has been identified and treated. However, no case studies have yet reported identification of an organic cause for Morgellons.

Other theories and research

The majority of research into novel causes for Morgellons have been conducted by scientists associated with the Morgellons Research Foundation and is published on the MRF web site. To date, none of these studies has been published in the peer-reviewed medical literature or been reproduced by researchers not affiliated with the MRF.

Theories about the fibers

Randy Wymore, a former research director of the MRF and presently Director of the Oklahoma State University Center for Health Sciences' Center for the Investigation of Morgellons Disease, claims that Morgellons patients have masses of dark fibers visible at 60x magnification under the unbroken skin, while unaffected individuals do not. The fibers did not look like fibers from clothing, carpet, or sporting goods, but fibers from patients in 4 different states "look(ed) very similar to one another." Wymore sent samples of fibers supplied by Morgellons patients to the Police Crime Lab in Tulsa, Oklahoma for analysis. After checking the fibers against known fibers in the FBI's national database, lab director Mark Boese said the fibers were "consistent with something that the body may be producing," adding, "These fibers cannot be manmade and do not come from a plant. This could be a byproduct of a biological organism."

Dr. Rhonda Casey, chief of pediatrics at Oklahoma State University Hospital and part of the MRF research team at OSU, reported that she has examined many patients skin via a dermatoscope and performed biopsies on both lesions and apparently healthy skin, and that "she saw fibers embedded in both places. The white ones, she says, are hard to see. A dermatologist who either didn't look at all, or didn't use a dermatoscope, might not see them under the skin." Casey also noted that all of her Morgellons patients exhibited neurological impairment.

Dr. Stricker, along with Dr. Citovsky, MRF board member from the State University of New York at Stony Brook and an expert on plant pathogens, reported in January, 2007 that Morgellons skin fibers appear to contain cellulose. Five skin samples of Morgellons patients contained evidence of DNA from Agrobacterium, a plant-infecting organism which is known to produce cellulose fibers at infection sites within plant host tissues. Agrobacterium can be responsible for opportunistic infections in humans with weakened immune systems, but have not been shown to be primary pathogens in otherwise healthy individuals.

Another MRF board member, Dr. Ahmed Kilani, the CEO of Clongen Labs and a microbiologist with a Ph.D. from Stanford University Medical School, does not agree that Morgellons is a bacterial infection. Based on the preliminary research that he has conducted so far, Kilani has hypothesized that Morgellons is not caused by a bacterium, but "is a more complex fungus, algae or a novel parasite. The fibers are most likely feeding structures as they have strong resemblance to aerial hyphae observed in many fungal species."

Bacterial hypothesis

Raphael Stricker, President of the International Lyme and Associated Diseases Society (ILADS) and a member of the MRF Medical Advisory Board, has written a review article on Morgellons for the American Journal of Clinical Dermatology. He reports that "Morgellons disease may be linked to an undefined infectious process." He claims that "many patients with Morgellons disease have positive Western blots for Borrelia burgdorferi, the causative agent of Lyme disease," and that treatment with antibiotics appropriate for Lyme disease leads to remission of Morgellons symptoms. However, the underlying data for these claims has not been published, nor have these results been reproduced by other scientists.

Environmental toxins

Richard Fagerlund, an entomologist who has a column titled "Ask the Bugman" in the San Francisco Chronicle, stated that he takes this issue seriously. He receives letters from people with Morgellons symptoms daily. He believes that the condition is reaching epidemic proportions, and believes that only a small percentage of these cases are delusional parasitosis, while the rest may be the result of something else, such as pollutants, especially pesticides.

Treatment

Most psychiatrists and dermatologists treat Morgellons by treating any underlying dermatological condition as the condition dictates, and treating other symptoms with antipsychotic medications. See, Psychiatric Arsenal Has Weapons Against Morgellons Disease , OCD Patients May Seek Help From Dermatologists and Pimozide at Least as Safe and Perhaps More Effective Than Olanzapine for Treatment of Morgellons Disease,. Other doctors have suggested Cognitive Behavior Therapy, see Cure found for Morgellons disease? .

Doctors and nurses in the MRF treat Morgellons very similarly to the controversial late-stage infectious Lyme disease ( "Most Morgellons patients, if found positive for Chlamydophila pneumonia, a Babesia species or a Borrelia species pathogenic to humans...and given appropriate antibiotics long enough, resolve most symptoms.") , with long term intravenous antibiotics. . One of the authors of the two original papers on Morgellons has said the rife machine helps in 30% of cases.

There is also a significant amount of self-treatment, with many web retailers offering various treatments. , and various of these are mentioned on the NMO's (ex-MRF board members) site

See also

• Medically unexplained physical symptoms
• Formication

References

1. ^ Unexplained Dermopathy (aka "Morgellons") Centers For Disease Control, June 12, 2007
2. ^ Savely VR, Leitao MM, and Stricker, RB. The mystery of Morgellons disease: infection or delusion? Am J Clin Dermatol. 2006;7(1):1-5 PMID 16489838
3. ^ Mysterious 'Morgellons disease' prompts US investigation, Emma Marris, Nature Medicine, 30 August 2006
4. ^ Dunn, Jeffrey (August, 2007). "Diffuse Pruritic Lesions in a 37-Year-Old Man After Sleeping in an Abandoned Building". The American Journal of Psychiatry. 164: 1166–1172. doi:10.1176/appi.ajp.2007.07030381. Retrieved 2007-08-04. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
5. http://www.timesonline.co.uk/tol/comment/article721795.ece
6. ^ Morgellons.org
7. "Morgellons disease: Managing a mysterious skin condition". Mayo Clinic. 2007-05-02. Retrieved 2007-08-04.
8. ^ DeVita-Raeburn, Elizabeth (March/April 2007). "The Morgellons Mystery". Psychology Today. Retrieved 2007-08-04. {{cite web}}: Check date values in: |date= (help)
9. A Letter to a Friend Sir Thomas Browne, 1690.
10. ^ Stobbe, Mike (2006-08-09). "CDC Probes Bizarre Morgellons Condition". CBS. Retrieved 2007-08-04. Cite error: The named reference "CDC Probes" was defined multiple times with different content (see the help page).
11. Harlan, Chico (2006-07-23). "Mom fights for answers on what's wrong with her son". Pittsburgh Post-Gazette. Retrieved 2007-08-04.
12. ^ LADHS Statement on Morgellons Disease, Los Angeles Department of Health Services, May 2006
13. "Mysterious Disease Plagues More Southlanders". May 22, 2006. {{cite web}}: Unknown parameter |org= ignored (help)
14. "CDC considers Texas for Morgellons study", My San Antonio News, posted Jun 26, 2006, accessed Jun 26, 2006.
15. Itching for Answers to a Mystery Condition, TIME, July 28, 2006
16. 2007-Q-09877, Morgellons CDC Request for Quotation DOC
17. Savely G, Leitao MM. Skin lesions and crawling sensations: disease or delusion? Adv Nurse Pract. 2005 May;13(5):16-7. PMID 15898309
18. ^ Harvey WT. Morgellons disease. Journal of the American Academy of Dermatology. 56(4):705-6, 2007 Apr. PMID 17367622
19. Paquette M. Morgellons: disease or delusions?. Perspectives in Psychiatric Care 43(2):67-8, 2007 Apr. PMID 17388848
20. Morgellons Case Definition Morgellons research Foundation, 2007
21. Ash. L.R., Orihel, T.C. 2007. Atlas of Human Parasitology, 5th Edition. American Society for Clinical Pathology Press, Chicago, Illinois, pp. 386-387 ISBN: 0891891676
22. A Medical Mystery: Delusional parasitosis Frank X. Mullen Jr, Reno Gazette-Journal, May 8, 2004.
23. Koblenzer, CS. The challenge of Morgellons disease. J Am Acad Dermatol 2006. 55:920-922. PMID 17052516
25. "Morgellons Disease, Cofield family", WKRG-TV, Mobile, May 22, 2006
26. "Morgellons Mystery". ABC News Primetime. Aug 9, 2006. Retrieved 2007-08-14.
27. Stricker RB, Savely VR, Zaltsman A, Citovsky V (2007) Contribution of Agrobacterium to morgellons disease. Journal of Iinvestigative Medicine 55 (1): S123-S123 Suppl. S, Jan 2007 (Abstract)
28. Hulse M, Johnson S, Ferrieri P. Agrobacterium infections in humans: experience at one hospital and review. Clin Infect Dis. 1993 Jan;16(1):112-7.
29. Kilani, A. Investigation of Novel Organism Implicated in Morgellons Disease. Research proposal published on the [http://www.morgellons.org/clogen1.htm MRF web site.
30. International Lyme and Associated Diseases Society (ILADS)
31. Persistent scabies-like condition may not be all in people's heads, Richard Fagerlund, San Francisco Chronicle, December 30, 2006

External links

• Morgellons Research Fountation
• Morgellons Watch Skeptical website.