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Morgellons (also called Morgellons disease or Morgellons syndrome) is a name given in 2002 by biologist Mary Leitao to a condition characterized by a range of cutaneous (skin) symptoms. Persons who suffer from this unexplained condition 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 also report fatigue, mental confusion, short term memory loss, joint pain, and changes in vision. It is not known at present whether the condition represents a new disease entity, or whether persons who identify themselves as having Morgellons have a common cause for their symptoms, share common risk factors, or are contagious. A majority of health professionals, including most dermatologists, regard Morgellons as a manifestation of other known medical conditions, including delusional parasitosis 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." Institutional Review Board approval for a CDC investigation into Morgellons is scheduled for October, 30 2007.

History

In 2001, 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 red, blue, black and white "bundles of fibers." 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, but her son developed more sores, and more fibers continued to poke out of them. Frustrated, she picked the name Morgellons disease for the affliction. Morgellons (with a hard g), is a description of an illness 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."

Ms. Leitao created the Morgellons Research Foundation (MRF) and its associated web site in 2002 to promote awareness of the disease and to raise money for research. She stated that she initially hoped to receive information from scientists or physicians who might understand the problem, but instead, thousands of others contacted her describing their sores and fibers, as well as neurological symptoms, fatigue, muscle and joint pain, and other symptoms. The MRF has now 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.

In May 2006, Morgellons was featured in a number of TV news segments on local Southern California stations, including a report titled, "Mysterious Disease Plagues More Southlanders". That same day the Los Angeles County Department of Health services issued a statement saying, "No credible medical or public health association has verified the existence or diagnosis of "Morgellons Disease", and "at this time there is no reason for individuals to panic over unsubstantiated reports of this disease". This media coverage 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 V. R. Savely, M. M. Leitao, and R. B. Stricker, members of the MRF, and was published July, 2006 by the American Journal of Clinical Dermatology. An article in the San Francisco Chronicle reported, "There have been no clinical studies" (of Morgellons disease).

CDC investigation

A Centers for Disease Control and Prevention 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 list of symptoms or differential diagnosis for Morgellons that is generally accepted by the medical community. Patients usually self-diagnose based on media reports and information published by the Morgellons Research Foundation. Symptoms usually include:

  • Disturbing sensations of insect-like 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
  • Debilitating fatigue
  • Cognitive dysfunction, including difficulty with concentration, short-term memory, and attention

Dr. William T. Harvey, director of the MRF medical advisory board, states that Morgellons patients also exhibit laboratory findings including increased levels of inflammatory cytokines, increased insulin, and antibodies to three bacterial pathogens. Many Morgellons patients have symptoms that are also consistent with Chronic Fatigue Syndrome, depression, obsessive-compulsive disorder, and attention deficit disorder. Dr. Rhonda Casey, chief of pediatrics at Oklahoma State University Hospital, while working with the OSU-CHS Center for the Investigation of Morgellons Disease, noted all her Morgellons patients looked ill with neurological symptoms, which included confusion, difficulty walking and controlling their foot (foot drop), and a sagging mouth when speaking; the OSU Center has issued a list of symptoms similar to that of the MRF.

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 and pathophysiology

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 "matchbox 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. Symptoms associated with delusional parasitosis, including urticaria (hives), paresthesia (unexplained tingling sensations in the skin), and pruritis (itching), are common side-effects of many prescription drugs. 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."

Known 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.

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. 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."

Dermatologists say any fibers are from clothing embedded in self-imposed sores, and the fibers patients bring in bags are textile in nature.

Bacterial hypothesis

Three members of the Morgellons Research Foundation, including Raphael Stricker, President of the International Lyme and Associated Diseases Society (ILADS), authored an article about Morgellons published by the American Journal of Clinical Dermatology in early 2006. The authors wrote that "Morgellons disease may be linked to an undefined infectious process," and reported that many patients with Morgellons disease have positive Western blots for Borrelia burgdorferi, the causative agent of Lyme disease, and treatment with anti-bacterials appropriate for Lyme disease leads to remission of Morgellons symptoms in most patients. Dr. Harvey has also stated there is serological evidence of bacterial pathogens in Morgellons patients. The underlying data for these claims have not been published and the findings have not been independently confirmed.

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 has not been shown to be a primary pathogen in otherwise healthy individuals.

Another MRF board member, Dr. Ahmed Kilani, the CEO of Clongen and a microbiologist with a Ph.D. from Stanford University Medical School, does not agree that Morgellons is a bacterial infection. Based on his own preliminary research, Kilani has hypothesized that Morgellons "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."

Environmental toxins

Richard Fagerlund, an entomologist who has a column titled "Ask the Bugman" in the San Francisco Chronicle, stated that he takes Morgellons disease seriously, and he receives letters from people with Morgellons symptoms daily. Twenty years ago, he got three to four letters like this a year. He believes the condition is reaching epidemic proportions and theorizes only a small percentage of cases are delusional parasitosis, while the rest may be caused by something else, such as pollutants, especially pesticides.

Treatment

Treatment for Delusional Parasitosis

Many dermatologist treat Morgellons as delusional parasitosis. After a thorough medical examination to rule out known organic causes for the symptoms, delusional parasitosis patients are typically prescribed one of several typical antipsychotic drugs. In the past, pimozide was the drug of choice; in addition to antipsychotic activity, it also has antipruritic activity, meaning it inhibits the sensation of itching. However, pimozide requires frequent electrocardiographic monitoring. Currently, atypical antipsychotics such as olanzapine or risperidone are used as first line treatment. Antipsychotics are effective at treating delusional parasitosis at doses as low as one-fifth to one-tenth the dose typically prescribed for schizophrenia. It is common for patients who believe they have Morgellons to reject a physician's diagnosis of delusional parasitosis. It has been suggested that the term Morgellons should be adopted by dermatologists to enhance their rapport with their patients, allowing them to overcome this resistance.

Treatment for infectious disease

People who say that they have Morgellons will frequently reject the diagnosis of delusional parasitosis and, "report that their symptoms are not taken seriously." There are medical practitioners that hypothesize Morgellons is an infectious process, including several associated with the MRF, who will listen to patient's symptoms, examine them, order laboratory tests, and treat Morgellons symptoms accordingly, including the use of antibiotics, antifungals, antiparasitic medications, herbal supplements, and light therapy. Physicians associated with the Morgellons Research Foundation have reported that some Morgellons patients who test positive for Lyme disease obtain symptom relief using aggressive, long-term antibiotic treatment for chronic Lyme disease. However, if the treatment is discontinued the symptoms return.

Self-treatment

Persons with Morgellons symptoms may turn to alternative remedies described on web sites and discussion groups. Such treatments may include vitamins, herbs, epsom salt baths, vinegar, antifungal soaps and shampoos, and natural oils . Some treatments are dangerous, however, and have included the use of bleach, veterinary medicines intended for de-worming horses, and industrial insecticides. There is no proof that any of these treatments are effective.

See also

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 J, Murphy MB, Fox KM. Diffuse Pruritic Lesions in a 37-Year-Old Man After Sleeping in an Abandoned Building. Am J Psychiatry 2007. 164:1166–1172. PMID 17671278 Full text link
  5. ^ Morgellons Research Foundation web site
  6. "Morgellons disease: Managing a mysterious skin condition". Mayo Clinic. 2007-05-02. Retrieved 2007-08-04.
  7. ^ Centers for Disease Control and Prevention (PGO) Acquisition & Assistance Branch B, Request No. 2007-Q-09877, Requisition/ Purchase Request No. 000HCVCH-2007-46765, 2007-07-31 Cite error: The named reference "CDCRFQ" was defined multiple times with different content (see the help page).
  8. ^ Harlan, Chico (2006-07-23). "Mom fights for answers on what's wrong with her son". Pittsburgh Post-Gazette. Retrieved 2007-08-04.
  9. ^ DeVita-Raeburn, Elizabeth (March/April 2007). "The Morgellons Mystery". Psychology Today. Retrieved 2007-08-04. {{cite web}}: Check date values in: |date= (help)
  10. ^ "Morgellons Mystery". ABC News Primetime. Aug 9, 2006. Retrieved 2007-08-14.
  11. A Letter to a Friend Sir Thomas Browne, 1690.
  12. "Mysterious Disease Plagues More Southlanders". May 22, 2006. {{cite web}}: Check date values in: |date= (help); Unknown parameter |org= ignored (help)
  13. LADHS Statement on Morgellons Disease, Los Angeles Department of Health Services, May 2006
  14. ^ Nasty disease? Or is it delusion? Erin Allday, Chronicle Staff Writer,San Francisco Chronicle, June 2, 2006.
  15. "CDC considers Texas for Morgellons study", My San Antonio News, posted Jun 26, 2006, accessed Jun 26, 2006.
  16. ^ "CDC Probes Bizarre Morgellons Condition", ATLANTA, Aug. 9, 2006, By MIKE STOBBE AP Medical Writer.
  17. Itching for Answers to a Mystery Condition, TIME, July 28, 2006
  18. Savely G, Leitao MM. Skin lesions and crawling sensations: disease or delusion? Adv Nurse Pract. 2005 May;13(5):16–7. PMID 15898309
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  21. Morgellons Case Definition Morgellons research Foundation, 2007
  22. 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
  23. A Medical Mystery: Delusional parasitosis Frank X. Mullen Jr, Reno Gazette-Journal, May 8, 2004.
  24. ^ Koblenzer, CS. The challenge of Morgellons disease. J Am Acad Dermatol. 2006. 55:920–922. PMID 17052516
  25. Hinkle, NC. Delusory Parasitosis. American Entomologist 2000. 46:17–25. Full text link
  26. Letter from Stan Husted, Supervising Public Health Biologist, California Department of Health Services, to Mary Leitao, dated Oct 31, 2003
  27. Elaine Monaghan (May 19, 2006). "All in the head?". The Times. Retrieved 2007-08-14. {{cite news}}: Check date values in: |date= (help)
  28. International Lyme and Associated Diseases Society (ILADS)
  29. Stricker RB, Savely VR, Zaltsman A, Citovsky V. Contribution of Agrobacterium to morgellons disease. J Invest Med. 2007. 55 (1): S123-S123 Suppl. S. (Abstract)
  30. 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. PMID 8448285
  31. Kilani, A. Investigation of Novel Organism Implicated in Morgellons Disease. Research proposal published on the [http://www.morgellons.org/clogen1.htm MRF web site.
  32. Persistent scabies-like condition may not be all in people's heads, Richard Fagerlund, San Francisco Chronicle, December 30, 2006
  33. Koo J and Lee CS. Delusions of Parasitosis: A Dermatologist's Guide to Diagnosis and Treatment. Am J Clin Dermatol. 2001. 2(5):285–290. PMID 11721647
  34. ^ Meehan WJ, Badreshia S, Mackley CL. Successful treatment of delusions of parasitosis with olanzapine. 2006. Arch Dermatol. Mar;142(3):352–5. PMID 16549712 Full text link
  35. Koblenzer CS. Pimozide at least as safe and perhaps more effective than olanzapine for treatment of Morgellons disease. 2006. Arch Dermatol. 142(10):1364. PMID 17043201
  36. Murase JE, Wu JJ and Koo J. Morgellons disease: A rapport-enhancing term for delusions of parasitosis. J Am Acad Dermatol. 2006. 55(5):913–914. PMID 17052509 Full text link
  37. ^ Morgellons Disease Baffles Patients And Doctors By Benjamin Chertoff, Popular Mechanics, Published in the June 2005 issue
  38. Disease: Real or state of mind? By Melissa Healy, Los Angeles Times, 2006-11-13
  39. Doctors Make Progress With Mysterious Disease KTVU-TV, Bay area, 2006-6-23
  40. Morgellons disease: The itch that won't be scratched, Daniel Elkan, NewScientist Magazine issue 2621, 2007-9-12
  41. Vital Signs: Bugs Are Crawling In My Skin, by Claire Panosian Dunavan, Discover, 2006-11-20

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