Morgellons

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"Morgellons" or "Morgellons disease" is a controversial medical condition, described as a multiple-symptom syndrome, characterized by skin lesions; a sensation that insects are crawling on or under the skin; fibers and granules coming out of the skin; and fatigue. Reported mental symptoms may include short-term memory loss and impaired thinking, described as "brain fog". The cause is unknown, and no diagnostic criteria have been established.

Dissatisfied with doctors' diagnosis of her two-year-old son's rash, Mary Leitao, of McMurray, Pennsylvania, coined the name Morgellons, and formed the Morgellons Research Foundation (MRF) in 2002. She is currently its Executive Director.

Leitao named it after a condition in Sir Thomas Browne's 1690 monograph A Letter to a Friend, wherein he describes "that endemial distemper of children in Languedoc, called the morgellons, wherein they critically break out with harsh hairs on their backs." Researchers from the Morgellons Research Foundation consider Morgellons a distinct and novel disease. The contemporary syndrome, however, is not confined to children, and the reported fibers do not appear to be hair.

The Morgellons Research Foundation states that Morgellons has been reported in every American state, and 15 other countries. Most of the U.S. cases are in California, Texas and Florida^[1].

Morgellons shares characteristics with a number of recognized medical conditions, including attention-deficit disorder, chronic fatigue syndrome, Lyme disease, obsessive-compulsive disorder, but especially with delusional parasitosis, a mental illness involving false beliefs about infestation by parasites.

The Journal of the American Academy of Dermatology printed two letters, and a commentary on them, in its November 2006 issue. Their consensus was that dermatologists should humor patients who think they have "Morgellons disease", but treat them for delusional parasitosis. ^[2]^[3]^[4]. The National Institutes of Health Office of Rare Diseases presently links their entry on Morgellons^[5] to the CDC's page on delusional parasitosis. The condition has been succesfully treated with the antipsychotic medication Pimozide^[6], which has been used to treat delusional parasitosis. Patents given this medication are terrified they are locked up. patents have been known to take it to get out of a terrifying, misunderstanding place. This has not been a proven treatment for Morgellons. Fibers and symptoms remain after this treatment.The patient is doing as told to get out of mental hospital you can not treat what you do not know. Patents given this medication are not belived nor any labs taken that would indicate an organic infection. Giving these medications without a full physical workup is hartmful to the patents.

A Nature Medicine article reported ^[7], "Most dermatologists deny the disease exists, saying the people who claim to suffer from it have either common skin illnesses or psychological disorders such as delusional parasitosis, in which people become irrationally convinced that they harbor parasites." Nanette Orman, an adjunct clinical professor from Stanford University, however, believes it may be related to Lyme disease.[2]

The Centers for Disease Control and Prevention (CDC) has scheduled an investigation, but postponed it six times since June, 2006.

1 Morgellons Research Foundation
2 Symptoms and diagnosis
3 Delusional parasitosis
4 Morgellons theories and research
- 4.1 CDC investigation
5 See also
6 References
7 External links
- 7.1 In the news
- 7.2 Videos

[edit] Morgellons Research Foundation

Mary Leitao of McMurray, Pennsylvania, has a Bachelor of Science degree in Biology from the University of Massachusetts at Boston^[8], and has worked as a chemist. She formed the Morgellons Research Foundation (MRF) in 2002, and is its Executive Director.

Leitao coined the name Morgellons (with a hard g) in 2002, while seeking treatment for her two-year-old son's rash, which doctors diagnosed as eczema. She named it after a condition in Sir Thomas Browne's 1690 monograph A Letter to a Friend, wherein he describes "that endemial distemper of children in Languedoc, called the morgellons, wherein they critically break out with harsh hairs on their backs." ^[9] A 1935 paper by British doctor C.E. Kellett identifies the name morgellons with the Provençal term masclous, or "little flies".^[10].

The Foundation's website states, "This non-profit foundation is dedicated to finding the cause of an emerging infectious disease, which mimics scabies and lice." The foundation raises public awareness of Morgellons via web and press campaigns; conducts letter writing campaigns to the U.S. Congress ^[11]; and conducts limited research.

In May 2006 the Morgellons Research Foundation was featured in a number of local TV news segments coordinated by the MRF's director of communications.^[12] This resulted in a significant rise in the public awareness of the term Morgellons. In response, the Los Angeles County Department of Health services issued a statement that

No credible medical or public health association has verified the existence or diagnosis of "Morgellons Disease." The current description of the disease is vague and covers many conditions. Until there is a credible, national standard for the diagnosis of this condition, there is no basis for making it a reportable disease.^[13]

Three of the eight MRF board members, including former chairman Charles Holman, medical director Greg Smith, and treasurer Judy Smith ^[14], resigned in August 2006, disagreeing with Leitao over the treatment of charitable contributions to the organization. Dr. Randy Wymore, an Oklahoma State University assistant professor of pharmacology and MRF's former director of research, has also resigned from his position at the organization, though his research program continues.

[edit] Symptoms and diagnosis

According to an opinion piece published by the MRF in the American Journal of Clinical Dermatology, Morgellons symptoms include skin lesions which can be anything from minor to disfiguring in their appearance, sensations of crawling and stinging on and under the skin, and the appearance of fibers and granules coming out of the skin. In addition, "[a]ccording to statistics from the Morgellons Research Foundation (MRF), the majority (95%) of affected patients also report symptoms of disabling fatigue and self-described "brain fog" or problems with attention. Patients also report a high incidence (50%) of fibromyalgia, joint pain, and sleep disorders. Other symptoms include hair loss, decline in vision, neurological disorders and disintegration of teeth in the absence of cavities or gingivitis. Most patients are unable to continue working, and those who are able to continue working report that they do not function optimally."^[1] The authors "declare[d] that they have no conflicts of interest related to the contents of this article." In fact, the paper was co-authored by the founder of the Morgellons Research Foundation and other MRF members involved in the treatment of patients exhibiting these symptoms.

There is no agreed-upon differential diagnosis, because Morgellons is not an accepted medical condition. The symptoms described by patients with Morgellons may result in the diagnosis of one or more of these conditions:

Atopic Dermatitis or Eczema - a common skin condition with various causes including stress
Cellulitis - A skin infection
Compulsive skin picking - Obsessive picking at one's own skin
Contact dermatitis, an allergic rash
Delusional parasitosis - a tactile hallucination of insects, snakes, or other vermin crawling over the skin
Drug side effects - from use, overuse, or withdrawal
Folliculitis - An infection of the hair follicles
Impetigo - A rash caused by bacterial infection
Lice - an infestation of parasitic insects
Nematodes - helminth or worm infestation
Neurodermatitis - Eczema or other skin condition exacerbated by scratching
Scabies - an infestation of the mite Sarcoptes scabei
Seborrhea - A condition due to over-active sebaceous glands
Tinea - A fungal infection of the skin or hair

If a specific complaint is not identified, a doctor might diagnose a medically unexplained physical symptoms (MUPS) syndrome, such as fibromyalgia or chronic fatigue syndrome.

[edit] Delusional parasitosis

Delusional parasitosis is one of the most common differential diagnoses that is used for these patients, and it is the primary source of controversy. The symptoms of delusional parasitosis are very similar to those presented by a Morgellons sufferer who rejects conventional diagnosis of their symptoms, or who presents a belief in the existence of an organism that cannot be observed except by the patient.

In her article Delusory Parasitosis, Nancy C. Hinkle^[15] outlines thirteen indications attributed to delusional parasitosis, many of which are shared by patients claiming to have Morgellons. These indications include:

The presentation of physical evidence such as skin scrapings and debris
Obsessive cleaning and use of disinfectants and insecticides
Rejection of the possibility of psychological or other explanations
Emotional trauma, desperation, social isolation
Having seen numerous physicians, to no avail

The belief that fibers are emerging from their skin is still present in these patients. This belief is generally regarded by doctors as either delusional or a result of simply mistaking fibers from clothing (lint) as fibers emerging from the body.^[16] One doctor, declining to be named for a news article, indicated that he treats patients simply by placing a cast over the affected area of skin, protecting it from the patient's scratching, which results in healing in a matter of weeks.^[17] This lends weight to the theory that perceived skin abnormalities interpreted as the manifestation of Morgellons are a side-effect of habitual scratching.

Patients who suffer from delusional parasitosis and who also believe they have Morgellons will often move from doctor to doctor in search of one who will offer them the diagnosis they are seeking. As a result, some doctors have adopted the use of the term "Morgellons disease" as "a rapport-enhancing term for delusions of parasitosis"^[4]. In the letter cited, Dr. Jenny Murase wrote,

"because the term “Morgellons disease” does not have the word “delusions” embedded in the term, it is a useful way to communicate with patients regarding their disease. As a case in point, I have established a close relationship with the patient described above by referring to her delusions of parasitosis as Morgellons disease."

Some entomologists have joined dermatologists in treating Morgellons as mental illness. The website of the Bohart Museum of Entomology, of the University of California, Davis, says [3]:

"If symptoms of itching and crawling sensations in the skin persist and no evidence of parasites can be found, then a syndrome called Delusional Parasitosis must be considered. A variety of causes have been suggested for these sensations, including parasitism by Collembola and Strepsiptera or the presence of organisms called Morgellons. "Morgellons" is a term used to describe what are purported to be fiber-like parasites of the skin, but after decades of detailed study there is no evidence of an unknown organism fitting this description. There is also no evidence that Collembola or Strepsiptera are biologically capable of parasitzing humans. However, there are quite a number of physiological, hormonal and neurological syndromes that will cause these symptoms."

In February 2005, a report on a Fox affiliate in Duval County, Florida, prompted the Duval County Health Department (DCHD) to investigate. Their report concluded:

"… it was determined after extensive reviewing of these articles that Morgellons Disease is synonymous with delusional parasitosis (CDC, 1999). DCHD Epidemiology consulted a pediatric dermatologist within the health department for his professional opinion. It was concluded that this is a psychological condition that has been mentioned in literature for hundreds of years."^[18]

The DCHD report noted there was a significant spike in reported cases after the news report, and said "this is attributed to the airing of Fox News’ coverage of the illness and is not a true cluster of disease."^[19]

[edit] Morgellons theories and research

To date, studies from the medical community indicate that Morgellons and delusional parasitosis are the same condition referred to by different names^[2]^[3]^[4]. No formal clinical studies have yet demonstrated an etiology of Morgellons, though one study has demonstrated that patients can be cured using Pimozide, reinforcing the contention that the condition is synonymous with delusional parasitosis, which is treated with the same drug^[6]. Stephen Stone, president of the American Academy of Dermatology, has stated: "There really is no scientific basis at this point to believe that this is real"^[7]. Only one paper treating Morgellons as a disease has been published in a medical journal; the paper was published as an opinion piece (not peer reviewed), co-authored by the founder of the Morgellons Research Foundation and other MRF-supported researchers.^[1] The Morgellons Research Foundation has published its own Case Definition for physicians, and MRF-supported researchers at Oklahoma State University and the State University of New York at Albany are undertaking ongoing clinical research into Morgellons.

The Pittsburgh Post-Gazette, reporting on Ms. Leitao's plight, noted that Dr. Randy Wymore, Oklahoma State University assistant professor of pharmacology and physiology, and former MRF director, recruited two Oklahoma State faculty physicians who tweezed fibers from beneath the skin of some Morgellons patients. The samples were sent to the Tulsa Police Department’s forensic laboratory. The police checked the samples against carpet and clothing fibers and other materials, and conducted chemical analyses and other tests, and found no matches against any fiber in their databases. However, the fibers taken from the Morgellons patients matched each other.^[20] There are apparently no published records of the composition of the fibers from this case or other Morgellons cases.

George Schwartz of Santa Fe, New Mexico initially believed the cause may be the bacterium Stenotrophomonas maltophilia, and has claimed success in treating patients with antibiotics that target this waterborne bacterium.^[17] He now believes it is a parasitic infection. In his booklet "Lisa's Disease, A Fiber Disease", he describes four stages to this condition. Stage four places body organs in jeopardy. Schwartz also treated patients with anti-worm medication and diatomaceous earth.^[21]. He says it is "a modern day plague which silently grows within the host and after weeks may explode into cavernous, thread- bearing skin lesions, and can extrude eggs and larvae" and is "a highly contagious, world-wide epidemic which will soon reach a critical mass". He has developed a treatment plan for the early stages^[22]. In August, 2006 he published a new book describing this disease and treatment plans.^[23] Currently he is barred from practicing medicine, due to a narcotics violation[4].

[edit] CDC investigation

The Centers for Disease Control and Prevention are launching a study of Morgellons disease:^[24] "We're going into this with an open mind," said Dan Rutz, spokesman for the CDC Morgellons task force that first met in June 2006.

"The 12-person CDC task force includes two pathologists, a toxicologist, an ethicist, a mental health expert and specialists in infectious, parasitic, environmental and chronic disease. Among other tasks, the group is developing a case definition of Morgellons."^[25]