Morgellons Totally Explained

Everything about Morgellons Disease totally explained

Morgellons (also called Morgellons disease or Morgellons syndrome) is a name given in 2002 by lab technician Mary Leitao to a proposed condition characterized by a range of cutaneous (skin) symptoms including crawling, biting, and stinging sensations; finding fibers on or under the skin; and persistent skin lesions (for example, rashes or sores), initially in her son. Despite the lack of evidence that it's a distinct condition, or any agreed set of diagnostic symptoms, a large number of individuals have self-diagnosed with the condition and, motivated by a widespread lack of acceptance in the medical community, have used political means to attempt to have the condition recognised.
The U.S government's Centers for Disease Control and Prevention (CDC) states that it isn't 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. Many health professionals, including dermatologists, regard Morgellons as a manifestation of other known medical conditions, including delusional parasitosis but this opinion isn't conclusive or unanimous. According to an article written by the Mayo Clinic staff, health professionals are divided in their attitudes about Morgellons: some believe it's a specific condition and expect it to be confirmed by research in the future; some believe it isn't a separate condition, rather its symptoms result from other conditions, often psychological; and some don't acknowledge Morgellons disease at all or reserve judgment until more is known about the condition. The CDC has begun an epidemiological investigation of the "Unexplained Dermopathy (aka 'Morgellons')."

History

In 2001, according Mary Leitao, a lab technician who earned her undergraduate degree in biology, her then two-year-old son developed sores under his lip and began to complain of "bugs." Leitao says she 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. There is no suggestion that the symptoms described by Browne are linked to the putative modern cases.
Leitao founded the Morgellons Research Foundation (MRF) in 2002. The MRF states on its website that its purpose is to raise awareness and funding for research into the condition, described by the organization as "a newly emerging infectious disease". Leitao 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 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's no reason for individuals to panic over unsubstantiated reports of this disease". In June and July 2006 there were segments on CNN, ABC's Good Morning America, and NBC's The Today Show. In August 2006, a segment of the ABC show Medical Mysteries and as the cover story of the January 20, 2008 issue of the Washington Post Magazine. The first article to propose Morgellons as a new disease in a scientific journal was a review article co-authored by V. R. Savely, M. M. Leitao, and R. B. Stricker, members of the MRF. It was published in 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). A New Scientist article in September 2007 also covered the controversy noting that it extends to Europe and Australia.

CDC investigation

A Centers for Disease Control and Prevention (CDC) task force first met in June 2006. In July 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." By August 2006, 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 May 2007, KGW-TV Newschannel 8's Laural Porter asked Rutz if he'd any information about the nature of the fibers. At that time Rutz said, "None. We don't know. We haven't studied them in a lab yet. There is nothing to imply there's [aninfectious process], but our mind is open to everything, including that remote possibility." Since then, the CDC has launched a funded study (see below) that will include further examination of fibers taken from Morgellons lesions by the CDC.
In June 2007, the CDC opened a website on "Unexplained Dermopathy (aka 'Morgellons')." In January 2008 it was reported that CDC was enlisting the aid of the U.S. Armed Forces Institute of Pathology and the American Academy of Dermatology "to conduct 'immediate' and 'rigorous' research."
On January 2008 the Centers for Disease Control and Prevention (CDC) in conjunction with Kaiser Permanente's Northern California Division of Research launched a funded study of the unexplained skin condition known as Morgellons. A press conference was held on Jan 16, 2008 with Dr. Michele Pearson, principal investigator for the CDC, and Dr. Joe Selby, Director of Kaiser Permanente's Northern California Division of Research. During the press conference, Dr. Pearson stated: "What I can tell you is real is the suffering that these patients are experiencing. I can't characterize this as a syndrome, as disease. I can tell you it's an unexplained illness." Clinical examinations for the study will be done in Oakland, California.

Symptoms and diagnosis

Morgellons is currently not recognized as a unique disorder, so there's currently no list of symptoms or differential diagnosis for Morgellons that's 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 (formication)
Skin rashes and lesions that don't 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 in a 2007 letter to the editor of the Journal of the American Academy of Dermatology that Morgellons patients exhibit laboratory findings including increased levels of inflammatory cytokines, increased insulin, and antibodies to three bacterial pathogens, although as of May, 2008, he hadn't published evidence for these claims. 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 Morgellons Research Foundation has adopted a Case Definition of Morgellons symptoms that has been referenced in other articles.

Proposed causes and pathophysiology

Delusional parasitosis

Many dermatologists view Morgellons as a new name for an old condition, delusional parasitosis. In delusional parasitosis, patients hold a delusional belief that they're 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. -- a medical sign characterized by the patient making collections of fibers and other foreign objects supposedly retrieved from the skin. 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. The sensations are real, but the attribution of the sensations to unknown parasites and the collection of fibers is part of the delusion. The MRF's William Harvey has written that non-healing Morgellons lesions have been found on infants' bodies in locations that the infants can't themselves reach to scratch,
Dr. Rhonda Casey, chief of pediatrics at Oklahoma State University Hospital and part of the MRF research team at OSU, reported that she's 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."

Bacterial hypothesis

Three members of the Morgellons Research Foundation, including Raphael Stricker, Director and former 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. However, Agrobacterium is already known to be responsible for opportunistic infections in humans with weakened immune systems, but hasn't been shown to be a primary pathogen in otherwise healthy individuals.

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 dermatologists 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.

Treatment for infectious disease

People who say that they've Morgellons will frequently reject the diagnosis of delusional parasitosis and, "report that their symptoms are not taken seriously." 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. 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.

Further Information

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