Zebras Unicorns Horses When you hear hoof beats think . . . . Morgellons Disease: What it is What it isn’t Marianne J. Middelveen, Mdes Raphael B. Stricker, MD
Disclosure Statement Speaker: Marianne J. Middelveen, Mdes Consultant Microbiologist Atkins Veterinary Services Has completed commercial bias disclosure forms and does not have any conflicts of interest.
Definition Morgellons disease (MD) is a dermatologic condition associated with spirochetal infections – mostly Borrelia spp. – and other co-infections. It is characterized by spontaneously- appearing, slowly-healing, ulcerative, filamentous skin lesions, that may be accompanied by stinging or crawling sensations. The key diagnostic criterion is the presence of colored filaments (mostly white, blue or red) that protrude from or are embedded in skin.
“Inanimate, L evenloos” History Sir Thomas Browne Father of Microbiology • 1643 – Sir Thomas Browne’s monograph described an illness, in which coarse black hairs emerged from the skin. • 1544 to 1884 – Kellet summarized Browne’s and other historical accounts – scientists debated if “hairs” were animate or inanimate. 1682 – drawing by Dr. Michel Ettmuller
History • 1894 – Thibierge – case studies of “acarophobia”, erroneous and unshakeable beliefs of skin infestation by parasites. • 1902 to 1938 – sporadic cases of “parasitophobias” or “dermatological hypochondriasis”.
Dr. Karl-Axel Ekbom History (continued ) • 1935 – French physician, Vié reported 6/8 subjects in his case studies had syphilis. • 1938 – Dr. Karl Ekbom – published seminal studies of delusionary parasitosis – patients had movement sensations and false belief of insect infestation. Ekbom reported that 3/7 subjects had syphilis, and mentioned self- collected specimens with “sand” and “little hairs”. • 1946 – Wilson and Miller, coin term Treponema pallidum “delusions of parasitosis” (DOP) for such spirochetal agent cases. of syphilis
History (continued) • 1983 – Lyell named the presentation of specimens “the matchbox sign”. Matchbox and skin specimens • 2001 – Biologist Mary Leitao, saw fibers in her son’ s skin, named the condition MD based on similarity to Browne ’ s description. • 2005 – Leito teamed up with sympathizers, founded MRF (defunct). Mary Leitao with her children • 2009 – Delusional Infestation (DI) proposed for MD. • 2006 – CEHMDF founded. • 2001 – to date: Polarized view of MD etiology: delusion vs. infection. 1 st Conference CEHMDF Cindy Casey Holman RN, Charles E Holman
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Morgellons disease (MD) proposed etiologies Hypotheses Supportive evidence Delusional disorder/Textile fibers. Peer-reviewed medical literature. Peer-reviewed medical studies. Infectious etiology/ Biofibers of human origin. Infectious etiology/ Filamentous organisms i.e. Speculation, no evidence. molds, insects, worms. Extraterrestrial origin/ Mystery fibers. Fantasy, no evidence. Bioengineering by nanites etc. / Man-made Fantasy, no evidence. filaments. Toxins/Filaments of silicone, dental adhesive, Fantasy, no evidence. chemtrails, GMOs, mercury etc. ucmp.berkeley.edu mst3k.wikia.com
Delusion Infection VS The favorite The dark horse • Caused by infection • Caused by mental illness • Lesions spontaneous • Lesions self-inflicted • Fibers are biofibers • Fibers are textile • Neuropsychiatric • Claim patients have fixed symptoms occur, but are delusional belief of parasite or secondary to infection fiber infestation
• Review article • History of DOP and MD • Examines evidence supporting Infectious etiology • Refutes evidence supporting the DOP hypothesis Borrelia spirochetes MD skin section
Over 50 articles support delusional parasitosis (DP) or delusional infestation (DI) etiology of MD PubMed search 2009-2018: • Opinion articles: ~27 articles that are opinion- Image: healthymind.com based and that offer little or no original research evidence. • Case studies: ~18 studies, diagnose delusional mental illness contrary to the American Psychiatric Association’s DSM -5, used inappropriate case definitions, inadequate laboratory analysis, none of the studies used methods appropriate to find borreliosis. • Original research: 4 key studies, 3 retrospective analyses by the Mayo Clinic, and 1 collaborative study by Centers for Disease Control and Prevention (CDC) and Kaiser Permanente (KP), all failed to perform lab analysis to detect spirochetes/borreliosis, all had flawed case definitions; fiber analysis was flawed and included analysis of contaminating cotton fibers.
Delusions are: Delusions are not: Delusions • true • false beliefs observation • incorrect s interpretation of • overvalued external reality ideas • firmly held despite • mistaken what most others beliefs believe to be true Delusional • maintained disorder somatic despite type should not incontrovertible be diagnosed and obvious proof when there is an to the contrary, underlying even to the point medical of being absurd conditions such as an infection.
Studies that support an infectious etiology PubMed search 2009-2018: • ~13 articles total • 3 are reviews, 2 of which present new previously unpublished evidence • 6 original research, 5 of which involve larger cohorts • 4 opinion
Borrelia Spirochetes • Most consistent pathogens found • Borrelia burgdorferi sensu stricto and sensu lato strains • Also Relapsing Fever Borrelia spp. • 7 labs detected DNA using 3 methodologies Borrelia burgdorferi 1,2,3,4,5 ,6,7 Borrelia garinii 1,4 Borrelia miyamotoi 1 Borrelia hermsii 1,4 1. Australian Biologics, Sydney 2. University of New Haven 3. Oklahoma State University 4. IGeneX Reference Laboratory 5. Mount Allison University 6. Perkin Elmer 7. McClains
• Cohort of 25 subjects • Visual, antigenic, and genetic confirmation of borrelial spirochetes • Detection directly in skin and in cultures from skin and fluid (detected viable organisms) • Different detection methods from independent laboratories provided corroborative evidence • Evidence suggests causality
Evidence of Spirochetal infection Electron Microscopy: • Samples for scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were TEM – callus section forwarded to the Electron Microscopy Facility, Department of Materials Science and Engineering, Clemson University, Anderson, South Carolina. • Spirochetes were detected in submitted samples – both in tissue and cultures . SEM – skin culture
Silver Nitrate Stains • Warthin-Starry and Dieterle stains are standard silver nitrate stains used to detect spirochetes. • Skin and/or culture specimens were fixed and processed for silver nitrate staining at Interscope Laboratories, Canoga Park, CA (ISL) and McClain Clinical Laboratories, Smithtown, NY Spirochetes (dark brown/black) (MCL). detected in Dieterle-stained histological • Subjects that have more severe sections of Morgellons tissue lesions have larger spirochetal load. Dieterle-stained cultured spirochetes
Borrelia immunostaining – skin tissue and culture University of New Haven McClain Labs Immunostain MD callus section. Helical spirochete MD histological section – callus Photos: Divya Burugu, University of New Haven Single spirochete Helical spirochete Immunostain MD skin culture. MD vaginal culture
Bb immunostaining controls Human psoriasis skin Gram-negative coliforms Not detected in skin without MD pathology Positive control Bb B-31 in human plasma Gram-positive cocci Human skin with normal bacterial flora
PCR Negative controls Experimental specimens • Skin from asymptomatic • 29 positive specimens (skin healthy people and cultures) from 20 • Normal human foreskin subjects • Normal skin from Morgellons • 5 positive skin cultures patients • 13 dermatological • Cultures from normal healthy specimens controls • 15 confirmatory sequences • Distilled water
Molecular Probes: Staining, MCL Bb DNA Hybridization Probes donated by Dr Alan MacDonald Culture and tissue • Probe FlaB – derived from the Bb flagellin B gene, and Probe 740 – derived from a Bb inner cell membrane protein. Top – MD tissue Fla B probe. • Nucleotide Basic Local Alignment Search Tool (BLASTn) disclosed no Bottom – MD tissue Probe 740. matches to either probe other than those of corresponding Bb gene sequences. • Visual confirmation of the presence of Borrelia DNA in tissue with Morgellons pathology, but not in controls
1. Australian Biologics, Sydney OTHER PATHOGENS 2. University of New Haven 3. Oklahoma State University DNA Detected in Morgellons samples 4. IGeneX Reference Laboratory by PCR and confirmed by sequencing, 5 Mount Allison University www.igenex.com https://www.researchgate.net Helicobacter pylori 2,3 Bartonella henselae 3,4 Rickettsia spp . 5 Treponema denticola 1,3
Filaments Key diagnostic criterion Blue Red MD filaments are biofibers of human origin, composed of structural proteins.
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