Morgellons

"Morgellons" or "Morgellons disease" is a controversial name that has been given to a speculated and equally controversial medical condition. Currently, there is no known etiology or treatment, and the diagnostic criteria has not yet been formally established. Patients who claim to have the disease describe the polysymptomatic syndrome as primarily characterized by skin lesions and the appearance of fibers and granules coming out of the skin. Most dermatologists deny that the disease exists and attribute it to a variation of delusional parasitosis; however, formal research is needed to make a conclusive determination. In June 2006, The Centers for Disease Control and Prevention began a full investigation into Morgellon.

Origin of name
The name Morgellons was coined in 2002 by Mary Leitao of McMurray, Pennsylvania, while investigating her son's unexplained rash. 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. A 1935 paper by British doctor C.E. Kellett identifies the name morgellons with the Provençal term masclous, or "little flies". It is doubtful that the 17th-century disease has anything to do with modern day Morgellons; however, the similarities were such that Leitao elected to use the name as a consistent label when addressing politicians, physicians and health departments.

Morgellons Research Foundation
Leitao, who has a Bachelor of Science degree in Biology from the University of Massachusetts at Boston and has worked as a chemist, formed the Morgellons Research Foundation (MRF) in 2002. The Morgellons Research Foundation website states: "This non-profit foundation is dedicated to finding the cause of an emerging infectious disease, which mimics scabies and lice." The foundation attempts to raise public awareness of Morgellons via web and press campaigns. They are conducting limited research into the cause of the symptoms. They also conduct letter writing campaigns to the U.S. Congress, urging that Morgellons be taken seriously.

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


 * […] 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.

The DCHD report notes that there was a significant spike in reported cases after the news report and that "this is attributed to the airing of Fox News’ coverage of the illness and is not a true cluster of disease."

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. 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.

Three of the eight board members of the organization resigned in August 2006 over disagreements with Leitao over the treatment of charitable contributions to the organization, including former chairman Charles Holman, medical director Greg Smith, and treasurer Judy Smith.

Dr. Randy Wymore, an Oklahoma State University assistant professor of pharmacology and MRF's director of research, has also resigned and distanced himself from the organization. He has stated that "The research I'm doing is not affected by this."

Symptoms
According to an opinion piece published 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 caries or gingivitis. Most patients are unable to continue working, and those who are able to continue working report that they do not function optimally." 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 Morgellons patients.

Differential diagnoses
The symptoms of patients presenting with Morgellons are varied, and may match several other medical conditions. Frequently these symptoms may then be diagnosed as any of a number of conditions including:


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

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

Delusional parasitosis is one of the differential diagnoses that is used for these patients that is controversial. 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. There is no agreed upon differential diagnosis since Morgellons is not an accepted medical condition.

In her article Delusory Parasitosis, Nancy C. Hinkle 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. 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. 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"

Morgellons theories and research
No formal clinical studies have yet been done on Morgellons. Only one paper mentioning Morgellons has been published in a medical journal; the paper was co-authored by the founder of the Morgellons Research Foundation and other MRF members.


 * The Pittsburgh Post-Gazette reporting on Ms. Leitao's plight noted that Dr. Randy Wymore, Oklahoma State University assistant professor of pharmacology and physiology, 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.

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. . 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. . 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. In August, 2006 he published a new book describing this disease and treatment plans. Currently he is barred from practicing medicine, due to a narcotics violation. The Morgellons Research Foundation published a Case Definition for physicians.

CDC investigation
The Centers for Disease Control and Prevention are launching a study of Morgellons disease: "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."

In the news

 * "Doctors puzzled over bizarre infection surfacing in South Texas", My San Antonio, 15 May 2006.
 * "Parasitic Infection Flummoxes Victims and Doctors", Slashdot, 19 May 2006.
 * "Frightening Skin Disease Invades L.A., CBS News, 20 May 2006.
 * "The Plague", Dallas Observer, 20 July 2006.
 * "Mysterious Skin Disease Causes Itching, Loose Fibers", ABC News, 28 July 2006.
 * "CDC Probes Bizarre Morgellons Condition", WREX-TV Channel 13, Rockford, IL August 10, 2006.
 * "Online Campaign Sparks Interest in New Disease", NPR News, Day to Day, 27 December 2006.
 * 

Morgellons 莫吉隆斯症