Background: Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have\nprotruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional\ninfestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is\na true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition\nand that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes\nhave been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious\nprocess.\nMethods & Results: Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing,\nwe present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme\nserological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal\ninfection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia\nstrains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study\npatients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that\nthe organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi\nwere cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic\ninfection. Based on these observations, a clinical classification system for MD is proposed.\nConclusions: Our study using multiple detection methods confirms that MD is a true somatic illness associated\nwith Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment\nfor this spirochete-associated dermopathy.
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