Morgellons and Incredulity

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Abstract
Morgellons disease (MD) is a dermopathy characterized by multicolored filaments that lie under, are embedded in, or project from skin. Although MD was initially considered to be a delusional disorder, recent studies have demonstrated that the dermopathy is associated with tickborne infection, that the filaments are composed of keratin and collagen, and that they result from proliferation of keratinocytes and fibroblasts in epithelial tissue. Culture, histopathological and molecular evidence of spirochetal infection associated with MD has been presented in several published studies using a variety of techniques. Spirochetes genetically identified as Borrelia burgdorferi sensu stricto predominate as the infective agent in most of the Morgellons skin specimens studied so far. Other species of Borrelia including Borrelia garinii, Borrelia miyamotoi, and Borrelia hermsii have also been detected in skin specimens taken from MD patients. The optimal treatment for MD remains to be determined.
Keywords: Morgellons disease, dermatitis, Lyme disease, Borrelia burgdorferi, spirochetes
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Introduction

Morgellons disease (MD) is an emerging dermopathy with worldwide distribution. The name “Morgellons” is derived from a disease recognized in the seventeenth century in French children by Sir Thomas Browne. These children were noted to have “coarse hairs” protruding from their backs.1 The distinguishing feature of MD is the appearance of skin lesions with filaments that lie under, are embedded in, or project from skin (Figures 1 and ​and2).2). Filaments can be white, black, or brightly colored.2–6 Fur thermore, MD patients exhibit a variety of manifestations that resemble symptoms of Lyme disease (LD), such as fatigue, joint pain, and neuropathy.2–6 A study found that 98% of MD subjects had positive LD serology and/or a tickborne disease diagnosis,5 confirming the clinical association between MD and spirochetal infection. Conversely, 6% of LD patients in an Australian study were found to have MD.7

Bovine digital dermatitis is an emerging infectious disease that causes lameness, decreased milk production, and weight loss in livestock. Proliferative stages of bovine digital dermatitis demonstrate keratin filament formation in skin above the hooves in affected animals. The multifactorial etiology of digital dermatitis is not well understood, but spirochetes and other coinfecting microorganisms have been implicated in the pathogenesis of this veterinary illness. Morgellons disease is an emerging human dermopathy characterized by the presence of filamentous fibers of undetermined composition, both in lesions and subdermally. While the etiology of Morgellons disease is unknown, there is serological and clinical evidence linking this phenomenon to Lyme borreliosis and coinfecting tick-borne agents. Although the microscopy of Morgellons filaments has been described in the medical literature, the structure and pathogenesis of these fibers is poorly understood. In contrast, most microscopy of digital dermatitis has focused on associated pathogens and histology rather than the morphology of late-stage filamentous fibers. Clinical, laboratory, and microscopic characteristics of these two diseases are compared.
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There is a suggestion that the fibers may contain cellulose. 20 A cellulose-protein complex was identified as a minor constituent of mammalian connective tissue, with increased amounts of such material noted in tissues from scleroderma patients and patients with other pathological skin conditions.51 The cellulose-producing plant pathogen Agrobacterium has been shown to infect nonplant species including humans, and polymerase chain reaction screening of tissue samples from five patients with Morgellons disease indicates the presence of Agrobacterium genes, implying a possible etiological involvement.29,52 However, further polymerase chain reaction testing has yet to reveal a link between tissue samples and pathogens, showing no significant statistical difference between negative controls and patients with Morgellons disease.30

There is a connection between Morgellons disease and Lyme disease, because the majority of patients with Morgellons disease demonstrate serological reactivity with B. burgdorferi proteins in Western blots20,25 or have a high probability of a Lyme disease diagnosis based on meeting defined criteria for the diagnosis.25 In addition, Morgellons disease is associated with positive serological evidence of coinfecting tick-borne pathogens, such as Babesia spp, Anaplasma phagocytophilum, Ehrlichia chaffeensis, and Bartonella henselae.25 Further evidence of a bacterial etiology is the fact that patients with Morgellons disease respond to antibiotic therapy.20,23
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There is strong evidence that Morgellons is not a delusional disease.20,25 Fibers are found under unbroken skin, indicating that they are not self-inflicted. Because they are not self-implanted textile fibers, they must be produced within the skin. The lack of detectible pathogens in lesions suggests also that fibers are human cell products.20,25 Keratinocytes are the cells most likely to produce these fibers. They are the predominant cells found in skin, and they are found in hair follicles. Fibers have been found embedded in and piercing skin, and they have been observed growing out of hair follicles. Recently we examined patterns of fiber formation in patients with Morgellons disease, and we found that these fibers possess physical and microscopic characteristics of keratin, often with elaborate shapes and reflected colors (Figure 3). The results of our investigation will be described in a forthcoming paper.
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In view of the above discussion, there is evolving evidence that Morgellons fibers have physical properties consistent with keratin. Keratin and chitin are the strongest known biofibers, and keratin shows no cellular structure. Likewise Morgellons fibers are very strong and show no cellular structure, consistent with keratin filaments. They are colored blue, red, purple, and black, which are all colors found naturally in keratin. Solvents have not been able to extract pigments. Keratin can demonstrate different colors including blue, red, and purple, not from pigment production but from microscopic refractive structures that produce constructive interference of light diffracting from structural layers.95 Bacteria have been shown to influence and enhance color intensity in keratin.96 The fibers demonstrate a “metallic-looking” sheen, consistent with keratin and iridescent coloring. Morgellons fibers fluoresce under ultraviolet light, a property that has been observed to occur with keratin fibers.97,98 Thus keratin composition may explain the “mysterious” fibers in Morgellons disease. The etiopathogenesis of these fibers remains to be determined.

Morgellons disease: Managing a mysterious skin condition
Morgellons disease is mysterious and controversial. Here you'll find answers to common questions about Morgellons disease — and suggestions for coping with it.
By Mayo Clinic Staff

Research
Morgellons disease, a little-known and often discounted illness, lacks the solid scientific data needed to point to a definitive cause.
Randy S. Wymore, Ph.D., assistant professor of pharmacology and physiology has taken on the research challenge in his academic research.
"Health care providers are shooting in the dark as to how to treat it. Antibiotics seem to help some, but if they are stopped the symptoms come back," Wymore says.
In coordinating research efforts, he sees a research challenge and a chance to help.
"I am doing this partly from scientific curiosity, but also with real empathy toward sufferers."