MJM, PJM and RBS serve without compensation on the scientific advisory panel of the Charles E. Holman Morgellons Disease Foundation. The other authors have no competing interests to declare.
MJM participated in the study design and coordination, performed culture, histology and immunohistochemistry experiments and drafted the manuscript. CB, JB, ES, KRF, YW and AF performed PCR tesing, in situ hybridization and DNA sequencing experiments. PJM participated in the study design and edited the manuscript. RBS participated in the study design and coordination and edited the manuscript. All authors read and approved the final manuscript.
Morgellons disease (MD) is a complex skin disorder characterized by ulcerating lesions that have protruding or embedded filaments. Many clinicians refer to this condition as delusional parasitosis or delusional infestation and consider the filaments to be introduced textile fibers. In contrast, recent studies indicate that MD is a true somatic illness associated with tickborne infection, that the filaments are keratin and collagen in composition and that they result from proliferation and activation of keratinocytes and fibroblasts in the skin. Previously, spirochetes have been detected in the dermatological specimens from four MD patients, thus providing evidence of an infectious process.
Based on culture, histology, immunohistochemistry, electron microscopy and molecular testing, we present corroborating evidence of spirochetal infection in a larger group of 25 MD patients. Irrespective of Lyme serological reactivity, all patients in our study group demonstrated histological evidence of epithelial spirochetal infection. Strength of evidence based on other testing varied among patients. Spirochetes identified as Borrelia strains by polymerase chain reaction (PCR) and/or in-situ DNA hybridization were detected in 24/25 of our study patients. Skin cultures containing Borrelia spirochetes were obtained from four patients, thus demonstrating that the organisms present in dermatological specimens were viable. Spirochetes identified by PCR as Borrelia burgdorferi were cultured from blood in seven patients and from vaginal secretions in three patients, demonstrating systemic infection. Based on these observations, a clinical classification system for MD is proposed.
Our study using multiple detection methods confirms that MD is a true somatic illness associated with Borrelia spirochetes that cause Lyme disease. Further studies are needed to determine the optimal treatment for this spirochete-associated dermopathy.
Savely G, Leitao MM. Skin lesions and crawling sensation: disease or delusion? Adv Nurse Pract. 2005;13:16–7. PubMed
Savely VR, Stricker RB. Morgellons disease: the mystery unfolds. Expert Rev Dermatol. 2007;2:585–91. CrossRef
Middelveen MJ, Burugu D, Poruri A, Burke J, Mayne PJ, Sapi E, et al. Association of spirochetal infection with Morgellons disease. F1000 Res. 2013;2:25.
Mayne P, English JS, Kilbane EJ, Burke JM, Middelveen MJ, Stricker RB. Morgellons: a novel dermatological perspective as the multisystem infective disease borreliosis. F1000 Res. 2013;2:118.
Middelveen MJ, Rasmussen EH, Kahn DG, Stricker RB. Morgellons disease: A chemical and light microscopic study. J Clin Exp Dermatol Res. 2012;3:140. CrossRef
Shah JS, Du Cruz I, Narciso W, Lo W, Harris NS. Improved sensitivity of Lyme disease Western blots prepared with a mixture of Borrelia burgdorferi strains 297 and B31. Chronic Dis Int. 2014;1:7.
Middelveen MJ, McClain SA, Bandoski C, Israel JR, Burke J, MacDonald AB, et al. Granulomatous hepatitis associated with chronic Borrelia burgdorferi infection: a case report. Research Open Access. 2014;1:875.
Mayne PJ. Investigations of Borrelia burgdorferi genotypes in Australia obtained from erythema migrans tissue. Clin Investig Dermatol Res. 2012;5:69–78. CrossRef
Cheli R, Mortellaro CM. Digital dermatitis in cattle. Proc 8th Int Meet Dis Cattle Milan. Italy. 1974;8:208–13.
Grund S, Nattermann H, Horsch F. Electron microscopic detection of spirochetes in digital dermatitis of cattle. Zentralbl Veterinarmed B. 1995;42:533–42. PubMed
Afa G, Caprilli F, Crescimbeni E, Morrone A, Progano G, Fazio M. Anti- Borrelia burgdorferi antibodies in chronic erythema migrans, benign lymphadenosis cutis, scleroderma and scleratrophic lichen. G Ital Dermatol Venereol. 1990;125:369–73. PubMed
Chao LL, Lu CF, Shih CM. Molecular detection and genetic identification of Borrelia garini and Borrelia afzelii from patients presenting a rare skin manifestation of prurigo pigmentosa in Taiwan. Int J Infect Dis. 2013;17:1141–7. CrossRef
Ekbom KA, Yorston G, Miesch M, Pleasance M, Rubbert S. The pre-senile delusion of infestation. 1945. Translation: Hist Psychiatry. 2003;14(54 Pt2):229–56.
Chmielewski T, Tylewska-Wierzbanowska S. Interactions between Borrelia burgdorferi and mouse fibroblasts. Pol J Microbiol. 2010;59:157–60. PubMed
Schmidt BL. PCR in laboratory diagnosis of human Borrelia burgdorferi infections. Cin Microbiol Rev. 1997;10:185–201.
Mursic VP, Wanner G, Reinhardt S, Wilske B, Busch U, Marget W. Formation and cultivation of Borrelia burgdorferi spheroplast-L-form variants. Infection. 1996;4:218–26. CrossRef
Brorson O, Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to tinidazole. Int Microbiol. 2004;7:139–42. PubMed
Meriläinen L, Herranen A, Schwarzbach A, Gilbert L. Morphological and biochemical features of Borrelia burgdorferi pleomorphic forms. Microbiology. published ahead of print January 6, 2015, doi:10.1099/mic.0.000027
Mayne PJ. Clinical determinants of Lyme borreliosis, babesiosis, bartonellosis, anaplasmosis, and ehrlichiosis in an Australian cohort. Int J Gen Med. 2015;8:15–26. PubMed
Zoechiling N, Schluepen EM, Soyer HP, Kerl H, Volkenandt M. Molecular detection of Treponema pallidum in secondary and tertiary syphilis. Br J Dermatol. 1997;136:683–6. CrossRef
- Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients
Marianne J Middelveen
Katherine R Filush
Peter J Mayne
Raphael B Stricker
- BioMed Central
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