title: Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: International Lyme and Associated Diseases Society, Bethesda, MD, USA. middel@telus.net.
authors: Marianne J
authors: MJ
authors: Middelveen
authors: Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. cbandoski@forsyth.org.
authors: Cheryl
authors: C
authors: Bandoski
authors: Australian Biologics, Sydney, NSW, Australia. Jennie.burke@australianbiologics.com.au.
authors: Jennie
authors: J
authors: Burke
authors: Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. unh@evasapi.net.
authors: Eva
authors: E
authors: Sapi
authors: Department of Biology and Environmental Science, University of New Haven, West Haven, CT, USA. KFilu1@unh.newhaven.edu.
authors: Katherine R
authors: KR
authors: Filush
authors: Australian Biologics, Sydney, NSW, Australia. techinfo@australianbiologics.com.au.
authors: Yean
authors: Y
authors: Wang
authors: Australian Biologics, Sydney, NSW, Australia. agustin.franco@optusnet.com.au.
authors: Agustin
authors: A
authors: Franco
authors: International Lyme and Associated Diseases Society, Bethesda, MD, USA. LaurietonMedical@gmail.com.
authors: Peter J
authors: PJ
authors: Mayne
authors: International Lyme and Associated Diseases Society, Bethesda, MD, USA. rstricker@usmamed.com.|, 450 Sutter Street, Suite 1504, San Francisco, CA, 94108, USA. rstricker@usmamed.com.
authors: Raphael B
authors: RB
authors: Stricker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D025065:Borrelia burgdorferi / Q000235:genetics / Q000302:isolation & purification*; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D005455:Fluorescent Antibody Technique; D006801:Humans; D017403:In Situ Hybridization; D008193:Lyme Disease / Q000150:complications* / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D055535:Morgellons Disease / Q000150:complications* / Q000382:microbiology* / Q000473:pathology; D016133:Polymerase Chain Reaction; D012867:Skin / Q000382:microbiology / Q000473:pathology
chemical_list: D004269:DNA, Bacterial