What is Morgellons Disease and Why is the Mayo Clinic Study So Important?
The Mayo Clinic recently produced a case study to better understand Morgellons disease, which could have significant implications for those suffering from it. Morgellons is a mysterious skin condition that has been baffling doctors for years. It is characterized by strange fibers and lesions in the skin and can cause extreme discomfort and fatigue. An incorrect diagnosis of delusional infestation and a lack of follow-up care were unfortunately made due to misunderstanding the condition. This article will explain how doctors went wrong and how they should have managed it better.
“There Was No Sign of Borrelia Infection”
Lyme tests are the worst way to detect if someone is infected with Borrelia, a tick-borne bacterium that causes Lyme disease and is scientifically associated with Morgellons. Sadly, there is a risk of false negatives when it comes to Lyme disease tests. Not only that, but these tests are also specifically for Lyme disease and do not detect conditions similar to it such as Tick-Borne Relapsing Fever or Leptospirosis. It can lead to misdiagnosis and lack of appropriate and immediate care.
In addition to standard tests, other researchers looking into Morgellons also employed more complex methods such as molecular testing, scanning electron microscopy, darkfield microscopy, and tissue antibody staining to confirm Borrelia’s presence. Mayo Clinic’s case-study is quite unclear about the methods used to identify Borrelia in the patient, hence the proof that the patient didn’t have Borrelia is shaky.
When diagnosing mental illness, it is imperative first to determine if there is an underlying cause of the psychiatric symptom, such as an infection. None of the case studies reviewed in this paper or the research studies involving larger cohorts of MD patients looked adequately for infections, in particular LD. Science has to be reproducible, and there has to be enough detail provided in the methodology description for the study to be replicated. This was not the case for detecting LD in many of the case studies. Borrelia spirochetes are readily detectable in MD tissue, but sensitive and specific methods are required.7,87 Although sensitive and specific direct-detection methods, such as antigen detection, culture of Borrelia spirochetes, and PCR detection of Borrelia DNA, exist, these methods are not standardized, and vary in sensitivity and specificity.104,105 They are not recommended by the CDC, which only endorses two-tier serological LD testing.7,87,106 Unfortunately, two-tier serological testing for LD, although specific for Bbss, lacks sensitivity and is little better than a coin toss in detecting LD.107,108History of Morgellons disease: from delusion to definition – PMC (nih.gov)
Mayo Clinic Doctors Characterized the Fibers, But Diagnosed the Patient as Delusional
Despite the fact that doctors observed and characterized fibers found in this patient, it was the patient who was eventually diagnosed as being delusional. This is a major problem because the fibers were indeed observed under microscopic conditions, obtained from patients’ skin biopsy. Most shocking is the fact that the patient reportedly “had no prior knowledge of Morgellons disease”.
It is important to recognize the more compelling research which makes a better case that Morgellons is not a delusional state, but rather an actual physical condition with observable symptoms. This recent case-study fails to take into account many existing medical literature reviews and symptom overlap analyses that have been conducted over the years.
If fibers are present and biofilaments of human origin, then they are a true observation. It is also possible that patients might observe fibers and mistake them for worms in which case the idea of infestation could be an overvalued idea. Real infestation with arthropods such as mites can also occur. Additionally, some patients could have lesions with adhering textile fibers that are accidental contaminants and could mistakenly believe that they have MD, in which case they do not have a delusional belief, but a mistaken belief. In summary, if a physician cannot differentiate between true observations, delusions, and overvalued ideas, they should not immediately make a diagnosis of delusional mental illness.Reframing delusional infestation: perspectives on unresolved puzzles – PMC (nih.gov)
The Loss of Follow-Up Demonstrates Misdiagnosis
The loss of follow-up is a key indicator of misdiagnosis when it comes to infection versus delusion. For example, if someone is misdiagnosed with a delusion rather than an infection, they may be prescribed antipsychotics instead of antibiotics. This can have serious consequences for their health and wellbeing, and they will not experience remission. A patient who is healing will be motivated to continue treatment, and the research has shown us that antibiotics are an effective therapy for Morgellons patients. It is therefore essential that all medical professionals ensure that they are providing adequate scrutiny to patients in order to ensure accurate diagnosis and responsible treatment.
We report a middle‐aged Caucasian female who developed symptoms of MD in the days following exposure to a tick bite after spending an afternoon hiking through a wooded area. She was subsequently treated with a course of Doxycycline and found on two‐week follow‐up to have complete remission of her symptoms. This case report further supports the theory for an infectious etiology of MD and encourages future studies into its pathophysiology.Treatment of Morgellons disease with doxycycline – PMC (nih.gov)
Comorbidity of Psychiatric Conditions with Bacterial Infections
The final major flaw in this case-study is it fails to recognize the established link between infections and psychiatric manifestations. Psychiatric conditions often co-occur with bacterial infections, and this comorbidity can have a significant impact on the patient’s overall health. For example, research has shown that infections such as Lyme disease can cause depression and schizophrenia. Similarly, there is evidence that antibiotics can be more effective than antipsychotics in treating certain psychiatric conditions. This highlights the importance of understanding the relationship between bacterial infections and psychiatric conditions in order to provide optimal care for patients suffering from both.
I’m depressed because a tick bit me? Depression has been reported in 8-45% of patients with post-treatment Lyme symptoms. But these numbers don’t tell the whole story. Many researchers believe that Lyme disease is vastly under-diagnosed. Diagnostic tests lack sensitivity, and the symptoms of Lyme disease often overlap with other disorders. Thus, the true prevalence of depression in those affected by untreated or undiagnosed Lyme disease may be much higher.Lyme Disease and Mental Health
Conclusion: Understanding the Limitations of the New Mayo Clinic Study on Morgellons Disease is Key
The Mayo Clinic’s recent case study on Morgellons Disease has been met with mixed reactions. While it has provided some valuable insights into the patients afflicted by this horrendous disease, it is important to understand the underlying fundamental limitations in order to make informed decisions about how to treat it. For those already aware that Morgellons is associated with Lyme disease, our best advice has always been to see a Lyme disease specialist. Because Morgellons occurs in light of Borreliosis, Lyme specialists are usually well-equipped to treat it in the most efficient way.
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