What the Public Needs to Know About Morgellons, Lyme Disease, and Science
As a Morgellons patient who understands the research, there is nothing more disparaging than consuming media which fails to even mention Lyme Disease when discussing the topic of my skin condition.
- What Morgellons means, means different things to different people.
- This article explores the potential that there is no Morgellons without an infection like Lyme disease.
Lyme disease is a Borrelia bacteria, I was tested for Borrelia bacteria and that test was positive for Tick Borne Relapsing Fever, which unlike the name implies is not a virus. TBRF is a bacteria, in the same family as Lyme Disease.
Characteristic Feature of a Specific Dermopathy
Morgellons itself is not a disease, it’s not an infection. Morgellons is a characteristic feature of a specific skin condition. You may have heard about Morgellons “fibers”. What people who cover this topic fail to mention when writing about Mary Leitao is that she is a trained microbiologist, and used a high powered microscope to observe her sons skin specimens. What she saw under that microscope would normally be invisible to the naked eye, microscopic fibers embedded within the layers of skin tissue. Completely, seemingly, out of place – but entirely invisible without the right magnification.
Misdiagnosis of MD is likely to be common as the filaments are microscopic and invisible without sufficient magnification or, if observed under magnification, may be miscategorized as textile fibers.
Morgellons disease: a filamentous borrelial dermatitis – PMC (nih.gov)
Histological Analysis
You may have noted the caveat that MD is misdiagnosed often because upon examination, the clinician cannot differentiate between textile fibers and MD filaments. What’s the difference? Looking below, we see an image magnifying 240x the inside of a skin ulceration. You may see two red fibers, maybe some wiry looking threads, they might look like they are underneath the surface of the skin, or they may look like there is a liquid covering them.
One patient at least, was accused of injecting these into their own skin. What are they, what are they really?
Histological studies on MD tissue show that MD filaments are not textile fibers. They are biofilaments of human cellular origin produced by epithelial cells and stem from deeper layers of the epidermis, the upper layers of the dermis, and the root sheath of hair follicles.6,10,11 Histological studies established that these filaments are predominantly composed of collagen and keratin,10,11 and are nucleated at the base of attachment to epithelial cells,11 thus demonstrating human cellular origin. Staining of embedded filaments with Congo red resulted in apple-green birefringence suggestive of an amyloid component, although this remains to be confirmed by more specific studies (unpublished data). Staining of embedded filaments with calcofluor-white produced negative results, demonstrating that filaments are not cellulose as found in cotton, linen, or other plant-based textile fibers, or chitin as found in fungal cells and insect exoskeletons (unpublished data).
A preliminary study using scanning electron microscopy (SEM) showed hairlike scales on a blue filament, suggesting that at least some MD fibers are hairs.10 The blue coloration of some fibers was first determined to be the result of melanin pigmentation as shown by positive Fontana Masson staining.11 An independent study concurred that embedded blue fibers in an MD specimen (supplied by the authors of this paper) were not textile fibers. SEM revealed that the blue fibers were microscopic hairs with cuticular scaling, and transmission electron microscopy (TEM) revealed darkly stained melanosomes that were not organized, a finding consistent with human hairs (Shawkey MD, unpublished data, 2013).
Microspectrophotometry reflectance data on fibers were consistent with patterns of pigmented tissues. Raman spectroscopy14 on two separate blue fibers showed relevant peaks that were indicative of carbamate compounds and melanin aromatic rings (Shawkey MD, unpublished observation, 2016). Hence, independent studies using different methodologies provided evidence that Morgellons fibers are hairlike extrusions and that the blue coloration is the result of melanin pigmentation. Although the mechanism for coloration of red fibers is not yet understood, there are no known textile fibers colored by blue melanin pigmentation.11
Morgellons disease: a filamentous borrelial dermatitis – PMC (nih.gov)
Why’s Lyme Disease Associated With Morgellons?
Several outlets have published articles on the association of Morgellons with Lyme Disease, but few of them make time to understand, and then report on the details of that association. Quite simply, while bugs, worms, fungus, and crystals weren’t common to the majority of Morgellons patients in recent research efforts, almost all Morgellons patients in those studies demonstrate evidence of exposure to Borrelia bacteria.
How many people? In two studies which looked at roughly 1500 Lyme disease patients, 500 in Australia, where tick infections like Relapsing Fever Borrelia do occur though are mainly attributed to foreign travel, and 1000 state-side, what they demonstrated was that in each group, 6% of Lyme Disease patients had confirmed evidence of these microscopic fibers embedded in their skin tissue – the defining characteristic of Morgellons.
How could Lyme Disease cause microscopic fibers to grow under the skin? Well, before we look at evidence which might support a theory, first consider that microscopic fibers aren’t the only artifacts being produced in Morgellons patients skin. You may have heard patients claiming they have “worms coming out of their skin”, and you might be heart broken to see them trying to dig them out.
One of these “worms” was extracted by two doctors for Inside Edition. Do you see it?
Wow, it does look like a worm, doesn’t it? But it’s not. When these artifacts were examined, in controlled environments, they were found to be a result of abnormal increase in the production of keratin and collagen in skin tissue. Not uniformly increased across the body, but in spots.
Protruding keratin projections were observed on the concave, underside surface of calluses. Some of these were sharp at the tips of the projection, while others were blunt or ballooned (Figure 1D). Clear, ingrown hairs or hairlike structures, approximately 60 μm in diameter, were observed protruding from the tips of some keratin projections. Patient 1 presented dermatological tissue with attached white filaments. In contrast, patient 4 had only small lesions without significant callus formation and presented a single chunk of dermatological tissue approximately 1 mm in diameter embedded with filaments rather than calluses.
(A) Filament cross, oblique, and lateral sections, from a specimen collected from patient 1 showing round, elliptical/elongated, bean-like, or curved morphology. Note the hollow medulla and surrounding cortex. Cytokeratin (CK) AE1/AE3 staining. 100× magnification. (B) Specimen from patient 1, demonstrating irregular, patchy keratin staining with CK AE1/AE3, longitudinal section. Note most filaments staining positive for keratin (dark brown). 100× magnification. (C) Specimen from patient 1, demonstrating irregular, patchy keratin staining with CK AE1/AE3. Cross, oblique, and longitudinal sections. Note most filaments staining negatively for keratin. 400× magnification. (D) Longitudinal section of filament from patient 1. Note retained nuclei, central medulla, and patchy keratin staining with CK AE1/AE3. 400× magnification. (E) Sectioned filament from a specimen from patient 1, which upon gross microscopic examination demonstrated floral-like or stellate formations. Note retained nuclei within tentacle-like filaments with tapered ends. CK AE1/AE3 staining. 400× magnification. (F) Sectioned callus from patient 1, showing filaments stemming from the stratum basale with evolution inwards towards the dermis. Note filament sections with hollow medulla alongside the stratum basale. CK AE1/AE3 staining. 100× magnification. (G) Gömöri trichrome collagen-positive section of activated fibroblasts with filamentous inclusions from patient 2. Collagen stains green, keratin stains red. Growth of filaments was upwards toward the external surface. 400× magnification. (H) Ruptured keratin projection from both external and internal surfaces from a specimen collected from patient 2, with areas of fibroblast proliferation stained green. Gömöri trichrome stain. 100× magnification. (I) Section from patient 2 stained with Gömöri trichrome, demonstrating both keratin (red) and collagen (green) filament cross-sections, with most filaments associated with the external callus surface. 100× magnification. (J) Gömöri trichrome stain of specimen from patient 2, demonstrating filaments in longitudinal, oblique, and cross-sections close to and within collagen-positive fibroblast collections (green). Note presence of filament cross-sections staining positively for keratin (red). 400× magnification. (K) Bovine digital dermatitis (BDD) filament, longitudinal section, showing positive CK AE1/AE3 staining. 100× magnification. (L) BDD filament, longitudinal section, showing negative CK AE5/AE6 staining. 100× magnification.
Characterization and evolution of dermal filaments from patients with Morgellons disease – PMC (nih.gov)
Evidence That Lyme Could Cause Morgellons
Knowing that these patients have serious problems with their skin, apparently, the question should become ‘why do they experience this disfiguring condition’? Well, one reason researchers are compelled to finger Lyme Disease, and infections in the same family including Tick Borne Relapsing Fever, as the culprit in the case of Morgellons is because of its ability to alter the skin cells it inhabits.
Skin fibrosis has been reported in Borrelia burgdorferi infection in Europe, but has been questioned by several authors. The objective of the present study was to examine the interaction of skin fibroblasts with B. burgdorferi sensu stricto B31 (BB) and B. afzelii (BA) in vitro by electron microscopy. We also determined the expression of collagen type I, TGF-β, FGF-1, calreticulin (CALR), decorin (DCN), and PDGF-α at the mRNA level in Borrelia/fibroblast co-cultures. Intact Borrelia attach to and transmigrate fibroblasts, and undergo cystic transformation outside the fibroblasts. Fibroblasts preserve their vitality and express a prominent granular endoplasmic reticulum, suggesting activated protein synthesis. On two different semi-quantitative real-time PCR assays, BB- and BA/fibroblast co-cultures showed a significant induction of type I collagen mRNA after 2 days compared to fibroblasts (fourfold for BA and 1.8-fold for BB; p < 0.02). In addition, there was a significant upregulation of mRNA expression of TGF-β, CALR, PDGF-α, and DCN in BA and BB co-cultures compared to control fibroblasts in monolayer cultures after 2 days (p < 0.01). The BA/fibroblast co-culture induced a considerably greater upregulation of collagen and growth factor mRNA compared to BB/fibroblast co-culture. In contrast, a significant down-regulation of FGF-1 (20-fold for BA and 4.5-fold for BB) mRNA expression was detected in co-cultures compared to controls (p < 0.01). The results of the study support the hypothesis that BB sensu lato, and BA in particular, enhances collagen mRNA expression and can stimulate growth factors responsible for increased collagen production.
Co-culture of human fibroblasts and Borrelia burgdorferi enhances collagen and growth factor mRNA – PMC (nih.gov)
What’s that you ask? The blood brain barrier? What’s bacteria doing inside the skin? Well, you may not have heard that Lyme disease is the same kind of bacteria as syphilis. Syphilis? Yes – the disease that causes skin lesions.
Not Everybody Who Believes They Have Morgellons Does
As you can see from the evidence presented in the investigation, Morgellons is a very specific skin condition, and not at all a mental disorder. So why then are doctors not differentiating between those who really have Morgellons and those who mistakenly believe they do? Well, the excuse most commonly used is “empathy“. And let’s be honest, leading someone to believe they have a skin condition they have no evidence of for the purpose of coaxing them into taking antipsychotic medication is not a great example of progressive healthcare. It’s kind of like repackaging the “hysterical women” diagnosis but for the 21st century.
One team of researchers at the Zhejiang University School of Medicine however disagree with this approach, and rightfully so. Publishing their review of existing literature in the journal, Psychology Research and Behavior Management, they say Morgellons is something specific, likely something you’ve never heard of even if you’ve heard allot about “Morgellons”. They say the medical approach should be to rule out Morgellons in patients, rather than leading those without evidence of the dermopathy to believe that they have the condition.
The first step needs to determine whether delusion exists or not. A delusion is defined as a firmly, but false belief held with strong conviction and contrary to the superior evidence. It is distinct from beliefs based on an unusual perception, such as formication. The beliefs that patients hold could be delusion, true observations, or overvalued ideas. This must be determined on a case-by-case basis. The presentation of a specimen is not a delusional behavior. Patients with DI/MD with animate or inanimate objects can exist, but the belief of cutaneous fibers may or may not be delusional. A physician is required to perform fiber analysis to identify the nature of fibers. 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.
The next procedure would be screening the causes of the symptoms. If a delusional belief is present, then various medical conditions need to be ruled out, including psychiatric disorders (eg, schizophrenia and depression), neurological illnesses (eg, dementia), metabolic illnesses (eg, diabetes), vitamin deficiencies, substance intoxication, tumor, dermatological illnesses (eg, pruritus senilis), and infection. History taking, physical examination, laboratory tests, and even skin biopsy should be carried out. The diagnosis of DI could be classified as primary and secondary. If there are cutaneous fibers present and the belief is not delusional, the underlying cause of the symptoms, such as potential infection, should be examined. A diagnosis of MD is more convincing when spirochetal infection is identified. If a patient has delusional beliefs and has cutaneous fibers, then testing of an underlying infection that can result in neuropathy is needed.
Reframing delusional infestation: perspectives on unresolved puzzles – PMC (nih.gov)
Why So Many Morgellons Patients Are Lost To Follow Up
Quite simply, you cannot and more importantly, should not attempt to treat a serious bacterial infection like Lyme Disease or syphilis with antidepressants and antipsychotics. Are doctors concerned with distinguishing between the patients who do have Morgellons from those who do not? They should be, from what we just reviewed regarding the evidence concerning Morgellons, our medical system in general would experience a resurgence of trust, and a wealth of success stories to showcase, driving endless amounts of desperate individuals into doctors offices and away from shady online groups where – terrible things are recommended.
Patients who experience poor medical treatment will drop the advice of their doctors and seek immediate relief elsewhere. Don’t gaslight patients who might have a bacterial infection into believing they are suffering with a mental illness. It’s just plain wrong, and completely ineffective.
