Boggild AK, Nicks BA, Yen L, et al. Delusional parasitosis: six-year experience with 23 consecutive cases at an academic medical center. Int J Infect Dis 2010; 14:e317–e321.
Boggild and colleagues analyzed 23 consecutive patients with a diagnosis of primary delusional parasitosis who had presented to the emergency department or the infectious diseases clinic at the University of Washington. Their median age was 45 years (range, 31–77 years); 15 were female. Ten patients reported being infested with worms, 8 with an unknown type of parasite or insect, and 1 with lice, and 2 patients reported skin inoculation. Reported symptoms included visualization and/or sensation of parasite movement in 39% and pruritus in 44%; 8 patients had skin lesions, which may have resulted from excoriation and/or attempts to extract or kill parasites, on examination. Eight patients brought in small containers, plastic bags, or tissue paper containing what they believed to be parasites. Only 4 patients accepted psychiatric referral.
Delusional parasitosis may be primary, as in the cases discussed here, or secondary to psychiatric disease, medical illness, intoxication, or substance abuse [1, 2]. The primary form is a “delusional disorder of the somatic type in which the person has a fixed belief” [2, p 784] that exists in the absence of other thought disorders. Thus, patients with delusional parasitosis may have normal mental function in other spheres of their lives and may remain otherwise fully functional. Although the delusion most often involves skin, some patients report the movement of worms internally or their presence in feces. Patients often present small containers containing various material, which they believe represents the parasite that has emerged from their skin or from a body orifice, a phenomenon that has been called the “matchbox sign” or “Ziploc bag sign.” Folie-a-dieux, in which a spouse, other family member, or significant other often shares the delusion, is common and may extend to additional acquaintances (folie-a-trois) or even to an entire family (folie-a-familie).
These patients are often referred to infectious diseases specialists, and treatment is difficult. They have often already seen multiple physicians and have been dissatisfied. As in the series from the University of Washington, patients often resist referral to psychiatrist, and the suggestion of referral may elicit anger. It is reported, however, that some patients respond well to administration of atypical antipsychotic agents.
Some interested parties have given the eponym Morgellons disease to delusional parasitosis, have created a Web site (http://www.morgellons.org/), and have developed an organization that successfully convinced the US Centers for Disease Control and Prevention to formally study “Unexplained Dermopathy (also called ‘Morgellons’)” . Enrollment in the study has been completed, and the results to date were reviewed by an external panel on 24 September 2009, with a summary of their review to be posted in November 2009. As of 13 April 2010, however, the results do not appear to have been released.
1. Freudenmann RW, Lepping P. Delusional infestation. Clin Microbiol Rev 2009; 22:690–732.
2. Frean J, de Jong G, Albrecht R. Imaginary bugs,real distress: delusional parasitosis. S Afr Med J 2008; 98:784–786.
3. Unexplained dermopathy (also called “morgellons”). http://www.cdc.gov/unexplained dermopathy/investigation.html.
This article above was just in this months edition …
My favorite quote …
Patients often present small containers containing various material, which they believe represents the parasite that has emerged from their skin or from a body orifice, a phenomenon that has been called the “matchbox sign” or “Ziploc bag sign.” Folie-a-dieux, in which a spouse, other family member, or significant other often shares the delusion, is common and may extend to additional acquaintances (folie-a-trois) or even to an entire family (folie-a-familie).
This is a real shoddy article I must say. I think Joe’s articles on DOP (available on this blog) show real investigative instincts and a desire to get to the truth no matter what the outcome. This article starts with the conclusion and reveals that no serious investigation was undertaken. This frankly looks embarrassing on the medical communities part.
Finally, the article states that “Some interested parties have given the eponym Morgellons disease to delusional parasitosis”, talk about begging the question. The authors cannot even fathom that Morgellons could be anything else but DOP. After all, we did not start calling DOP Morgellons, rather doctors started referring to us as DOP without so much as an examination. Apparently, DOP is contagious as they go on to explain that it can spread to ones family members and friends. I’m really surprised they didn’t just go ahead throw in the “old internet disease” routine while they were in there.