Delusional Parasitosis

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’)” [3]. 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.

References

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.
April 2010.
DOI: 10.1086/653461


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.

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Comments on: "Infectious Diseases Society of America on Morgellons" (6)

  1. Sigh…
    This article just rehashes what we’ve been reading/hearing all along about morgs and DOP. It just has a more recent date stamp on it. Frustrating.

  2. Joe Keleher said:

    I suppose the paradym will change with time. Instead of being frustrated with ignorance, be thankful for the growing number of medical professionals willing to think outside of the box. I have noticed the CDC listing of dermatological conditions no longer includes DOP.

  3. The infectious Disease society does not really care to believe. I have larva, specs, grains, fiber balls popping all day long. I crawl constantly, I don’t have sores, but my mother, whom I caught this from, does. That cannot be DP. I have all the samples, but you know, if they cared, they would want to see them. This is stuff I could not collect from the environment. It is obviously not linen. Some specs, under the scope are symmetrical and quadrant. The fiber balls are so tightly woven and have the blue and red thread around them. When I torch them with a match they maintain their shape. How could that be DP? I am going to write to them now but just wanted to post.

    • Am in the same situation with myself and my mother, although she again has sores and lesions, which I do not. Equily my brother has began to get the same problems without knowledge of mine or my mothers symptoms. How anyone can say this is DP is beyond me. This article is a joke!

  4. Just goes to show the medical community is so convinced they know everything that they seem to go to great lengths to establish that anything they don’t understand or don’t know dosen’t exist. I don’t know about you but I beleive in statistics and science and I have never read anything about contagious delusions LOL. If it’s collective hysteria they are referring to, then it certainly dosen’t cover this because there would have to be prior knowledge of the illness and that’s not the case. Also the statistical chances of all those people all having the exact same delusion describing the exact same symptoms all over the world without knowing each other is absurd, it’s far more likely that there is a type of parasitic infestation that they are not familiar with yet and it dosen’t help that they ignore it instead of researching it almost every time. The human arrogance in that article is staggering. And just to show they don’t know everything, they got the french all wrong. That’s “folie à deux”, “folie à trois” and “folie en famille”. The last two are not even common expressions in French, I suspect anglophones use that more than we do.

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