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Moregellons Lyme hypothesis

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This is a controversial Fringe science hypothesis: that some of the fibres found by Morgellons sufferers in their skin are caused by infection by B. burgdorferi and other spirochetes, the causes of Lyme disease; and that this can happen many years after the initial infection. This hypothesis links it to to the suggestion that spirochetes can persist after treatment of Lyme disease, which is also controversial. The hypothesis is that this infection alters the expression of keratinocytes and fibroblasts cells, creating micro-fibres of keratin / collagen beneath the surface of the skin, leading to the itching and painful sensations reported by sufferers.

The general consensus of the CDC and other medical researchers is Morgellons is not a separate condition, and that these fibres are an example of the matchbox sign of delusional parasitosis, characterized by patients making collections of fibers and other foreign objects supposedly retrieved from the skin. A large scale study was carried out by the Centers for Disease Control (CDC) funded by an initiative of the Obama administration, which concluded in 2012. The report conclusion was that there is no reproducible or convincing scientific evidence of any relationship to B. burgdorferi infection".

As a result, the suggested link between Morgellons and infection with Borrelia spirochetes described below is considered by the medical and scientific community to be Fringe science, in the first sense of researches that follow the scientific method, and are published in peer reviewed scientific journals, but are not considered by other researchers in the topic area to be mainstream science.

For details of the mainstream view on this topic, see the main Morgellons article.

Suggested link between Morgellons and infection with borrelia spirochetes

The Mayo Clinic page about Morgellons refers to a group of researchers, three of them associated with the Morgellons Disease Foundation, who have found a possible link between Morgellons and infection with Borrelia spirochetes .

The published papers by these researchers suggest a connection with Bovine Digital dermatitis which has similar symptoms of subcutaneous microfilaments of keratin and collagen. They believe that spirochetes such as Borrelia burgdorferi, which causes Lyme disease, are able to persist in the body using the mechanisms of persistence in Lyme disease.

In their 2015 paper in BMC dermatology Marianne Middelveen et al assert that tests for Borrelia burgdorferi used in the CDC study had limitations that could have lead to non detection in cases where it is readily detectable by more sensitive tests.

"The search for spirochetal pathogens in that study was limited to Warthin-Starry staining on a small number of tissue samples and commercial two-tiered serological Lyme disease testing as interpreted by the CDC Lyme surveillance criteria. It should be noted that only two of the patients in our study group were positive for Lyme disease based on the CDC Lyme surveillance criteria and yet Borrelia spirochetes were readily detectable in this group of 25 MD patients."

These researchers attribute their success in detecting Borrelia burgdorferi and closely related spirochetes to several factors

  1. Clear diagnostic criteria for patient selection: fibers visible underneath unbroken skin or embedded in or projecting from skin, documented by a healthcare provider
  2. Ability to culture spirochetes in vitro to increase opportunity of detection
  3. High spirochetal load for the lesions, similar to lesions in cattle with BDD
  4. Use of molecular hybridization and PCR methods, able to detect spirochetal DNA in picogram range.

The authors agree that the cotton fibres extracted by the CDC are unrelated to the disease, and are probably from clothes and swabs. However they say that the fibres they study are a different phenomenon. They require 60 times magnification to be seen, and can be found beneath unbroken skin.

The fibres they found were made of keratin and collagen, and they believe they result from the proliferation and activation of keratinocytes and fibroblasts. They hypothesize that this may be triggered by the spirochete infection altering keratin and collagen expression. They cite previous research which has shown that Borrelia burgdorferi has a preference for infecting fibroblasts and keratinocytes.

In earlier papers by researchers following this line of investigation, the authors agree with the CDC that there are associated psychosomatic disorders. But differ from the CDC in their understanding of the cause / effect connection. Based on patient reports and observations, they believe that the physical symptoms occur first, and the psychosomatic disorders follow later.

In particular, they say that they found no evidence of a higher occurrence of pre-existing psychosomatic disorders in this group of patients than there is in the population at large (0.03%), which in their view distinguishes this group of patients from usual cases of delusional parasitosis. They also found that most patients (97%) with Morgellons had a history of Lyme disease.

Annual conference on Morgellons

An annual three day conference is held for researchers to present and discuss their findings, including investigations of this hypothesis of a Lyme disease connection. It is held in Austin, Texas, and the conference in 2015 had twelve presenters.

This is sponsored by the Morgellons Disease Foundations a 501(c)3 nonprofit organization committed to "advocacy and philanthropy in the battle against Morgellons Disease", Its director is Cindy Casey-Holman and the organization is named after her deceased husband Charles Holman. Their funding amounts to about $50,000 a year, which is used for small grants, various expenses, and the annual conference.

Previously, the Morgellons Research Foundation was the primary patient advocacy group in the 2000s, but it no longer exists. This was founded by Mary Leitao, a biologist from Pennsylvania.

Publicity for this hypothesis in news stories

This hypothesis has been mentioned in the news a few times recently due to the connection with Joni Mitchell who says she has Morgellons, for instance it's been covered by CBS News l

It was also covered earlier in 2015 by the The Atlantic

Previously suggested causes

There have been several other hypotheses for Morgellons mentioned in scientific journals, especially before the CDC report.

  • Fungi - DNA extracted from two fibre samples sent to him by a Morgellons sufferer by Ahmed Kilani, director of Clongen Laboratories (2007)
  • Agrobacterium - Vitaly Citovsky of Sotny Brook University, NY found this in Morgellons lesions. This is a genus of bacteria that's used commercially to produce genetically modified plants, which in laboratory conditions can insert its DNA into human cells. (2007)

There are also many suggestions which are Fringe science in the second sense of researches not following the scientific method, or at least, not published in peer reviewed scientific journals.

External links

References

  1. ^ Harvey, William T; Bransfield, Robert C; Mercer, Dana E; Wright, Andrew J; Ricchi, Rebecca M; Leitao, Mary M (2009). "Morgellons disease, illuminating an undefined illness: a case series". Journal of Medical Case Reports. 3 (1): 8243. doi:10.4076/1752-1947-3-8243. ISSN 1752-1947. PMC 2737752. PMID 19830222. {{cite journal}}: Cite has empty unknown parameter: |1= (help)
  2. ^ Savely, Virginia R., and Raphael B. Stricker. M "Morgellons disease: analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology." Clinical, cosmetic and investigational dermatology: CCID 3 (2010): 67. PMID 21437061
  3. ^ Savely, Virginia R; Leitao, Mary M; Stricker, Raphael B (2006). "The Mystery of Morgellons Disease:infection or delusion?". American Journal of Clinical Dermatology. 7 (1): 1–5. doi:10.2165/00128071-200607010-00001. ISSN 1175-0561. PMID 16489838.
  4. ^ Middelveen, Marianne J; Burugu, Divya; Poruri, Akhila; Burke, Jennie; Mayne, Peter J; Sapi, Eva; Kahn, Douglas G; Stricker, Raphael B (2013). "Association of spirochetal infection with Morgellons disease". F1000Research. doi:10.12688/f1000research.2-25.v1. ISSN 2046-1402.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ^ Middelveen, Marianne J; Bandoski, Cheryl; Burke, Jennie; Sapi, Eva; Filush, Katherine R; Wang, Yean; Franco, Agustin; Mayne, Peter J; Stricker, Raphael B (2015). "Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients". BMC Dermatology. 15 (1). doi:10.1186/s12895-015-0023-0. ISSN 1471-5945.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  6. Schulte, Brigid (January 20, 2008). "Figments of the Imagination?". Washington Post Magazine. p. W10. Retrieved 2008-06-09.
  7. "Unexplained Dermopathy (aka "Morgellons"), CDC Investigation". Centers For Disease Control. November 1, 2007. Retrieved 2011-05-09.
  8. CDC report FAQ
  9. "Morgellons disease: Managing a mysterious skin condition (page 2)". Mayo Clinic. 2015. A possible link between Morgellons and infection with Borrelia spirochetes has been suggested by one group of researchers. Three in the group are affiliated with the Morgellons Disease Foundation.

    In an earlier study, researchers with the Centers for Disease Control and Prevention (CDC) concluded that Morgellons disease, which they refer to as an unexplained dermopathy, isn't caused by an infection or parasites. They studied samples of skin, blood, urine and hair.

    Further research is needed to determine whether Morgellons is a new disorder and, if so, to develop diagnostic criteria.
  10. Middelveen, Marianne J; Bandoski, Cheryl; Burke, Jennie; Sapi, Eva; Filush, Katherine R; Wang, Yean; Franco, Agustin; Mayne, Peter J; Stricker, Raphael B (2015). "Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients". BMC Dermatology. 15 (1). doi:10.1186/s12895-015-0023-0. ISSN 1471-5945. We achieved a high degree of success in detecting Bb and closely-related spirochetes from MD dermatological tissue. We attribute our success to several key factors. First, as stated previously we had a clear diagnostic criterion that allowed us to select the appropriate clinical cohort. Second, in contrast to T. pallidum, the treponemal agent of syphilis, Borrelia spp. can be cultured, thereby magnifying their numbers in vitro and increasing the opportunity for detection. Third, unlike secondary and tertiary syphilitic skin lesions where treponemes are seldom detected, we observed that MD lesions carry a high spirochetal load that allows for relatively easy detection, similar to lesions seen in cattle with BDD. Finally, we used a variety of sensitive microscopic and molecular methodologies to detect Borrelia spp., including molecular hybridization and PCR techniques that can detect spirochetal DNA in the picogram range.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  11. Middelveen, Marianne J; Bandoski, Cheryl; Burke, Jennie; Sapi, Eva; Filush, Katherine R; Wang, Yean; Franco, Agustin; Mayne, Peter J; Stricker, Raphael B (2015). "Exploring the association between Morgellons disease and Lyme disease: identification of Borrelia burgdorferi in Morgellons disease patients". BMC Dermatology. 15 (1). doi:10.1186/s12895-015-0023-0. ISSN 1471-5945. The mechanism of filament formation in MD is not yet elucidated. The filaments are composed of keratin and collagen and arise from proliferative keratinocytes and fibroblasts in human epithelial tissue. Bb appears to have a predilection for fibroblasts and keratinocytes, and invasion of these cells by Borrelia spirochetes has been reported. Bb appears to attach to fibroblasts followed by engulfment of the spirochetes, formation of vacuoles and intracellular replication. Intracellular sequestration of Bb in skin fibroblasts and keratinocytes may protect the spirochetes from host defense mechanisms. It is therefore reasonable to hypothesize that Bb intracellular infection of keratinocytes and fibroblasts may alter keratin and collagen expression and that the presence of Borrelia spirochetes in dermatological tissue is a primary etiologic factor in the evolution of MD lesions.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  12. 8th Annual Medical - Scientific Conference on Morgellons Disease, March 28-29, 2015 in Austin, TX.
  13. Morgellons Disease Conference - presenters
  14. press release for the 2014 conference
  15. Board of directors
  16. Form 990EZ for the Charles Holmann Foundation,
  17. What is Morgellons Disease? Is it a physical or psychological condition? , Coco Ballantyne, Scientific American, May 13, 2009
  18. Mitchell and the mystery of Morgellons disease ByJESSICA FIRGER, CBS NEWS, April 2, 2015, 5:47 PM
  19. Diagnosis or Delusion? Critical article covering the foundation by Katherine Foleyjan, 2015.
  20. ^ Elkan, Daniel (2007-09-12). "Morgellons disease: The itch that won't be scratched". No. 2621. New Scientist Magazine. One researcher who believes he already knows is Ahmed Kilani, director of Clongen Laboratories, a private research organisation in Germantown, Maryland. Kilani says that he managed to break down two fibre samples sent to him by a Morgellons sufferer using protein-digesting enzymes and extracted DNA from them. When he sequenced the DNA, he found that it belonged to a fungus. This makes sense, Kilani says: many fungi embed a root in their host and send out long filaments called hyphae. "This is what the fibres could be," he says. Clongen has not charged the patient for its services and now plans to apply for a government grant to carry on the work.

    However, at Stony Brook University, part of the State University of New York, biochemist Vitaly Citovsky has another idea. He found that Morgellons lesions contain Agrobacterium, a genus of bacterium that causes tumours in plants. Control groups test negative. In 2001, when he knew nothing of Morgellons, Citovsky discovered that Agrobacterium, which is used commercially to produce genetically modified plants, is - under laboratory conditions, at least - able to insert its DNA into human cells. This is the only recorded example of trans-kingdom DNA transfer (Proceedings of the National Academy of Sciences, vol 98, p 1871).

    Could Agrobacterium be causing a new human disease? "We don't yet know," Citovsky says. "Agrobacterium could just sit there in a lesion, like an opportunistic infection. Or it could genetically transform the host, as it does in nature with plants. The next stage will be to infect mice with Agrobacterium and see if we can recreate the disease."
  21. Stricker, R. B., et al. "Contribution Of agrobacterium to Morgellons Disease: 287." Journal of Investigative Medicine 55.1 (2007): S123.
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