Filament formation associated with spirochetal infection: a comparative approach to Morgellons disease

Abstract

Bovine digital dermatitis is an emerging infectious disease that causes lameness, decreased milk production, and weight loss in livestock. Proliferative stages of bovine digital dermatitis demonstrate keratin filament formation in skin above the hooves in affected animals. The multifactorial etiology of digital dermatitis is not well understood, but spirochetes and other coinfecting microorganisms have been implicated in the pathogenesis of this veterinary illness. Morgellons disease is an emerging human dermopathy characterized by the presence of filamentous fibers of undetermined composition, both in lesions and subdermally. While the etiology of Morgellons disease is unknown, there is serological and clinical evidence linking this phenomenon to Lyme borreliosis and coinfecting tick-borne agents. Although the microscopy of Morgellons filaments has been described in the medical literature, the structure and pathogenesis of these fibers is poorly understood. In contrast, most microscopy of digital dermatitis has focused on associated pathogens and histology rather than the morphology of late-stage filamentous fibers. Clinical, laboratory, and microscopic characteristics of these two diseases are compared.

<p>Classification and Staging of Morgellons Disease: Lessons from Syphilis</p>

“…Histochemical studies demonstrate that the cutaneous filaments in MD are not self-implanted synthetic man-made textile fibers, but are hair-like human biofilaments composed of the structural proteins keratin and collagen, the products of keratinocytes and fibroblasts, respectively. 5,8,9,17,26 The cellular base of attachment at the stratum basale is nucleated and continuous with surrounding skin cells, consistent with human cellular origin. 5,8,9,17,26 Furthermore, the characteristic blue color seen in some fibers results from melanin pigmentation, and blue filaments contain melanocytes and melanin granulation, providing irrefutable evidence that these are not synthetic manufactured fibers.…”

“…Various members of the genus Treponema cause a comparable condition, bovine digital dermatitis, in cattle. 5 T. denticola has been detected in some MD skin specimens, although not independently of Bbsl. 5 Because Treponema is known to cause a comparable condition in an animal model, and because treponemes are spirochetes like Borrelia spp., it is possible that T. denticola or other pathogenic treponemes could be key etiologic factors in the evolution of MD in some patients.…”

“…5 T. denticola has been detected in some MD skin specimens, although not independently of Bbsl. 5 Because Treponema is known to cause a comparable condition in an animal model, and because treponemes are spirochetes like Borrelia spp., it is possible that T. denticola or other pathogenic treponemes could be key etiologic factors in the evolution of MD in some patients. In support of that hypothesis, there is historical evidence linking MD-like cases to treponemal infection, as discussed below.…”

“…Morgellons disease (MD) is a dermatological condition in which lesions that contain unusual filamentous inclusions and/or projections spontaneously arise. [1][2][3][4][5] The filaments are distinctive in part due to their varied white, red, blue, green or black coloration, and because visually they resemble microscopic textile fibers. [6][7][8][9] In addition, the dermopathy may be accompanied by formication (sensation of something crawling on skin).…”

“…6,7,10 In addition to filamentous dermopathy, patients frequently experience Lyme-like symptoms such as musculoskeletal, neurological and cardiovascular manifestations suggestive of spirochetal etiology. [1][2][3][4][5]8 Cohort studies indicate that most patients with MD test positively for Borrelia infection and/or have a clinical Lyme disease (LD) diagnosis. 4,[11][12][13] Two separate cohort studies have demonstrated that MD afflicts approximately 6% of LD patients.…”