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

Abstract

Introduction: Morgellons disease (MD) is a contested dermopathy that is associated with Borrelia spirochetal infection. A simple classification system was previously established to help validate the disease based on clinical features (classes I-IV). Methods: Drawing on historical and pathological parallels with syphilis, we formulated a more detailed staging system based on clinical features as well as severity of skin lesions and corresponding histopathological infection patterns, as determined by anti-Borrelia immunohistochemical staining. Results: Clinical classes I-IV of MD are further categorized as mild, moderate and severe, or stages A, B and C, respectively, based on histopathological findings. Stage A lesions demonstrated little or no immune infiltrates and little or no disorganization of cells; macrophages were not present, and hemorrhage was negligible. Extracellular isolated spirochetes and intracellular staining of keratinocytes in the lower epidermis was occasionally seen. Stage C lesions demonstrated positive staining of keratinocytes in the stratum basale and stratum spinosum and positive intracellular staining of macrophages for Borrelia. Aggregate Borrelia colonies were frequently encountered, hemorrhage was frequent, and intracellularly stained fibroblasts were occasionally seen. Stage B lesions demonstrated a pattern intermediate between Stages A and C. Conclusion: The enhanced staging system provides objective criteria to assess the severity of dermopathy in MD. Further studies are needed to determine the optimal treatment for MD based on this staging system related to Borrelia infection.

Imaging analysis of Bartonella species in the skin using single‐photon and multi‐photon (second harmonic generation) laser scanning microscopy

“…infections, we recognize the importance of coinfections as we and others expand our future studies to include other coinfections and diseases such as Morgellons disease. 42 Importantly, the presence of striae-like skin track lesions in patients presenting with neuropsychiatric symptoms indicate testing for suspected Bartonella spp. infection.…”

Dermatological and Genital Manifestations of Lyme Disease Including Morgellons Disease

“…Control staining, as previously described, demonstrated no reactivity to common Gram-positive and Gram-negative organisms, nor was it reactive to fungal-infected human skin specimens or inflamed skin specimens from a patient diagnosed with psoriasis. 14 …”

“…4–12 Histological studies have revealed that MD lesions demonstrate hyperplasia and parakeratotic hyperkeratosis, and that the characteristic cutaneous fibers are composed of keratin and collagen originating primarily from keratinocytes within the stratum basale. 13 , 14 Thus, MD fibers are of undeniable human cellular origin and are not manufactured artifacts.…”

“… 15–17 These skin manifestations of LD are reminiscent of secondary syphilis, which is associated with a spectrum of skin pathology including macular, papular, follicular, lichenoid, vesicular or pseudovesicular, psoriasiform, corymbiform, annular, pustular, rupial, frambesiform, pigmentary, and condylomata lata lesions. 14 MD lesions can likewise demonstrate wide variation in gross morphological features that resemble those of LD-associated and syphilitic lesions. 14 …”

“… 14 MD lesions can likewise demonstrate wide variation in gross morphological features that resemble those of LD-associated and syphilitic lesions. 14 …”