T A K E A T R I P

*


*

Charles E. Holman Foundation

www.thecehf.org/

You +1'd this publicly. Undo

Morgellons Disease Information, Awareness and Support

********************* ********************* ********************************

***********************************

The mother who never gave up Published: August 28, 2012 - 3:00AM THE news that would turn Cindy Corrie's life inside out came about noon on a Sunday in March 2003. She was at home, then in Charlotte, North Carolina, when the phone rang. ''The apartment was kind of a mess, there were papers all over the place, and Craig [her husband] was doing the laundry,'' she recalls in a soft, hesitant voice. On the line was her son-in-law, Kelly Simpson, but Cindy could hear her elder daughter Sarah ''crying, just hysterical'' in the background. They had bad news, Kelly said.
''At that point Sarah got on the phone and said: 'It's Rachel.' The first words that came out of my mouth were: 'Is she dead?' I guess I just had to articulate the worst possibility. And Sarah said: 'We think so'.''
Sarah and Kelly had picked up a phone message from a neighbour in the family's home town of Olympia, Washington, conveying sympathy after hearing about ''the tragedy'' on television. They turned on their TV set to find, scrolling across the bottom of the screen, the words: ''Olympia activist killed in Gaza Strip.''
''Sarah thought: if it's Rachel, why haven't Mum and Dad called me? Then she thought: they don't know.'' Still holding the phone, Cindy walked across a car park to her husband in the apartment block's laundry room. ''You can't soften something like that. I said: 'It's Sarah and Kelly, and they say Rachel's dead'.''
Rachel Corrie, 23, had been crushed under an Israeli military bulldozer while trying to prevent the demolition of a Palestinian home in Rafah, at the southernmost end of the Gaza Strip. According to witnesses, the bulldozer driver had driven straight at her, then reversed over her, even though she was clearly in his line of vision.
Rachel was a volunteer for the pro-Palestinian direct action organisation the International Solidarity Movement and the youngest of the Corrie's three children. Her death propelled her family into an almost decade-long battle for accountability and justice. What Cindy describes as ''a milestone'' in that fight will come today when a court in Haifa hands down its verdict in a 2½-year civil lawsuit brought by the Corries against the state of Israel.
''If you had told me 10 years ago that this would happen to us, and I'd do any of the things I have done since that time, that any of us would, I'd say you're crazy,'' says Cindy. ''Always for parents there's that dread of something happening to a child. I don't even know how to describe how we got through those first minutes and hours.''
Rachel was born on April 10, 1979, five years younger than her sister, Sarah, and seven years younger than her brother, Chris. Asked what Rachel was like, Cindy pauses. ''It's kind of a sad question. You try to hold on to all the memories, but you realise there are things that you lose. Sometimes it's hard to remember.''
But these are some of the ways she describes her daughter: inquisitive, with a rich inner life; creative; an intense observer; an artist; a sympathetic listener; expressive; a constant doodler; able to connect with different people; a poet.
''I always thought that when she came through the front door as an adult, you just knew it was going to be interesting.''
The Corries lived in Olympia, a small community centred on the progressive liberal Evergreen State College, which Rachel later attended. Cindy describes the town as ''politically and environmentally aware'', much like the Corries themselves.
''As a family we were certainly always politically interested, with a lot of discussion going on, but we were not activists, not protesters.''
Cindy, now 64, the oldest of six siblings, grew up in a ''very conservative Lutheran'' household, but describes her own immediate family as ''spiritual'' rather than church-going. They were ''middle-income - we lived really quite modestly, we were pretty frugal people''. Cindy had rarely been outside the US, certainly never to Europe or the Middle East.
By early 2003, Craig Corrie had taken a job in North Carolina, and the couple moved to Charlotte, although always with the intention of returning to their home base in Olympia. ''Like a lot of families, we had just been trying to get our kids through college, and finally we were free of that responsibility. It was like when we were first married - we could decide what to do with our time.''
They hiked in the Appalachian Mountains, took driving trips, saw movies. Cindy learnt French and played the flute. ''I'm really grateful for that time. It was a quiet time before this really intense period that came after. We spent a lot of time thinking about how we were going to spend the years ahead. It was a pleasant interlude.''
Back in Olympia, following September 11, their younger daughter was becoming drawn into the burgeoning peace movement and beginning to explore the reasons behind the atrocity. ''That drew her to Israel and Palestine as at least part of the problem,'' says Cindy.
As for her parents, ''it wasn't that we weren't interested [in the Israeli-Palestinian conflict], but I think we were just very distanced from it. We knew about it in the way that most Americans did, by listening to news reports.
''Our sympathies were very much with the Israeli Jewish narrative, because that's what we knew. I read The Diary of Anne Frank to my kids when they were growing up, and that was the narrative we connected with - and the Palestinian narrative really didn't exist for us.''
But Rachel decided to volunteer as an activist for the Palestinian cause. At the time, the second intifada (uprising) against the Israeli occupation was under way, with an escalating cycle of violence from both sides: frequent suicide bombings carried out by Palestinian militants, and incursions, shootings, shellings and demolitions by the Israeli military.
''It felt a little unnerving,'' says Cindy. ''At first we hoped it wouldn't happen. But Rachel was 23 years old, and was very much making her own decisions, as we thought she should. We had always supported our kids in whatever steps they wanted to take. Some people say: 'Why did you let her go?' That was not ever something I felt was my role.''
Cindy began learning about the Middle East: reading, watching films, discussing the issues with her daughter. Once Rachel had arrived in the Gaza Strip, her frequent emails home, describing what she was seeing and experiencing, illuminated what had been a distant conflict.
''They brought us a view, a perspective, that we had never seen before,'' she says.
The couple were anxious, but not unduly so. Rachel called soon after arriving in Rafah, asking her parents if they could hear the sound of shelling in the background. ''I could hear her voice trembling. Craig and I carried our anxiety with us.'' Cindy spoke to her daughter again, six days before her death. ''She sounded really happy.''
Then, on March 16, 2003, came that terrible phone call, ''the worst moment of my life''. Cindy ''stumbled through'' the following hours, days and weeks, feeling physically ill. ''I couldn't sleep. I would drift off, then feel jolts of pain through my arms. And then there was that thing of going to sleep and then waking up and finding that it is a nightmare, but it's real and it's always there every day.''
Immediately, intuitively, Cindy ''knew we had to get her words out. I knew how important that was to her, and I knew what the impact had been on family and friends. She wanted to find ways for people to hear about what she was seeing.''
The family released Rachel's emails to the media. ''It was The Guardian [in London] that picked them up very quickly, and it was huge, very significant. All kinds of things came from that.''
Rachel's powerful writing was adapted into an acclaimed stage play, My Name is Rachel Corrie, performed in at least 10 countries, including Israel. It was also published in book form, Let Me Stand Alone.
Meanwhile, the day after Rachel's death, then Israeli prime minister Ariel Sharon promised then US president George W. Bush a ''thorough, credible and transparent'' investigation into Rachel's death.
Less than a month later, an internal inquiry by the Israeli military concluded that its forces were not to blame. The driver of the bulldozer had not seen Rachel before she was crushed beneath the vehicle, it said. No charges were brought and the case was closed.
The Corries' battle for justice has dominated their lives for close to a decade. They found themselves ''up against a wall of Israeli officials determined to protect the state at all costs, including at the expense of truth'', as they said in a statement last northern summer.
They learnt how to campaign, deal with the media, assess legal documents, challenge authority and harness the support of their government whenever possible. Eventually - their ''absolutely last resort'' - in March 2010 they sued the state of Israel over Rachel's death, accusing its military of either unlawfully or intentionally killing her, or of gross negligence.
''The demands of the lawsuit have been huge,'' Cindy says. ''In some ways, we were naive, coming from the United States, where it's unusual for a trial not to be over within a few weeks.''
In the past 2½ years, the Corries have spent a total of eight months in Israel, broken into short visits to coincide with the sporadic hearings. Now, Cindy says, ''I'm just relieved to be at this point and, no matter what happens, we'll be at the other side.
''It's very unpredictable. We believe we know what should happen, but we also know what the state [of Israel] has to say. We'll have a verdict, and then we'll determine how to respond. But we know this won't be the end.''
Apart from justice for Rachel, the Corries are also committed to justice for the Palestinians. Six months after Rachel's death, Cindy and Craig finally visited Gaza, and the house their daughter was trying to protect from demolition. There have been subsequent visits to Gaza, and Cindy hopes there will be more in the future.
The family have made many friends from Gaza, including the occupants of the house, the Nasrallah family, whose home was finally razed in the spring of 2004. Cindy says she now has a ''deeper sense of what injustice means''.
''Craig and I have been so blessed because Rachel gave us this opportunity to focus here. There's no end to the work that can be done around this issue, and other peace and justice issues. If, miraculously, the Israeli-Palestinian situation could be fixed, there'll be something else that could command and deserve attention.''
But, she adds: ''I know realistically I have to find a way to get more balance in my life than I have now. I look at the weeds in my yard and I think about how much I'd love to go out and work there for an hour every day. I hardly cook any more. I'd like to make some time for those kinds of things.''
The verdict in the lawsuit, she says, is part of a process, ''one piece of what we've done. In terms of what happened to Rachel and the accountability that we're seeking, the process has shown there are huge problems here [in Israel] in investigations and the legal system. There continue to be things that need to be discussed, exposed and addressed.''
''Closure'' is not something Cindy is expecting. ''Closure isn't the right word. In my mind, it suggests that there's an end to something, and I just don't see that happening.
''The loss, the void, is permanent. You feel it every day of your life,'' she says slowly, hesitantly. ''What happened to Rachel will never be OK, but I feel pretty at peace with where I am. All you ever do is take the next breath and the next step. I'm still just taking the next step, but you get to the point where it's OK to do that.''
GUARDIAN

This story was found at: http://www.canberratimes.com.au/world/the-mother-who-never-gave-up-20120827-24wf0.html

what are Universites teaching about ECONOMICS

any "MBA's" have opinions and what are Universites teaching about ECONOMICS ... & "the Dollar"?
*******************************
http://www.topmba.com/business-schools/mba-programs
--------------------------------------------------------------

Life in Iraq Under U.S. Occupation

************************************ ************************************ ************************************

Arm the Homeless "the1st shall be last..."

Arm the Homeless "Where ever somebody is stuggling to be Free, look in my EYES and you see me."

From 2008 = Pinellas County, Houston & L.A. are especially high in Morgellons, though it has been found all over the Planet and 50 States of the U.S.A.
The "CDC Outsourched (Keizer) Study" was fraudulant, skewed and msleading to the point of the Purpose (TRUE) of the CDC Report was intentional manipuation, deception and mis-information.
***************************
below older, but revealing Florida local news report on Morgellons
***************************

Uploaded by st0ckman on Jan 23, 2008

http://st0ckman.blogspot.com
The illness is called Morgellons and Florida, Texas and California are states with apparent hot spots for the condition, Local 6 reported.

People who report suffering from the condition identify a range of symptoms including vision loss, mental confusion and fatigue. Some sufferers also said they have experienced tiny fibers that pop out of their skin.

"They typically describe a disturbing skin sensation such as itching or stinging or pins and needles," Centers for Disease Control Dr. Michele Pearson said.

Last summer, registered nurse Cindy Casey said the constant lesions on her body forced her to quit working.

"It's miserable," Casey said. "It feels like you've got splinters coming out."

Thousands of people claim to have Morgellons and a foundation has been formed.

However, some are not certain Morgellons is a legitimate disease.

"The reason we are doing an investigation is to learn more about it," Pearson said.

Researchers plan to follow up with 500 people who claim to have the condition.

Volunteers will get blood tests, skin exams as well as psychological evaluations.

Doctors at Oklahoma State University have been studying Morgellons for years and said they don't know what's causing it.

The CDC's year-long study will try to figure out what's causing Morgellons and if there's any way to treat it.

F~~k the War RACKET (from a Veteran for Peace, 2003)

‘I don’t want to be complicit’ in an Israeli strike on Iran, says US army chief

Martin Dempsey warns that, while it may delay the Iranian nuclear program, an Israeli military campaign could also unravel international sanctions on the Tehran regime

.............................................~~~~~~~~~~~~~~~~~~........................................

he US should not become embroiled in an Israeli military strike on Iran that would not only fail to destroy Iran’s nuclear program, but could also undo international diplomatic pressure on Tehran, the Chairman of the Joint Chiefs of Staff General Martin Dempsey said Thursday in London.

Such an attack by Israel would “clearly delay but probably not destroy Iran’s nuclear program,” Dempsey said, adding: ”I don’t want to be complicit if they [Israel] choose to do it.”

The US’s top general – the Guardian reported – said that he could not presume to know Iran’s ultimate intentions in pursuing a nuclear program, as intelligence was inconclusive on that score. It was clear, however, he maintained, that mounting pressure from the American-led “international coalition… could be undone if [Iran] was attacked prematurely.”

Last week, Dempsey said that Israel and the US did not see eye to eye on the Iranian nuclear threat, admitting that Washington and Jerusalem were on “different clocks” regarding Tehran’s nuclear ambitions.

He noted, however, that he understood Israel’s urgency in calling for action against Iran’s nuclear program.

“They are living with an existential concern that we are not living with,” he said.

Dempsey added that he and Israeli Defense Forces Chief of General Staff Lt.-Gen. Benny Gantz spoke on a bi-weekly basis to coordinate intelligence, despite gaps in understanding how close Iran was to a breakout nuclear capability.

“We compare intelligence, we discuss regional implications. And we’ve admitted to each other that our clocks are turning at different rates,” he said.

Thursday’s comments from Dempsey, who was in London for the Paralympic Games, come amid mounting chatter over a possible Israeli strike on Iran’s nuclear program. The US has been working to keep Israel from launching a unilateral strike, maintaining that sanctions should be given more time to work.

Last week, the former American ambassador to Israel, Martin Indyk, termed Israel’s talk of attacking Iran “a classic case of crying wolf.”

Joshua Davidovich contributed to this report.

 

Listen Carefully ... then decide!

http://www.legitgov.org/node?page=1

H A Y F O R K

going HOME . . . . . . .   H A Y F O R K

~ ~ ~ ~ ~ "H O M E" ~ ~ ~ ~ ~

PUSH WHITEHOUSE > TRUE ECOLOGICAL WISDOM!

PUSH WHITEHOUSE > TRUE ECOLOGICAL WISDOM!
http://americasgreatoutdoors.gov/
These "new (or newly implented) programs" be TRULY within "Ecological Wisdom" and Future Focus.
^^^^^^^^^^^^^^^^^^^^^^^^^

1. GRASSROOTS DEMOCRACY
Every human being deserves a say in the decisions that affect their lives and not be subject to the will of another. Therefore, we will work to increase public participation at every level of government and to ensure that our public representatives are fully accountable to the people who elect them. We will also work to create new types of political organizations which expand the process of participatory democracy by directly including citizens in the decision-making process.

2. SOCIAL JUSTICE AND EQUAL OPPORTUNITY
All persons should have the rights and opportunity to benefit equally from the resources afforded us by society and the environment. We must consciously confront in ourselves, our organizations, and society at large, barriers such as racism and class oppression, sexism and homophobia, ageism and disability, which act to deny fair treatment and equal justice under the law.

3. ECOLOGICAL WISDOM
Human societies must operate with the understanding that we are part of nature, not separate from nature. We must maintain an ecological balance and live within the ecological and resource limits of our communities and our planet. We support a sustainable society which utilizes resources in such a way that future generations will benefit and not suffer from the practices of our generation. To this end we must practice agriculture which replenishes the soil; move to an energy efficient economy; and live in ways that respect the integrity of natural systems.

4. NON-VIOLENCE
It is essential that we develop effective alternatives to society’s current patterns of violence. We will work to demilitarize, and eliminate weapons of mass destruction, without being naive about the intentions of other governments. We recognize the need for self-defense and the defense of others who are in helpless situations. We promote non-violent methods to oppose practices and policies with which we disagree, and will guide our actions toward lasting personal, community and global peace.

5. DECENTRALIZATION
Centralization of wealth and power contributes to social and economic injustice, environmental destruction, and militarization. Therefore, we support a restructuring of social, political and economic institutions away from a system which is controlled by and mostly benefits the powerful few, to a democratic, less bureaucratic system. Decision-making should, as much as possible, remain at the individual and local level, while assuring that civil rights are protected for all citizens.

6. COMMUNITY-BASED ECONOMICS AND ECONOMIC JUSTICE
We recognize it is essential to create a vibrant and sustainable economic system, one that can create jobs and provide a decent standard of living for all people while maintaining a healthy ecological balance. A successful economic system will offer meaningful work with dignity, while paying a “living wage” which reflects the real value of a person’s work.

Local communities must look to economic development that assures protection of the environment and workers’ rights; broad citizen participation in planning; and enhancement of our “quality of life.” We support independently owned and operated companies which are socially responsible, as well as co-operatives and public enterprises that distribute resources and control to more people through democratic participation.

7. FEMINISM AND GENDER EQUITY
We have inherited a social system based on male domination of politics and economics. We call for the replacement of the cultural ethics of domination and control with more cooperative ways of interacting that respect differences of opinion and gender. Human values such as equity between the sexes, interpersonal responsibility, and honesty must be developed with moral conscience. We should remember that the process that determines our decisions and actions is just as important as achieving the outcome we want.

8. RESPECT FOR DIVERSITY
We believe it is important to value cultural, ethnic, racial, sexual, religious and spiritual diversity, and to promote the development of respectful relationships across these lines.

We believe that the many diverse elements of society should be reflected in our organizations and decision-making bodies, and we support the leadership of people who have been traditionally closed out of leadership roles. We acknowledge and encourage respect for other life forms than our own and the preservation of biodiversity.

9. PERSONAL AND GLOBAL RESPONSIBILITY
We encourage individuals to act to improve their personal well-being and, at the same time, to enhance ecological balance and social harmony. We seek to join with people and organizations around the world to foster peace, economic justice, and the health of the planet.

10. FUTURE FOCUS AND SUSTAINABILITY
Our actions and policies should be motivated by long-term goals. We seek to protect valuable natural resources, safely disposing of or “unmaking” all waste we create, while developing a sustainable economics that does not depend on continual expansion for survival. We must counterbalance the drive for short-term profits by assuring that economic development, new technologies, and fiscal policies are responsible to future generations who will inherit the results of our actions.

Know Your Enemy

Rage Against The Machine Rage Against The Machine Rage Against The Machine

what is Our 'World Outlook'...hmmmm?????

 

http://www.legitgov.org/

GP Platform ...then info on Morgellons

Green Party, Jill Stein & GP PLATFORM(LINKED) Info (Morgellons info below) ******************* Morgellons info below *******************

Sick and Scary and my Experience with the "Mental Health Care" is very similar to the horrors of this movie made of the "Cancer" of Greed and Corporate Profit curruption of "Treatment". USE WITH CARE or you could be taken advatage of to your disavantage or damage!!! Having "Mental Health Issue" (or problems/defficiency) and have found help of "Exception" of a Good Psycologist/Therapist (see previous posts of CBT/MBT). The "RULE" is "Mental Health Services" is dangerous and must be used with caution, analysis and Consideration. It killed Lisa, Our Sister, in 2008! Also, at a recent stay @ the Veterans Hospital (i have Morgellons, though they didn't even do a thing to help it in 12 days hospitilized!!!) Watch the video through as it is not "fluff" but is thorough, information packed and and precise of the TRUTH OF MENTAL HEALTH CARE !!! (especially with "pay for service" corporate and personal GREED) The Documentery says it all ... (but can't tell the Nightmares of Millions of persons)!

23 Aug 12 Morgellons update 7 Q.? of Cure???

 

The below makes out or shows the CDC Morgellons (Keizer=only 115 Patients and Only 40 pts. were examined & the rest only medical papers from Keizer "HeslthCare" were "reviewed!)
`~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Microfibers help virus fool the body's immune system July 31, 2012 in Medical research Enlarge Bio-macromolecule fibers formed by the electrostatic interaction between plasmid DNA and positively charged peptides. A key challenge in virus-based gene therapy is avoiding detection by the human immune system so that the virus would not be deactivated before it reaches its intended target. Now, researchers at the Institute of Bioengineering and Nanotechnology (IBN) have succeeded in circumventing the body’s own defense mechanism by combining two IBN innovations. google_protectAndRun("render_ads.js::google_render_ad", google_handleError, google_render_ad);Ads by GoogleRockland Immunochemicals - Secondary Antibodies HRP FITC IRDye Antibody Conjugates - www.rockland-inc.comDNASTAR- Cloning Software - Supports all major cloning methods. Try a fully-functional free trial! - www.dnastar.com In a recent study published in Advanced Materials, IBN researchers demonstrated that cancer cells could be more effectively eliminated when therapeutic viruses were encased in microfibers or synthetic tissue fibers. Using a novel method developed at IBN, the researchers were able to encapsulate an insect virus with fibers produced from peptides and DNA for gene delivery. As the structure of the microfibers closely resembles human tissue fibers, they were able to ‘disguise’ the virus by reducing the body’s ability to recognize the virus and prevent its premature deactivation. Tests conducted on mice with brain tumor show that the microfiber-coated viruses could significantly slow down tumor growth and prolong survival, in comparison to treatment with uncoated viruses. Gene therapy is a technique for correcting defective genes responsible for disease development. It involves using DNA encoded with a functional gene to replace a mutated gene, and viruses that are stripped of its disease-causing ability are used as a tool to deliver the therapeutic gene into the target cells. IBN has been investigating the use of engineered insect virus to treat cancer and neurological disorders since 2003, and the first successful gene delivery to human embryonic stem cells using a baculoviral vector was achieved at IBN in 2006. That same year, IBN researchers published a paper in Cancer Research demonstrating the delivery of therapeutic genes by baculoviral vectors for cancer treatment in an animal tumor model. In trying to prevent the body from disabling the virus before it reaches the diseased cells, the research team led by IBN Group Leader Dr. Shu Wang turned to a unique microfiber fabrication technique developed by Dr. Andrew C. A. Wan at IBN. In the human body, tissue fibers are naturally formed by the assembly of two different types of macromolecules, such as proteins and DNA. Currently, synthetic tissue fibers are fabricated with only one type of biomolecular material because fibers composed of more than one type of biomolecule are difficult to produce. Using a water-based chemical process, IBN scientists were able to construct tissue fibers from two biomolecular materials – peptides and DNA. The researchers flanked two droplets of the oppositely charged peptide and DNA molecules after it has been dissolved in water. Upon contact, the droplets zipped together to form a two-component fiber. Fiber formation presumably occurs from the electrostatic interaction between the positively charged peptide molecule and the negatively charged DNA molecule. Through the same procedure, baculoviral vectors were added to the DNA solution to coat the virus with the fibers. Dr. Shu Wang shared, “For the very first time, we have shown that two biomolecules, namely peptides and DNA, can interact with each other to form structured fibers in a test tube. Since these biomolecules are readily metabolized in the human body to naturally occurring molecules and have no adverse toxicity, they hold strong biomedical potential for the delivery of therapeutic drugs, genes, proteins and viruses to combat cancer.” “This innovative application of microfibers with viral vectors is an exciting development for gene therapy that was made possible through multidisciplinary collaboration between biologists, chemists and materials scientists at IBN. Our fibrous materials are also of great interest as biocompatible tissue engineering scaffolds for applications in regenerative medicine,” said Professor Jackie Y. Ying, IBN Executive Director. More information: 1. J. Yang, et al. “Microfibers Fabricated by Non-Covalent Assembly of Peptide and DNA for Viral Vector Encapsulation and Cancer Therapy,” Advanced Materials, (2012) DOI: 10.1002/adma.201201145. 2. J. Zeng, J. Du, N. Palanisamy and S. Wang, “Baculoviral Vector-Mediated Transient and Stable Transgene Expression in Human Embryonic Stem Cells,” Stem Cells, 25 (2007) 1055-1061. 3. C. Y. Wang, et al., “Recombinant Baculovirus Containing the Diphtheria Toxin A Gene for Malignant Glioma Therapy,” Cancer Research, 66 (2006) 5798-5806. 4. A. C. A. Wan, et al., “Silica-Incorporated Polyelectrolyte-Complex Fibers as Tissue Engineering Scaffolds,” Advanced Materials, 18 (2006) 641-644.

Read more at: http://medicalxpress.com/news/2012-07-microfibers-virus-body-immune.html#jCp

New Reseach on Morgellons(NOT fake CDC one!)

Morgellons Disease: A Chemical and Light Microscopic Study
Marianne J. Middelveen1, Elizabeth H. Rasmussen2, Douglas G. Kahn3 and Raphael B. Stricker1*
1International Lyme and Associated Diseases Society, Bethesda, MD
2College of Health Sciences, University of Wyoming, Laramie, WY
3Department of Pathology, Olive View - UCLA Medical Center, Sylmar, California
*Corresponding author: Raphael B. Stricker, MD 450 Sutter Street, Suite 1504 San Francisco, CA 94108, USA Tel: (415)399-1035 Fax: (415) 399-1057 E-mail: rstricker@usmamed.com
Received January 27, 2012; Accepted March 12, 2012; Published March 16, 2012
Citation: Middelveen MJ, Rasmussen EH, Kahn DG, Stricker RB (2012) Morgellons Disease: A Chemical and Light Microscopic Study. J Clin Exp Dermatol Res 3:140. doi:10.4172/2155-9554.1000140
Copyright: © 2012 Middelveen MJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Morgellons disease is an emerging multisystem illness characterized by unexplained dermopathy and unusual skinassociated filament production. Despite evidence demonstrating that an infectious process is involved and that lesions are not self-inflicted, many medical practitioners continue to claim that this illness is delusional. We present relevant clinical observations combined with chemical and light microscopic studies of material collected from three patients with Morgellons disease. Our study demonstrates that Morgellons disease is not delusional and that skin lesions with unusual fibers are not self-inflicted or psychogenic. We provide chemical, light microscopic and immunohistological evidence that filaments associated with this condition originate from human epithelial cells, supporting the hypothesis that the fibers are composed of keratin and are products of keratinocytes.
Keywords
Morgellons disease; Digital dermatitis; Lyme disease; Borrelia burgdorferi; Spirochetes; Keratin
Introduction
Morgellons disease (MD) is an emerging dermatological disorder and multisystem illness. The disease is characterized by unexplained dermopathy associated with formation of unusual filaments found both subcutaneously and emerging from spontaneously appearing, slow-healing skin lesions [1]. Filaments associated with MD appear beneath unbroken skin [1,2], thus demonstrating that they are not self-implanted. Filaments have been observed protruding from and attached to a matrix of epithelial cells [3]. This finding demonstrates that the filaments are of human cellular origin and are not textile fibers. These filaments have not been matched with known textile fibers, and dye-extracting solvents have failed to release coloration; the fibers are also very strong and heat resistant [4,5]. MD filaments are physically and chemically consistent with keratin, a biofiber produced in the epithelium by keratinocytes. A recent report from the Centers for Disease Control and Prevention (CDC) confirmed that these filaments have a protein composition that is consistent with keratin [6].
Lyme disease-like symptoms in MD such as neurological disorders and joint pain are evidence of systemic involvement [1,2,7] . Objective clinical evidence of disease has been demonstrated by its association with peripheral neuropathy, delayed capillary refill, decreased body temperature, tachycardia, elevated pro-inflammatory markers, cytokine release, selective immune deficiency and elevated insulin levels, suggesting that an infectious process is involved [8,9]. Patients may demonstrate abnormal laboratory findings indicative of low-grade anemia, endocrine dysfunction, immune dysfunction and inflammation [8,10]. Patients with MD are predominantly seroreactive to Borrelia burgdorferi (Bb) antigens, suggesting a likelihood of Lyme borreliosis or related spirochetal infection [1,10]. Patients also demonstrate a higher than expected percentage of positive laboratory findings for other tick-borne diseases, suggesting the possible involvement of coinfecting pathogens [10].
The observation of unusual filaments forming in lesions is not unique to humans afflicted with MD. Similarities between MD and bovine digital dermatitis (BDD) have been described [3]. BDD is an emerging disease afflicting cattle and is characteristically associated with unusual filament formation in skin above the hooves [11]. Latestage proliferative lesions demonstrate elongation of keratinocytes, hyperkeratosis, and proliferation of long keratin filaments [12-14]. Consistent detection of spirochetes associated with lesions is evidence of spirochetal etiologic involvement [15-20]. Experimental induction of lesions with tissue homogenates [21] and pure cultured treponemes [22] supports a role for spirochetes as primary etiologic agents.
Like BDD, MD is associated with apparent spirochetal infection and unusual filament production [3]. A comparison between BDD and MD suggests that the unusual fibers seen in MD patients may result from hyperkeratosis and filament production as described in BDD. It appears that MD fibers are likewise composed of keratin produced by keratinocytes, a phenomenon that has been demonstrated in BDD [3]. The following three case studies provide further evidence supporting this hypothesis.
Materials and Methods
Human and bovine samples
Three patients meeting the clinical criteria for Morgellons disease collected calluses, scabs, filaments, and other dermatological debris and submitted the material for microscopic examination. The collected samples were examined by bright-field microscopy at 100x magnification. Specimens were illuminated either superior or posterior to the specimen. Some specimens were also illuminated with ultraviolet (UV) light.
Biopsies from cattle with BDD were kindly provided by Dr. Dorte Dopfer, Faculty of Veterinary Medicine, University of Wisconsin, Madison, WI. Biopsy material from proliferative late stage BDD was examined for comparison to MD samples with 8x magnification under a dissecting microscope. This material was also tested for fluorescence under UV light.
For the chemical experiments, samples of normal hair, filaments from Cases 1 and 2 and BDD fibers were studied for reactivity to three caustic agents: sodium hypochlorite 12%, sodium hydroxide 10%, and potassium hydroxide 10%. Each sample was suspended in 150 μl of the chemical solution for up to two hours, and serial light microscopy was performed at 0, 1, 10, 30, 60 and 120 minutes. Dissolution of fibers was assessed by fraying, loss of shape and/or disintegration at each timepoint.
For the immunohistological experiments, filament samples from Cases 1 and 2 were stained for keratin using monoclonal antibodies. Briefly, formalin-fixed paraffin-embedded filaments were incubated with monoclonal antibodies AE1/AE3 (Dako North America Inc, Carpinteria, CA) and AE5/AE6 (Cell Marque Corporation, Rocklin, CA) directed against cytokeratins 1/3 and 5/6, respectively, using the Envision® + Dual-Link System-HRP (Dako) according to the manufacturer’s instructions. The samples were stained using a horseradish peroxidase label, and the brown staining of keratin was visualized under light microscopy.
Clinical Observations
Case 1
The patient is a 72-year-old grandmother and former fashion model who developed painful lesions on her hands while working in her garden in San Antonio, Texas, in 1994. The lesions were punctate with ragged edges and healed slowly, leaving visible scarring. Fibers were observed in the lesions and under intact skin on her hands using a 60x handheld microscope. Topical steroids had no effect. The patient also noted the onset of fatigue, joint pain and muscle aches, and systemic steroid treatment exacerbated these symptoms without any improvement in the skin lesions. Medical evaluation was negative for autoimmune or infectious diseases, and neuropsychiatric evaluation was entirely normal. Biopsy of a lesion demonstrated hyperkeratosis and parakeratosis with no visible organisms or evidence of vasculitis. However “textile fibers” were noted in the dermal layer of the biopsy specimen.
In 2001, after numerous visits to dermatologists and other medical specialists and treatment with topical emollients and antiinflammatory medications, the patient had persistent skin lesions on her hands, fatigue and musculoskeletal pain. Despite the use of gloves to avoid scratching, her lesions persisted and she was unable to work in her garden or hold her grandchildren due to pain in her hands and joints. She recalled numerous tickbites but never saw an erythema migrans (EM) rash, and she was found to have positive testing for B. burgdorferi, Babesia microti and Bartonella henselae. She was treated with antimicrobial medications and her fatigue and musculoskeletal pain improved significantly. However her skin lesions persisted. She received anti-parasitic medication, and the lesions improved to the point that she could once again do gardening. The lesions persist but are “manageable” (Figure 1A).
Figure 1A: Lesions on hands of Case 1 following extensive antimicrobial treatment. Note erythematous base with ragged edges.
Case 2
The patient is a 49-year-old registered nurse who had numerous tickbites while hiking, camping and horseback riding in Missouri, Texas and Northern California over more than a decade. She never saw an EM rash. In 1997 while living in San Francisco she developed painful lesions on her face, trunk and extremities. The lesions were punctate with ragged edges. Some lesions healed slowly, leaving visible scarring, while others did not heal at all, and fibers that were resistant to extraction were observed within several lesions. Fibers were also observed under intact skin using a 60x handheld microscope. Topical steroids had no effect. Biopsy of a lesion on her leg revealed hyperkeratosis and parakeratosis without evidence of infection or vasculitis. However, “textile fibers” were noted in the dermal layer of the biopsy specimen. She also developed fatigue and musculoskeletal pain, and systemic steroid treatment exacerbated these symptoms without any improvement in the skin lesions. Medical evaluation was negative for autoimmune or infectious diseases, and neuropsychiatric evaluation was completely normal.
Because of persistent fatigue, musculoskeletal pain and her history of tick exposure, the patient was evaluated for Lyme disease in 2004 and had positive testing for B. burgdorferi and Ehrlichia chafeensis. Antibiotic therapy led to improvement in the fatigue and musculoskeletal pain, but the skin lesions persisted. She received antiparasitic medication and her skin lesions improved somewhat, but new lesions appeared and healing lesions caused painful scarring. She has received intermittent courses of antibiotics over the past six years, and her skin lesions continue to wax and wane (Figure 1B).
Figure 1B: Lesions on back of Case 2. Note punctate appearance of open lesions and scarred appearance after healing. Lesions occur in locations that could not be easily reached by the patient.
Case 3
The patient is a 47-year-old business manager who was in excellent health until he developed a “bullseye” rash, fever, chills, severe headache, musculoskeletal pain and malaise after hiking in the woods near Atlanta, Georgia, in 1995. He had pulled ticks off his dog, which also became ill at the same time. He was diagnosed with fibromyalgia and treated with pain medications, but by 2000 he had become progressively disabled by muscle pain and fatigue. In 2002 he developed crawling sensations on his head, face, groin and other body areas where there was hair. The sensations were accompanied by painful skin lesions. He was diagnosed with folliculitis and put on a topical antibiotic, which made his skin symptoms worse. He began to notice painful fibers coming out of the skin on his face, head and other hirsute areas, and he could not sleep because the fibers were so painful. He extracted fibers from his facial lesions, but new ones appeared. He was diagnosed with trichotillomania and delusional parasitosis.
He went to several dermatologists and was treated with topical lindane and oral cephalexin without benefit. Treatment with oral ketoconazole and fluconazole provided marginal improvement in the crawling sensations and skin lesions. A scalp biopsy demonstrated increased numbers of catagen and telogen follicles with fragmented hair fibers and inner root sheath consistent with trichotillomania. There were no visible organisms or evidence of vasculitis. Medical evaluation was negative for autoimmune or infectious diseases, and neuropsychiatric evaluation revealed reactive depression. He was treated with antidepressants without benefit. Finally in 2005 a physician noted fibers under his skin using a 60x hand-held microscope. Testing for Lyme disease was indeterminate in 2006, and treatment with doxycycline was given for one month without benefit. The patient continues to suffer from crawling sensations, skin lesions, musculoskeletal pain, disabling fatigue and depression. He is reluctant to see any more physicians about his skin condition (Figure 1C).
Figure 1C: Head of Case 3 photographed at disease onset in 2002 (top) and during disease flare in 2011 (bottom). Note punctate lesions with ragged edges in bottom picture. Patient shaved his head in effort to decrease pain from scalp lesions.
Results
MD Microscopic observations
Case 1: Microscopic examination revealed a wide range of filaments in various stages of formation ranging from early stages that demonstrated either single or clusters of hyaline, tentacle-like projections with tapered ends (tentacle diameter approximately 5 μm) to macroscopic masses or mats of tangled fibers (approximately 1 mm diameter) (Figures 2A-2H). Floral-like formations of early-stage filaments were observed in some samples that were collected on different dates and years (Figure 2A). These structures had tapered ends with bases originating at a central point and were found in groups anchored to a dried dermal matrix. The reverse side of some of these specimens revealed a layer of pavement epithelial cells (Figure 2B). Epithelial matrices anchoring longer hyaline fibers were observed, suggesting that as the tentacle-like projections increase in length individual fibers may become tangled, or clumped (Figure 2C). Various structures composed of clumps, strings, and nest-like balls of hyaline filaments were observed and some of these were glued together by clotted or dried exudate (Figure 2D). This suggests that tangled filaments may eventually separate from the supporting epithelial matrix and form balls and other tangled structures.
Figure 2A: Fibers from Case 1. Note floral appearance of fibers (100x magnification).
Figure 2B: Pavement epithelium on underside of floral fibers shown in Case 2A (100x magnification).
Figure 2C: Hyaline fibers forming macroscopic masses in finger webbing from Case 1 (50x magnification).
Figure 2D: Clumps of hyaline filaments surrounding clotted or dried exudate from Case 1 (100x magnification).
Some samples revealed raised unidentified papules protruding from dried epithelial tissue that might be abnormal hair follicles. Long isolated colored filaments, filament fragments, balls, and clumps of fibers (red, blue, black and green) were also observed, but were not attached to or growing from epithelial tissue. Many of these colored filaments had bulb-like ends (50 μm diameter) that looked very much like those found in hair follicles (Figure 2E).
Figure 2E: Blue filament with bulb-like ends (50 μm diameter) similar to a hair follicle from Case 1 (100x magnification).
Many fibers displayed iridescence under bright-field microscopy and were fluorescent under UV lighting. Hyaline or white fibers fluoresced brightly, as did blue fibers (Figure 2F). Red and green fibers displayed striking iridescence (Figure 2G, Figure 2H) but fluoresced with less intensity than the blue and white fibers. This suggests that melanin pigments may be associated with red and green filaments. Early floral-shaped clusters were brightly fluorescent. Human hair was not fluorescent nor was normal skin. Color intensity and hue of the red and blue filaments was influenced by the color spectrum of the illuminating light. This property and the presence of iridescence suggests that a structural component is involved in the unusual colors seen in Morgellons fibers.
Figure 2F: Bluish fluorescence of fibers under UV lighting from Case 1 (100x magnification).
Figure 2G: Iridescence of a green fiber from Case 1 (100x magnification).
Figure 2H: Striking iridescence of a red fiber from Case 1 (100x magnification).
Case 2: Microscopic examination of scab material revealed scab detritus imbedded with long filaments of various colors (Figures 3A- 3D). Hyaline, red, blue, and light purple fibers were observed (10-40 μm diameter) (Figure 3A, Figure 3B). One sample revealed fibers tangled around a hair and these fibers may have been associated with the hair follicle (Figure 3C). Smaller, pale purple fibers (10 μm diameter) appeared to form a mesh around the follicle. Some samples revealed fibers that lay beneath or penetrated dermal tissue Figure 3D.
Figure 3A: Red and blue fibers in skin samples from Case 2 (100x magnification).
Figure 3B: Red and blue fibers embedded in skin from Case 2 (100x magnification).
Figure 3C: Fibers tangled around a hair (larger black shaft to right of figure) in Case 2 (100x magnification).
Figure 3D: Fibers penetrating dermal tissue from Case 2 (100x magnification).
Case 3: Microscopic examination was performed with particular attention to hair follicles, as the patient had reported unusual filament formation associated with the follicles. Microscopy revealed abnormalities of the follicular bulbs and the hair associated with these follicles that indicated abnormal functioning of follicular keratinocytes (Figures 4A-4D). Many follicles contained malformed bulbs with distorted shapes, and some follicles had two or more hairs branching from a single inner root sheath (Figure 4A). Filaments stemming from the bulb end were found in some follicles and these appeared as rootlike growths (Figure 4B). Transparent filaments were observed that stemmed from cells within the inner root sheath (Figure 4C). On some hairs red or blue colored filaments branched from the shaft (Figure 4D). Many hairs were flattened or tape-like on cross-section rather than concentric. These hairs were similar in appearance to Morgellons filaments.
Figure 4A: Hair follicle from Case 3 showing two hairs branching from a single inner root sheath (100x magnification).
Figure 4B: Hair follicle from Case 3 showing filaments stemming from bulb end (100x magnification).
Figure 4C: Hair follicle from Case 3 showing transparent filaments stemming from the inner root sheath (100x magnification).
Figure 4D: Hair follicle from Case 3 showing blue fiber (top) and red fiber (bottom) branching from the hair shaft (top, 100x magnification; bottom, 200x magnification).
BDD Microscopic observations
Biopsies from late proliferative stage BDD lesions were examined microscopically for comparison (Figures 5A-5D). Although the scale of filaments was much larger, the BDD filaments (roughly ten times larger) were similar in appearance compared to the specimens observed in Case 1 (Figure 5A, Figure 5B). Filaments were macroscopic, opaque and dirty white in color, ranging in size from less than 0.5 mm in diameter to about 1 mm in diameter. In cross section filaments appeared to originate beneath the stratum corneum (Figure 5C). Longer filaments were close to 1 mm in length. The BDD filaments demonstrated fluorescence under UV light (Figure 5D).
Figure 5A: Bovine digital dermatitis (BDD) sample showing coarse fibers (8x magnification).
Figure 5B: BDD sample showing floral fibers (8x magnification). Note similarity to MD floral fibers from Case 1 (Figure 2A).
Figure 5C: Cross section of BDD sample showing coarse fibers that originate beneath the stratum corneum (8x magnification).
Figure 5D: BDD sample showing coarse fibers with fluorescence under UV lighting (8x magnification).
Chemical Experiments
Samples of normal hair, colored filaments and dermal material from Cases 1 and 2, and BDD fibers were subjected to immersion in caustic agents. Duplicate experiments with each caustic agent were performed on each sample. Results of the experiments are shown in (Table 1) Normal hair and patient filaments began to fray after incubation for 1 minute, and the patient filaments had completely disintegrated after incubation for 120 minutes in 12% sodium hypochlorite. Normal hair was still visible at this timepoint. In contrast, patient filaments began to fray at 1 minute in 10% sodium hydroxide but were still visible after 120 minutes, similar to normal hair. The hair and patient filaments were more resistant to 10% potassium hydroxide, with visible fraying beginning at 10 minutes and fibers still visible at 120 minutes. Although the larger BDD fibers appeared to be more resistant to the chemicals, fraying and shape change similar to the human samples was evident at 120 minutes with each caustic agent.
Table 1: Dissolution of Morgellons filaments and BDD fibers in caustic reagents.
Keratin immunostaining
The results of keratin immunostaining experiments are shown in Figure 6. The MD filaments from Case 1 stained strongly with the “pankeratin” antibody AE1/AE3 directed against cytokeratin 1/3. In contrast, the filaments stained weakly with the more restrictive antibody AE5/AE6 directed against cytokeratin 5/6. Staining with AE1/ AE3 was seen over the length of the fiber, while staining with AE5/ AE6 was only detected in the outermost scale. Melanin pigmentation was not seen in the fibers. No staining was detected with an irrelevant monoclonal antibody, and similar positive keratin staining with AE1/ AE3 was detected in MD fibers from Case 2 (data not shown).
Figure 6: Keratin immunostaining of fiber from Case 1. Immunostaining was performed as described in Methods section. Top: Staining with anti-CK AE1/ AE3. Bottom: Staining with anti-CK AE5/AE6 (200x magnification).
Discussion
Our three patients had features of MD that are commonly described in the medical literature, including insidious onset, dermatological signs and systemic symptoms, lack of response to immunosuppressive treatment and association with tickborne diseases [1-3]. Case 1 had skin lesions confined to the hands (Figure 1A), while Cases 2 and 3 had disseminated skin lesions over the head, trunk and extremities (Figures 1B and 1C). In addition, Case 3 had symptoms associated primarily with hair follicles, and a sensation of change in hair composition and texture is often reported by Morgellons patients [1,10]. These MD patterns have been recognized in prior studies [1,2] and we propose a classification of localized MD versus disseminated MD based on the distribution of the dermopathy. Although the reason for this dermopathy distribution is unknown, the location of skin lesions may be related to the cell of origin of the fibers seen in lesions or under the skin, as discussed below. Further study of the dermopathy distribution in MD is warranted.
The present study demonstrates Morgellons filaments that clearly originate from a layer of pavement epithelial cells visibly held together by desmosomes (Figure 2). The predominant cells found in pavement epithelial tissue are keratinocytes. We also noted MD fibers that clearly originate from the inner root sheaths of hair follicles (Figures 2-4), and keratinocytes are the predominant cell type in this tissue. Keratinocytes produce the biofiber keratin. A cross section of BDD filaments likewise demonstrates filament origin from cells beneath the stratum corneum (Figure 5), consistent with descriptions in the literature of growth from keratinocytes [14,19]. Thus MD filaments and BDD filaments appear to be similar in formation at the cellular level, both originating from keratinocytes in the stratum spinosum or stratum basale. MD differs from BDD, however, in that MD filaments appear to originate from follicular keratinocytes as well as epidermal keratinocytes. Both MD filaments and BDD filaments fluoresce in UV light (Figures 2-5). We have also shown for the first time that MD filaments contain keratin (Figure 6), and keratin staining was positive using a “pankeratin” monoclonal antibody but negative with a more restricted keratin ligand. This observation indicates that the fibers originate from specific tissues that require further characterization.
The observation that MD fibers are found beneath unbroken skin, may grow from an epidermal matrix and are associated with hair follicles suggests that they are not self-implanted textile fibers [1-3]. The filament formation described in MD is associated with a high likelihood of Bb infection [1,10]. BDD in cattle is associated with hyperkeratosis, keratin filament formation and spirochetal infection [12-20]. Hyperkeratosis and excessive keratin production associated with chronic inflammation has been demonstrated in humans with cholesteatoma [23,24],and alterations in keratinocyte expression of HLA markers and tissue enzymes have been reported in association with Bb infection [25,26]. These observations suggest that hyperkeratosis and keratin filament production associated with spirochetal infection is a plausible explanation for the clinical and microscopic findings in MD.
Hyaline and colored filaments from the three case studies demonstrate iridescence and an appearance consistent with keratin. Red, blue, purple and black are colors found in keratin and are associated with structural coloring and/or melanin production [27-30]. Clusters of early filaments described in Case 1 demonstrate that fibers are anchored and growing from a basal epithelial cell matrix. They are clearly biological and human in nature and are not implanted textile fibers. Various growth stages of fibers attached to epidermal matrices have been observed. These range from early filaments isolated or in clusters (that are only a few μm in diameter and 10 μm long) to long tangled mats (with fibers 10 μm or wider in diameter and several hundred μm long). Similar filament structures have previously been reported and photographed in MD [31]. Textile fibers have never been produced in this manner, and the suggestion that these unusual formations are manufactured textile fibers is not credible.
Longer fibers with tapered ends anchored to a cellular matrix were observed in Case 1, demonstrating filament evolution. Colored fibers were often found near larger hair follicles or appeared to have follicular bulb-like ends, suggesting an association with hair follicles and follicular keratinocytes. Our chemical studies suggest that MD filaments and BDD fibers react to caustic agents in a manner similar to normal hair, although MD filaments appeared to be more susceptible and BDD fibers less susceptible to the caustic agents Table 1. In preliminary studies using scanning electron microscopy, the presence of scales on a blue filament indicated that this specimen was a fine hair (D’Alba L and Shawkey MD, unpublished observation, December 2011). This finding suggests that some of the colored fibers of follicular origin may in fact be modified hairs. Differences between the keratinocytes found in the inner root sheath of hair follicles and keratinocytes found in the basal skin layer may account for the differences of location, structure, coloring and size of fibers seen in this study [32,33]. The effect of spirochetes on keratinocyte function may also play a role in altered keratin production associated with MD and BDD [22,25,26].
In conclusion, MD lesions were not caused by self-mutilation or delusions in the three cases presented here. The photographic evidence clearly demonstrates that the unusual fibers or filaments described in this study are not self-implanted textile fibers. All three patients had symptoms and laboratory findings consistent with systemic illness and indicative of tickborne disease. Neuropsychiatric testing was normal in two cases and influenced by the disease in the third case, and all three patients were examined by a medical practitioner who confirmed the presence of fibers underneath unbroken skin compatible with a diagnosis of MD.
We have demonstrated that filaments found in MD patients have chemical, physical and immunohistological features of keratin. The presence of individual filaments attached to epithelial tissue is consistent with keratin and suggests that the filaments are produced by keratinocytes. Morgellons filaments have been photographed growing from pavement epithelial cells, and this process resembles the evolution of filaments seen in BDD. Because BDD is a disease in which spirochetes have been identified as primary etiologic agents, and spirochetal sero-reactivity has been associated with MD, it is reasonable to assume that spirochetal infection plays an important role in MD filament production. Further immunohistological and electron microscopy studies are needed to solve the mystery of Morgellons filaments.
Conflict of Interest Statement
RBS serves without compensation on the medical advisory panel for QMedRx Inc. He has no financial ties to the company. MJM, EHR and RBS serve without compensation on the scientific advisory panel of the Charles E. Holman Foundation. DGK has no conflicts to declare.
Acknowledgements
The authors thank Drs. Gordon Atkins, Robert Bransfield, Dorte Dopfer, Alan MacDonald, Peter Mayne, Deryck Read, Matthew Shawkey, Janet Sperling, Ginger Savely, Michael Sweeney and Randy Wymore for helpful discussion. We thank Dr. Robert B. Allan for technical support and Lorraine Johnson for manuscript review, and we are grateful to Harriet Bishop, Cindy Casey and Lee Laskowsky for providing first-hand information about Morgellons disease.
References
	Savely VR, Leitao MM, Stricker RB (2006) The mystery of Morgellons disease: infection or delusion? Am J Clin Dermatol 7: 1-5. Savely VR, Leitao MM (2005) Skin lesions and crawling sensations: disease or delusion? Adv Nurse Pract 13: 16-17. Middelveen MJ, Stricker RB (2011) Filament formation associated with spirochetal infection: A comparative approach to Morgellons disease. Clin Cosmet Investig Dermatol 4: 167-177. Elkan D. Morgellons (2007) disease the itch that won't be scratched. New Scientist 2621: 46-49. Wymore RS (2011) Morgellons disease research; shotgun DNA analysis, PCR, microscopy and spectroscopy. Morgellons Medical Conference, Austin, Texas. Pearson ML, Selby JV, Katz KA, Cantrell V, Braden CR, et al. (2012) Clinical, epidemiologic, histopathologic and molecular features of an unexplained dermopathy. PLoS ONE 7: e29908. Savely VR, Stricker RB (2007) Morgellons disease: the mystery unfolds. Expert Rev Dermatol 2: 585-591. Harvey WT (2007) Morgellons disease. J Am Acad Dermatol 56: 705-706. Harvey WT, Bransfield RC, Mercer DE, Wright AJ, Ricchi RM, et al. Morgellons disease, illuminating an undefined illness: a case series. J Med Case Reports 3: 8243. Savely VR, Stricker RB (2009) Morgellons disease: analysis of a population with clinically confirmed microscopic subcutaneous fibers of unknown etiology. Clin Cosmet Investig Dermatol 3: 67-78. Cheli R, Mortellaro CM (1974) Digital dermatitis in cattle. Proc 8th Int Meet Dis Cattle, Milan, Italy 8: 208-213. Vink WD, Jones G, Johnson WO, Brown J, Demirkan I, et al. ( 2009) Diagnostic assessment without cut-offs: application of serology for the modeling of bovine digital dermatitis infection. Prev Vet Med 92: 235-248. Dopfer D, Willemann MA(1998) Standardisation of infectious claw diseases. Proceedings of the 10th International Symposium on Lameness in Ruminants; Lucerne, Switzerland 244-254. Borgmann JE, Bailey J, Clark EG (1996) Spirochete-associated bovine digital dermatitis. Can Vet J 37: 35-37. Blowey RW, Sharp MW (1988) Digital dermatitis in dairy cattle. Vet Rec 122: 505-508. Read DH, Walker RL, Castro AE, Sundberg JP, Thurmond MC (1992) An invasive spirochaete associated with interdigital papillomatosis of dairy cattle. Vet Rec 130: 59-60. Scavia G, Sironi G, Mortellaro CM, Romusi S (1994) Digital dermatitis: further contribution on clinical and pathological aspects in some herds in northern Italy. Proc Int Symp Dis Ruminant Digit 8: 174-176. Grund S, Nattermann H, Horsch F (1995) Electron microscopic detection of spirochetes in dermatitis digitalis of cattle. Zentralbl Veterinarmed B 42: 533-542. Döpfer D, Koopmans A, Meijer FA, Szakáll I, Schukken YH et al. ( 1997) Histological and bacteriological evaluation of digital dermatitis in cattle, with special reference to spirochaetes and Campylobacter faecalis. Vet Rec 140: 620-623. Demirkan I, Carter SD, Murray RD, Blowey RW, Woodward MJ(1998) The frequent detection of a treponeme in bovine digital dermatitis by immunochemistry and polymerase chain reaction. Vet Microbiol 60: 285-292. Read DH, Walker RL(1998) Papillomatous digital dermatitis (footwarts) in California dairy cattle: clinical and gross pathologic findings. J Vet Diagn Invest 10: 67-76. Gomez A, Cook N, Dopfer D, Bernardoni N, Dusick A, et al. (2011) An experimental infection model for digital dermatitis. Lameness in Ruminants Conference, New Zealand. Hamajima Y, Komori M, Preciado DA, Choo DI, Morobe K et al. (2010) The role of inhibitor of DNA-binding (ID1) in hyperproliferation of keratinocytes: the pathological basis for middle ear cholesteatoma from chronic otitis media. Cell Prolif 43: 457-463. Raynov AM, Choung YH, Park HY, Choi SJ, Park K (2004) Establishment and characterization of an in vitro model for cholesteatoma. Clin Exp Otorhinolaryngol 1: 86-91. Tjernlund U, Scheynius A, Asbrink E, Hovmark A (1986) Expression of HLA-DQ antigens on keratinocytes in Borrelia spirochete-induced skin lesions. Scand J Immunol 23: 383-388. Gebbia JA, Coleman JL, Benach JL (2001) Borrelia spirochetes upregulate release and activation of matrix metalloproteinase gelatinase B (MMP-9) and collagenase 1 (MMP-1) in human cells. Infect Immun 69: 456-462. Shawkey MD, Hill GE (2005) Caratenoids need structural colors to shine. Biol Lett 1: 121-124. Shawkey MD, Shreekumar RP, Hill GE, Siefferman LM, Roberts SR (2007) Bacteria as an agent for change in structural plumage color: correlational and experimental evidence. Am Nat 169: S112-S121. D'Alba L, Saranathan V, Clarke JA, Vinther JA, Prum RO, et al. (2011) Colour-producing ß-keratin nanofibres in blue penguin (Eudyptula minor) feathers. Biol Lett 7: 543-546. Chung WJ, Oh JW, Kwak K, Lee BY, Meyer J, et al. (2011) Biomimetic self-templating supramolecular structures. Nature 478: 364-368. Charles E. Holman Foundation (2012) Accessed February 16. Rugg EL, Leigh IM (2004) The keratins and their disorders. Am J Med Genet C Semin Med Genet 131C: 4-11. Moll R, Divo M, Langbein L (2008) The human keratins: biology and pathology. Histochem Cell Biol 129: 705-733.