Posted by Librarian on 10/2/2005, 9:55 am, in reply to "Re: Publications Frye #2-Part A"
Board Administrator

Results: The variety of "organisms" that were identified microscopically included: two intact collembolans ("springtails"), one partial set of collembolan abdominal tergites with an intact spring-like furcula still attached, one lepidopteran larva ("caterpillar"), several ants, a tiny icheumon wasp, numerous assorted coleopteran beetles (including flour beetles) and beetle body parts, several winged dipteran flies and midges, empty flea egg cases, one neuropteran "ant-lion" (which the patient swears she extracted from a sore on her face), one psocid "book louse," numerous urticarial setae from dermestid carpet beetles, two spiders and several mites. (figure 1) Several stained recut sections of full-thickness skin biopsies were obtained from consulting dermatologists. Although each of these dermatologists and the pathologists who had examined these biopsies originally did not identify parasitic organisms, I found mites embedded deeply within the epidermis of four of them: the balance were negative. These mites were diagnoses as Demodex follicularis var. hominis. Skin scrapings from one elderly female patient yielded several mites that were identified as Sarcoptes scabei var hominis. This patient is also the person who submitted the greatest variety of insects and arachnids that she claimed were taken from her head and body. With the thought that perhaps these mites were really bird's nest parasites or wildlife mites that could have caused an infestation, I travelled to her locale and spent an entire day examining her home and garden. I even examined an active nest that was occupied by a very angry bluejay and her nestings, but after vacuuming the mother bird, her nestlings, and their shared nest, I was not able to identify any mites or other ectoparasites from this or any other site. It is interesting and instructie to note that in only one case was the mate or partner of an "infested" patient similarly affected. In that one notable case, I flew from California to an eastern state to examine the patients and their home to try to determine whether there was an organic aetiology for their (perceived) dermatological condition. Their home, automobiles and clothing were examined carefully; samples from these sites were gathered for subsequent processing and microscopic investigation. Skin scrapings and full-thickness skin biopsies were obtained with the co-operation of a sympathetic dermatologist. Nothing was found in the wife's skin scrapings. However, two intraepidermal mites that are consistent with Demodex follicularis var. hominis were identified in stained serial skin microsections of her husband's full-thickness skin biopsies. Whether these mites, which are commonly found in the nasolabial folds in the majority of human adults, were the aetiologic agents in this patient is conjectural; however, it might be significant that these mites were also found in skin sections that were obtained from this patient's arm and shoulder. Certainly, the mere finding of these mites served to validate the belief of this affected patient and his loved ones. An uncounted, but large number of "fibre-bugs" were a consistent finding in the specimens submitted by every patient. Upon microscopic examination and comparison with known exemplars, they were identified positively as lint balls composed of matted cotton, wool, and artificial fibres. Discussion: The early findings of clearly established parasitic mites in at least some of the patients that were referred to me by the NPA served to spur the investigation and to validate the beliefs of many who were closely following the progress of my efforts by "networking," with each other via telephone, facsimile, post and e-mail. Thus, shortly after one patient had learned the identity of her "bugs," those results were disseminated widely among others in the "network." In analyzing over a year's efforts to elucidate the cause of this puzzling spate of human suffering, it is not sufficiently clear to me that the collembolans that were initially blamed as the prime suspects were unfairly maligned. Certainly, they (like so many other arthropods) possess hair-like setae which, when they come into contact with sensitive mammalian skin, can cause irritation, and even florid urticaria. However, much valuable time and materials were expended in searching for something that may not exist, except in the imagination of those who perceived that they were infested. It has been an interesting experience that has been highly instructive. In mid-1996, I was invited by the NPA and Harvard University's School of Tropical Medicine and Public Health to present a paper describing my findings. I entitled the lecture "Evaluation of patients presenting with suspected pediculosis, scabies, or delusional parasitosis." In that lecture, I exhibited photo-micrographs of some of the organisms and inanimate objects that I had identified from the patients who were referred to me by the NPA. The final slide that I displayed was the quote by Dr. Daniel E. Koshland, former editor of the prestigious Science magazine, which I believe represents my reaction to this interesting foray into comparative medicine. "The gene for unbridled dedication to a lost cause will always overwhel the pure logic gene." In a wide-ranging colloquial discussion following my presentation, I found that my colleagues at Harvard who also have examined microscopically numerous "fibre-bugs" and other self-collected specimens from patients believing themselves to be infested, had come to the same inescapable conclusion as I had that the vasst majority of these unfortunate persons were tormented by a disorder that should appropriately be treated by a sympathetic psychiatrist. Sadly, most of the patients will not accept that vertict and, thus, will continue to suffer.