Delusional Parasitosis in a School Teacher Living in a Rural Area: Parasitological Approach

Abstract

Delusional parasitosis is a psychotic illness. Patients often present to dermatologists with scars that are selfinflicted because they attempt to extract the "parasites". We report a 58 -year-old female with an eightmonth history of a crawling sensation on her skin and constant generalized itching, which she believed to be caused by insects and worms crawling across her skin. Examination revealed self-inflicted scratches at various stages of healing, which were limited to body parts within easy reach. The patient visited many physicians; it seems that she mutilated in an attempt to remove the offending organisms. She also presented skin scrapings and debris to her doctors, claiming that they contained worms and insects. Light pressure on the lesions did not produce any extrusion of macroparasites, and no parasites such as helminths and insect larvae (myiasis), were observed during microscopy. Thin smear scrapings were stained and examined to rule out parasitic diseases such as leishmaniasis and mycosis; however, no evidence of parasites was found. Our patient was administered with amisulpride 100 mg twice a day, which resulted in the complete remission of delusions after five weeks. The skin lesions were managed with clobetasol propionate ointment. A careful clinical examination combined with parasitological tests can be decisive in diagnosing delusional parasitosis, especially for patients from rural areas.

Psychological interventions in the treatment of delusional parasitosis: a brief review

“…In this review, the rates of complete remission exhibited variations across all treatment modalities, regardless of whether typical or atypical antipsychotics were employed and whether psychotherapy was coadministered. These diverse outcomes can in part be attributed to the comorbidities associated with DOP patients such as depression, 1,4,7–11 schizophrenia, 4 ADHD, 6 anxiety, 4,5,7,9 and obsessive–compulsive disorders 4 . The existing gap in achieving full remission with the independent use of psychotropic medication along with the coexistence of comorbidities prompted this study to investigate the potential effect of using a combined approach of psychotherapeutic interventions and psychotropic medications in the treatment of individuals with DOP.…”

“…However, complete remission was only obtained in three studies. [4][5][6] Patients were offered psychological intervention alongside psychiatric treatment in an additional three studies. 5,7,8 Among those three studies, only one study reported that the inclusion of psychological intervention with psychotropic medication may have potentially positively contributed to the patients' remission, 5,7 although the results reveal a correlation rather than direct causation with the remission observed in the patient.…”

“…Across the nine studies analyzed, it was consistently observed that patients with diagnosed delusional parasitosis achieved partial remission irrespective of the treatment approaches employed. However, complete remission was only obtained in three studies 4–6 . Patients were offered psychological intervention alongside psychiatric treatment in an additional three studies 5,7,8 .…”

Insects Under The Skin? Ziploc And Matchbox Evidence In The Expert Forensic Stain Laboratory

“…This applies to our cases as well. A core feature of the disorder includes the collecting of traces of putative insects in small baggies or matchboxes ("matchbox / ziploc symptom") [5,7,[22][23][24][25][26][27][28]. This, too, is reflected in our cases (Figure 1).…”

“…According to the literature, the condition predominantly affects single women over the age of 50 [7,11,15,17,18,[20][21][22][23].…”