Delusions of parasitosis: a brief review of the literature and pathway for diagnosis and treatment

“Doctor, You Must Examine My Creature Collection!”: A Case Report of Delusional Infestation

“…Patients with delusional infestation present to various healthcare providers and/or non-medical personnel; this may also account for the variance of reported delusional infestation occurrence. Delusional infestation diagnoses at outpatient clinics have ranged from 0.6 patients per 1000 individuals (0.06 percent) to 20 patients per 1000 individuals (2 percent) [6]. Retrospective studies of patients admitted to the hospital for psychiatric reasons have shown the occurrence of delusional infestation to range from seven of 10,000 admissions (0.07 percent) to 67 of 1000 admissions (6.7 percent); indeed, a psychiatric clinic only evaluated 73 delusional infestation patients during a period of 29 years [5,6].…”

“…They may expose their skin to harsh cleansers and insecticides to eliminate the organisms. Also, in addition to their fingernails, they may use sharp instruments (such as knives, scissors, tweezers, and toothpicks) to extract the creatures from their skin [1][2][3][4][5][6].…”

“…Their clinical manifestations of delusional infestation are more prevalent on body sites that are more readily reachable with the fingers of their dominant hand. They include secondary skin lesions, such as excoriations, prurigo nodules, scars, and ulcers; thickening of the skin (lichenification) from chronic rubbing and secondary cutaneous bacterial infections may also be observed [1][2][3][4][5][6].…”

“…Therefore, based on the considerable overlap of the disorders--especially with regard to successful management with psychiatric drug therapy--many investigators favor Morgellons disease to be a subtype of delusional infestation [15][16][17][18]. Numerous associated diseases have been observed in patients with a delusional infestation (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Indeed, in this setting, the disease-associated manifestations in some of the affected patients with secondary delusional infestation resolved when the primary condition was treated.…”

“…In addition, they have an abnormal tactile sensation of their skin originating from their delusion. Although the delusional infestation patient is convinced that they have an infestation, no organism is present; however, the typical features of delusional infestation may be exhibited by the patient, such as a positive creature collection sign, repeated requests for not only a thorough workup but also additional investigations to document the organism, and insistence on multiple treatments to completely eradicate the infestation [1][2][3][4][5][6][7].…”