Reader Comments

Post a new comment on this article

Actinomycosis

Posted by cynt on 17 Apr 2012 at 05:09 GMT

I did not see a copy of the tool used to review the medical records to find patients who met “pre-defined criteria” for inclusion in the study. Also, did not see a copy of the “standardized tool” researchers used to screen potential patients by telephone.
Figure 4. “Representative skin lesions detected on clinical examination.” These lesions do not look typical of the lesions from self-proclaimed Morgellons sufferers. I invite you to visit http://www.timesocket.com... to view the photographs posted.
There was no indication that the researchers specifically searched for a class of infectious agents known to cause chronic, purulent wounds: Actinomycetes. Actinomycosis is often missed, even by experienced clinicians. Actinomycetes are anaerobic gram positive rods. It was not clear if both aerobic and anaerobic wound cultures were done and if so, was specialized culture media used to identify this slow- growing bacteria. Typically, this organism does not culture well.
Diagnosis is often made by the identification of “sulfur granules” in draining sinus tracts or purulent material. It was not clear if purulent material was examined microscopically for the presence of sulfur granules.
Trauma may facilitate the entry of Actinomycetes into skin/soft tissue. Interestingly, 20% of study patients reported a previous physician-diagnosed infectious skin condition such as “scabies”. There was no mention of the scabies type (i.e. Norwegian) or whether or not the scabies was resistant to treatment. These seem pertinent research questions, especially since 16% of lesions “had features consistent with arthropod bite or drug allergy”.
Additionallly, I believe many conclusions in the study and the Q&A summary are misleading and not supported by the study results. Example from Q&A: Of 62 skin specimens examined…” Not noted is the fact that of the 62 biopsies performed, only 37 were from lesions. Twenty-two of the biopsy specimens were done from normal skin and three specimens were from undocumented sites. Fifteen of 37 lesion specimens (41%) grew common skin bacteria (Staph/Strep).Yet, among the conclusions, “the skin lesions were not caused by any known infection.” I am not convinced that the study design excluded all known infections.
Sixteen out of 37 samples (43%) of the biopsied skin lesions contained foreign material. The type of foreign material was not irrefutably determined. The various conclusions were that these fibers were a combination of one or more of the following: probably or resembling cotton, “likely silicates”, [consistent with] “a substance used in resorbable suture”, “probably nylon”, “consistent with nail polish” and polyethylene, possibly from contamination. With so many unanswered questions, how can we use this data to draw any conclusions?



No competing interests declared.
report a concern respond to this posting