I have Morgellons. Bullseye rash on the back of my leg around 2010.
The tissue changes in Morgellons patients have been demonstrated:
"Protruding keratin projections were observed on the concave, underside surface of calluses. Some of these were sharp at the tips of the projection, while others were blunt or ballooned (
Figure 1D). Clear, ingrown hairs or hairlike structures, approximately 60 μm in diameter, were observed protruding from the tips of some keratin projections. Patient 1 presented dermatological tissue with attached white filaments. In contrast, patient 4 had only small lesions without significant callus formation and presented a single chunk of dermatological tissue approximately 1 mm in diameter embedded with filaments rather than calluses.
BDD biopsies demonstrated chronic, late-stage, off-white, or grey filamentous projections on the external surface. In some samples, ingrowth of keratin on the interior surface was apparent.
Almost all the filaments from patients 1–4 that were cut longitudinally, obliquely, and in cross-section demonstrated a hollow medulla and surrounding cortex. The filaments were round, elliptical/elongated, bean-like, or curved. This morphology was consistently visible in histological sections (
Figure 2A)."
https://pmc.ncbi.nlm.nih.gov/articles/PMC3544355/
A recent review from China details how to distinguish Morgellons from delusional infestation:
"The first step needs to determine whether delusion exists or not. A delusion is defined as a firmly, but false belief held with strong conviction and contrary to the superior evidence. It is distinct from beliefs based on an unusual perception, such as formication. The beliefs that patients hold could be delusion, true observations, or overvalued ideas. This must be determined on a case-by-case basis. The presentation of a specimen is not a delusional behavior. Patients with DI/MD with animate or inanimate objects can exist, but the belief of cutaneous fibers may or may not be delusional. A physician is required to perform fiber analysis to identify the nature of fibers. If fibers are present and biofilaments of human origin, then they are a true observation. It is also possible that patients might observe fibers and mistake them for worms in which case the idea of infestation could be an overvalued idea. Real infestation with arthropods such as mites can also occur. Additionally, some patients could have lesions with adhering textile fibers that are accidental contaminants and could mistakenly believe that they have MD, in which case they do not have a delusional belief, but a mistaken belief. In summary, if a physician cannot differentiate between true observations, delusions, and overvalued ideas, they should not immediately make a diagnosis of delusional mental illness.
The next procedure would be screening the causes of the symptoms. If a delusional belief is present, then various medical conditions need to be ruled out, including psychiatric disorders (eg, schizophrenia and depression), neurological illnesses (eg, dementia), metabolic illnesses (eg, diabetes), vitamin deficiencies, substance intoxication, tumor, dermatological illnesses (eg, pruritus senilis), and infection. History taking, physical examination, laboratory tests, and even skin biopsy should be carried out. The diagnosis of DI could be classified as primary and secondary. If there are cutaneous fibers present and the belief is not delusional, the underlying cause of the symptoms, such as potential infection, should be examined. A diagnosis of MD is more convincing when spirochetal infection is identified. If a patient has delusional beliefs and has cutaneous fibers, then testing of an underlying infection that can result in neuropathy is needed."
https://pmc.ncbi.nlm.nih.gov/articles/PMC6171510/
Morgellons may be associated with syphilis, though direct evidence from a group of Morgellons patients did not corroborate that hypothesis:
"Sixteen subjects were selected who met the case description for MD as determined by a healthcare professional and who had suitable dermatological specimens for study. PCR and serological evidence of exposure to or infection with
Borrelia and other co-involved pathogens is summarized in
Table 1. All patients in our study had evidence of infection and/or exposure to
Borrelia. Eight patients had serologic evidence of infection and/or exposure to Bb, and two patients had serologic evidence of infection and/or exposure to RFB. Twelve patients had detectable Bbsl DNA and six patients had detectable RFB DNA in clinical specimens. Nine patients had evidence of infection and/or exposure to co-involved pathogens as follows: Hp (9),
Bartonella henselae (5),
Babesia spp. (2),
T. denticola (2),
Ehrlichia chaffeensis (1),
Anaplasma phagocytophilum (1),
Chlamydia pneumonia (1),
Toxoplasma spp. (1), and
Mycoplasma spp. (1). Of the subjects in our study, 14/16 were tested by PCR technology for the presence of
T. denticola and
T. pallidum DNA. All were negative for
T. pallidum, and 2/14 were positive for
T. denticola DNA, but
T. denticola was not found independently of
Borrelia DNA."
https://pmc.ncbi.nlm.nih.gov/articles/PMC7012249/
Morgellons patients exhibit mixed bacterial biofilms in their skin:
"In this study, Bb/Hp dual infection was detected in MD skin sections using tissue culture, PCR technology, IHC staining, FISH testing and confocal microscopy. The PCR data from this study revealed that callus material from 14 MD subjects tested positive for at least one sequence from either Bb or Hp, and eight subjects tested positive for at least one sequence from both bacteria. This finding verified that Bb and Hp are pathogens that can be present in MD skin sections. Given the fact that both Bb and Hp infections can cause illness in humans, including dermopathy, the presence of Bb and Hp in skin demonstrating MD pathology strongly suggests that these organisms could jointly contribute to MD evolution. IHC staining and FISH testing for Bb/Hp overlapped on consecutive sections, revealing that these pathogenic organisms co-localize in aggregates consistent with biofilms."
https://pmc.ncbi.nlm.nih.gov/articles/PMC6627092/