Table 2 Primary Abnormal Findings

2. Rural abode or exposure to unhygienic conditions (third world travel or simply soil exposure) may be risk factors.

3. Onset rate is moderately rapid, without recognizable prodrome, commonly preceded by a healthy state.

4. Once ill, exercise capacity is significantly reduced.

5. The illness is common among family members and close associates, both related genetically and unrelated (such as spouses).

6. Most patients experience weight gain after disease onset.

7. Micro-angiomas appear rapidly on skin after illness onset in most.

8. Fever is recurrent in at least half of those affected.

9. The first illness sign may be the sudden appearance of persistent itching. Ulcerative lesions follow in some cases.

10. Once dermal symptoms begin, patients experience extrusion of unfamiliar material described variously as filamentous, "fuzz balls", black or white "flecks" or "rice grains".

11. Numerous CNS effects occur, that includes bizarre cranial nerve phenomena, anxiety and emotional sequelae. The former tend to be transient.

12. Numerous Peripheral Nervous System findings appear after illness onset. Unlike CNS effects, these are serious, permanent and progressive, and include sensory and motor nerves.

13. All Morgellons have elevated heart rate (>72 BPM) and low body temperature by oral thermometry (<97.5 degrees F).

14. Orthostatic intolerance is intermittent but common in most.

15. Most have some formally diagnosable emotional illness that begins with or becomes apparent after Morgellons disease onset.

16. Endocrine abnormality number and type is higher than background. Most common are Diabetes Type II, Hashimoto's Thyroiditis, hyperparathyroidism and adrenal hypofunction.

17. Most have elevated fasting insulin levels accompanied by elevated TNF-alpha (insulin receptor blocker) [15, 16].

18. Common clinical laboratory abnormalities include:

a. RBCs have abnormal morphology. On manual examination, RBCs were non-discoid, varied in color and size.

b. Natural Killer Cell (CD 56 + CD 16) number and function are very low in most.

c. A/G ratio and globulin level are frequently elevated.

d. Sedimentation Rate and ANA are extremely low despite other common autoimmune-like conditions.

e. Elevated cytokines include: TNF-alpha, IFN-gamma, IL-6, C Reactive Protein, Homocysteine and serum Leptin.

19. Despite no fact-based Case Definition of Delusions of Parasitosis (DP), each of our 25 patients could have been given such an illness label as well. As pointed out by Trabert in a meta-analysis of 1,223 DP cases and others, most DP data were taken from isolated cases. Psychiatric-skewed labels were common such as "psychocutaneous disease", "acarophobia" and "monosymptomatic hypochondriasis" with no serious search for consistent physical abnormalities or microscopic parasitic agents [17].