TWiP 221: Delusional parasitosis

Michelle and Alexander join TWiP to solve their case of the 36 Year Old Male with shortness of breath, stinging pain in the extremities, fatigue, abdominal cramps, and bowel irregularities, and discuss host cell invasion by Trypanosoma cruzi.

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[anymoose]

I had a patient who was repeatedly complaining about bugs on the wall. It was medical consensus that these were either, hallucination, behavioral, ” or visual disturbance with delusion. It wasn’t until I did a home visit that anyone witnessed the bugs on the wall. They needed an exterminator not more psych meds. As a long Covid patient it is difficult to hear this easy dismissal. A matchbox with a random bug doesn’t mean some blood shouldn’t be drawn.

[spamletspamley]

A refreshing return to more detailed discussion of progress in the science, after a long period of just reading out guesses, with no time for anything else. I don't know how you'd reballance this, but I diid find the early episodes, when going through all the different kinds of parasite more engaging.
I wonder, though, if, when you are discussing papers that are rather difficult to mentally picture, now that you are able to compartmentalise the screen, you could fit in an extra window to show us what you are all looking down at, when discussing some picture or graph, to make it easier to follow. I found it hard to keep in my mind, just what Dickson's paper had actually discovered and why it was important.

I wasn't quite so happy with the unqualified acceptance, that anything that wasn't parasitic, must be one for the psyches. Just all the other blinkered compartmentalised 'specialities, also tend to be too ready to dismiss anything not in their field, as something for the psyches too. This is the process that left M.E. sufferers in limbo as untouchables for generations, until interest was rekindled by Long CoViD. The problem is not 'doctor shopping' patients: it's the compartmentalisation that forces patients to guess the speciality and have to be right first time, or be dumped on the psyches, who have no cures for anything but are only too happy to give a diagnosis by lack of diagnosis, that brands patients for life as hypochondriacs. What is needed to end this tragic impasse, is one stop multidisciplinary diagnostic centres, where the whole patient can be properly assessed with a step by step elimination of possibilities following a reliable algorithmic 'key' as we do when identifying anything else, wherher id be a plant or insect species, or an electrical fault. Difference is, that when we identify in any other field, we keep going until we arrive at the answer, whereas, in medicine, we get three guesses, then we're sent to the shrinks waste bin. Of course, there are real delusional cases, but their existence by absence of evidence, lets the 'just pull your socks up brigade' get away with decades of psychological torture of a great many people, who did nothing wrong, but contract a disease before much was known about it.
I've tried to email about the need for multidisciplinary diagnostic centres before, but got no replies. I have been pleased to see signs in the medical press that the idea is at long last beginning to catch on, in particular with respect to improving health outcomes in the 'third world', which I thought Dr Griffin in particular would know about.

Sorry if this sounds like a moan. It isn't meant to be: it's meant to point out that new tech is now making previously unimagined ways of working possible, if only the 'specialities' would come out of their closets and put all their heads together to deal with whole bodies in one visit (virtual if need be).

Hope to hear (see) more of these progress paper episodes in the future. Thanks for all you do.

[feebis]

Oh I had this recently. Then I went and looked up my symptoms and it fit with this. Mine was caused by anxiety and really bad living conditions. Man it sucked.

[tonaruch]

Michele and Alexander thanks for coming

[annemariegrieb]

@ Michelle and
Alex: impressive presentation!

[ehfik]

greetings from vienna! very interesting episode, thank you!

[jellicle_kitten]

Heh I really thought the title meant that the patient would have a brain infection that caused hallucinations))) Very cool that you raised awareness for this condition. I remember during covid lots of people found "worms" in surgical masks. Obviously those were just some tiny threads. But there was a whole MOVEMENT, lots of chats, videos. Ppl called them "morgellomas" or smth like that. All of this is very sad for me as also a person with mental illnesses. You gotta treat your real condition as soon as possible, otherwise you'll waste years of your life and all of your savings on tests and quacks who'll recommend all kinds of "treatments". Or you may have some connective tissue disorder that would cause fatigue & chronic pains, also mast cell activation for rashes. But it's easy for our anxiety to hang on to the idea that you just gotta find that ONE infection, it'll be treated and you'll be good as new. I wish((

[terenzo]

Hot musical outro. Before we venture into Outer Space, we've a great deal of exploring to do in Inner Space.

[mkilptrick]

I really enjoyed this episode. It brought up a subject that I was totally unprepared for.

[johnbillings]

My grandmother had this. She would do strange things in an attempt to void them from herself and her surroundings. She would go crazy over lint thinking it was bugs and would have me help her pick them up with masking tape. She would also put astringent in her ears (and mine) because she thought bugs were in our ears. Strange times. 😮

[malin]

Demodicosis causes similar symptoms but rarely any testing is done for this. tick bite??

[AndiS-dzpq]

The title says it all, wish I hadn’t read it before watching.

[shokuchideirdrecarrigan]

Most people don’t enjoy consulting a doctor. Symptoms especially pain generally drive the visits. Psychiatry is rarely a solution. Generally, with few exceptions, seeing doctors has been useless if not dangerous. The US medical system is an appalling mess. Lots of shooting arrows in the dark and chuckles.

[dawnbarchett]

I would like to add that methamphetamine users are known for thinking that they have subcutaneous parasites when none are present.

[colinheim]

I may be suffering from DP.

What you mentioned about 1st yr med students thinking they have everything is a great way to have real empathy for those (maybe 'us', hehe) people with delusional parasitosis. When people first learn about something they start to see it everywhere. Combine that with the fear of an unseen enemy of dubious origin... how do 1st year med students even get to the 2nd year..?? Hats off to ya. I guess it helps to have other docs around to tell you to stop being delusional 😂

[Chickday]

we live in a globalized world and yet currently the medical culture in america is sanitary no bugs here. well i had strongaliods never left the country and was threatened with the psych ward until pled my case of globalization hopefully just because they don’t see doesn’t mean anything and there is cases of live insects fruit flies infestation in nasal passages and insect infections in wounds

[iford]

Here in the US, where medical tests are out of reach for many of these patients (with or without insurance) I have occasionally agreed to a anti parasitical. It NEVER helps.

[anthonyrstrawbridge]

It was really fun. We adopted a five year old female whom had previously been raised with a drug addict in a crack house type environment. Sandy, appears to be healthy and well socialized but routinely exhibits this questionable routine at home when otherwise everything would be unremarkable. It starts with her obsessively licking her anal orifice. Sporadically, she spends a relatively insignificant time peering at her her vaginal areas then sniffs and apparently smells before just spending a few moments licking the area. Sandy persistently and almost obsessively migrates too out five year old male short hair Chihuahua and picks one single spot having an area of approximately 15 square millimeters located at his left shoulder area and again obsessively licks, smells, and visually inspects that area. Nicholas is a real trooper as he just gives in and tolerates the behavior which often occurs for approximately fifteen minutes. We continue to watch and love her but I find that my mind often wanders in considering Sandy's behavior and Nicholas's shoulder. Oddly, after approximately twelve months of introducing Sandy into the home with Nick a large almond shaped mass developed on his opposite shoulder. The oncologist has determined that the mass is malignant. Any thoughts?

[matazmataz]

There is an istinctive set of feelings related to having small moving creatures on the body because all animals have parasites. This gets triggered in these people. Causes may vary.