Insights into the Medical Evaluation of Ekbom Syndrome: An Overview.

Ekbom syndrome, also known as delusional parasitosis (DP) or delusional infestation, is an uncommon psychiatric disorder distinguished by an enduring conviction of parasitic infestation, persisting notwithstanding the presence of medical evidence to the contrary. Primarily affecting middle-aged women, DP can manifest either as isolated psychological distress or as a component within a more intricate psychiatric framework, substantially influencing the quality of life for affected individuals. Its pathophysiological mechanism involves uncertain dopaminergic imbalances and dysfunction in the dopamine transporter system. Dermatologists often play a pivotal role in diagnosis, as patients first seek dermatological assessments of their signs and symptoms. However, DP frequently originates from underlying psychiatric disorders or medical variables, manifesting with neurological and infectious causative factors. The diagnostic complexity is attributed to patients' resolute convictions, leading to delayed psychiatric intervention. First-line DP treatment involves antipsychotics, with newer agents demonstrating promising prospects, but the lack of standardized protocols poses a significant therapeutic challenge. In this narrative review, both a comprehensive approach to this uncommon pathology and an update on the state of knowledge in this medical subfield focused on optimizing the management of DP are provided. The complexity of DP underlying its uncommon nature and the incomplete understanding of its pathophysiology highlight the need for further research through multicenter studies and multidisciplinary teams to enhance therapeutic efficacy and safety.

The plague: a case of delusional infestation with folie à deux / A praga: um caso de delírio de infestação com folie à deux

Folie à deux or Shared psychotic disorder (SPD) is a rare condition characterized by shared psychotic symptoms between two or more individuals. Delusional parasitosis (DP) is an uncommon psychiatric illness in that patients believe they are infested by insects, without evidence to support this belief. DP occurs in 5­15% of SPD. We report a case of cutaneous DP with SPD between an elderly mother and a daughter that lived together and withdrew from other social contacts for the last three years. We aim to highlight the relationship between SPD and DP, its prognosis, and clinical implications.

Folie à deux ou Perturbação Psicótica Compartilhada (PPC) é uma condição rara caracterizada por sintomas psicóticos compartilhados entre dois ou mais indivíduos. O delírio parasitário (DP) é uma doença psiquiátrica incomum em que os pacientes acreditam estar infestados por insetos, sem evidências que sustentem essa crença. O DP ocorre em 5 a 15% das PPC. Relatamos um caso de um DP cutâneo com PPC entre uma mãe idosa e uma filha que viviam juntas e afastadas de outros contatos sociais nos últimos três anos. O nosso objetivo é destacar a relação entre PPC e o DP, o seu prognóstico e implicações clínicas

Delusional parasitosis: an entomological perspective after a 20-years-experience in two public medical and veterinary entomology laboratories.

Delusional parasitosis (DP) is psychiatric disorder characterized by the unshakeable belief of being infested by endo- or ectoparasites, without any evidence of infestations. Hence, DP sufferers often consult medical entomologists or dermatologists, rather than seeking help from a mental health practitioner. Here we present 39 cases of suspected DP occurred in twenty years in two Italian public medical entomology laboratories, to highlight their common features and peculiarities, based on the interviews and material brought to our laboratories. Our results confirmed that DP affects both sexes, but is more frequent in females over the age of 50 years. Cases of psychological contagion, mostly affecting elderly people, were reported within seven family units. Some rare or unique features of DP sufferers involved: the fixed belief to be infested by endoparasites, olfactory hallucinations of unpleasant smell, self-harm to get rid of the imaginary parasite and suicidal thoughts. We suggest the term "Digital pics sign" to describe a modern derivative of the "Matchbox sign", where the DP sufferers showed pictures and videos, in person or sent by email, as proofs of being infested. Medical entomologists, being the most frequently contacted professionals by DP sufferers, may be crucial to raise awareness about this psychological disorder and to encourage a multidisciplinary approach amongst medical professionals and pest control operators.

British Association of Dermatologists guidelines for the management of adults with delusional infestation 2022.

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of delusional infestation (DI) in adults. Linked Comment: I. Coulson. Br J Dermatol 2022; 187:457.

[Delusional Parasitosis associated with diabetes mellitus treated in outpatient care during COVID-19 pandemic - case report].

The presenile dermatozoic delusion, subsequently referred to as Ekbom's syndrome and delusional parasitosis is a rare chronic condition, having an undetermined etiology and rising challenging treatment approaches. The diagnosis of delusional parasitosis can be presumed on the basis of the clinical history, but it is important to thoroughly assess the existence of an underlying systemic disorder or unrecognized skin disorder. A skin examination must be performed to rule out an infestation or a skin disorder. We present a 63-year-old diabetic woman with a high level of resilience towards the psychiatric treatment for whom we successfully offered outpatient psychiatric and dermatological assistance during the pandemic COVID-19. The trigger for a successful treatment scheme in outpatient care in a case of delusional parasitosis was the close and trustful relationship between the patient and the doctor. Different pharmacological treatments were approached and adjusted according to the patient adherence and the objective result (quetiapine XR, duloxetine, risperidone, olanzapine, and lamotrigine along with chronic disease treatment and wound management). Having a mutual agreed objective criteria for the treatment outcome, and creating a throughout examination scheme with frequent medical checks, increased the patient adherence to the treatment.

Drug-induced Delusional Infestation.

It is considered that certain drugs might induce delusional infestation, yet, to date, no studies have been performed to identify the pharmacodynamics associated with these treatments. The aim of this review is to summarize current available knowledge of drug-induced delusional infestation. A literature search was performed for primary studies on suspected drugs reported to induce delusional infestation. Included articles were evaluated systematically using the Naranjo criteria. In addition, drug mechanisms of action were compared. The final selection included 31 studies, in which a total of 26 classes of drugs were identified. Anti-Parkinson drugs were most frequently associated with delusional infestation, followed by antidepressants, antiepileptics, antibiotics, prescription stimulants, and a few other drug groups. The current available literature suggests that the onset of delusional infestation is initiated by drug-induced alterations in neurotransmitter levels, predominantly dopamine, in the central nervous system.

Right frontal meningioma presenting as delusional parasitosis.

Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.

Delusional parasitosis. A multicenter retrospective study in Spanish infectious disease services / Parasitosis delirante. Un estudio retrospectivo multicéntrico en los servicios españoles de enfermedades infecciosas

Introduction: Delusional parasitosis or Ekbom syndrome is a condition described mainly in the fields of psychiatry and dermatology, with a complex diagnostic and therapeutic approach. However, it is uncommon to assess patients with this disease in infectious disease units. The objective of this work is to describe the experience of three infectious diseases departments with respect to this entity. Methods: A retrospective descriptive study of 20 patients diagnosed with delusional parasitosis in three Infectious Diseases Services was performed between 2003 and 2017. Results: The median age of the patients was 54 years, with a female/male ratio of 1.5:1. In 9 patients, an endoparasitic delirium (mainly digestive) was described, in 5 an ectoparasitic form was described, and in the remaining 6, a mixed form was described. Fourteen patients presented some type of psychiatric disorder. Four patients had alcohol or drug abuse disorder. All patients had made consultations to other specialties with a median of three per patient (range 1–7). Ten patients received “empirical” antiparasitic treatment and 8 received some type of psychopharmaceutical treatment. The evolution was very variable: in 3 patients, the delusional parasitosis was resolved; in 9 patients, the clinical manifestations persisted, and the remaining patients were lost to follow-up. Conclusions: Ekbom syndrome is a common process in infectious diseases, presenting some differences with other series evaluated by dermatologists and psychiatrists. Management of this disease should promote a multidisciplinary approach to enable a joint treatment, thus optimizing patient management and therapeutic adherence.(AU)

Introducción: La parasitosis delirante o síndrome de Ekbom es una afección descrita principalmente en los campos de la psiquiatría y la dermatología, con un enfoque diagnóstico y terapéutico complejo. Sin embargo, es poco frecuente evaluar a los pacientes con esta enfermedad en unidades de enfermedades infecciosas. El objetivo de este trabajo es describir la experiencia de 3 departamentos de enfermedades infecciosas con respecto a esta entidad. Métodos: Entre 2003 y 2017 se llevó a cabo un estudio descriptivo retrospectivo de 20 pacientes a los que se les diagnosticó parasitosis delirante en 3 servicios de enfermedades infecciosas. Resultados: La mediana de edad de los pacientes era de 54 años, con una proporción mujeres/varones de 1,5:1. En 9 pacientes se describió un delirio endoparasitario (principalmente digestivo), en 5 se describió una forma ectoparasitaria y en los 6 restantes una forma mixta. Catorce pacientes presentaban algún tipo de trastorno psiquiátrico. Cuatro pacientes presentaban un trastorno de alcoholismo o drogadicción. Todos los pacientes habían acudido a consultas de otras especialidades con una mediana de 3 por paciente (intervalo de 1-7). Diez pacientes recibieron tratamiento antiparasitario «empírico» y 8 recibieron algún tipo de psicofármaco. La evolución fue muy variable: en 3 pacientes se resolvió la parasitosis delirante; en 9 pacientes persistieron las manifestaciones clínicas y se perdió el seguimiento de los demás pacientes. Conclusiones: El síndrome de Ekbom es un proceso habitual en las enfermedades infecciosas, que presenta algunas diferencias con otras series evaluadas por dermatólogos y psiquiatras. El tratamiento de esta enfermedad debe promover un enfoque multidisciplinario que permita un tratamiento conjunto, optimizando así el tratamiento del paciente y el cumplimiento terapéutico.(AU)