Resources for Managing Unknown Irritations Suspected as Caused by Arthropods

When you applied for the job of insect diagnostician, you envisioned identifying pests and their damage and communicating those results with management recommendations to a stakeholder. You were trained in insect taxonomy and looked forward to using those skills you had worked many hours to obtain.
 
Then you receive an email about a strange and terrifying phenomenon that has invaded someone’s body, home and vehicle. They assume it's a parasite since they’ve seen it in their urine, bowel movements, sputum and nasal secretions. They have pictures of all examples of the invasion into their food and other areas of the apartment. The parasite has penetrated wood, heavy glass, tin, refrigerator, coffee pot, microwave, and air fryer. They have pictures to support their claims. They indicate it's invisible so they assume it's airborne but they desperately need a definitive identification to eradicate it from their home, car and, most importantly, body. It is too difficult to discuss or describe in an email, so they request a phone consultation. They are scared and unable to sleep or eat due to their high stress level and thank you in advance for responding to this email as soon as you can.
 
What do you do?
 
When a person starts to feel sensations like arthropods, such as insects and mites, or other parasites, are attacking their body, it can cause significant stress and anxiety. Occasionally, everyone struggles with mysterious itching or biting sensations that feel like parasitism; however, numerous other causes can mimic the sensations of being bitten, such as allergies, static electricity, household cleaning products, poor diet, medications, illness, or even clothing. Those suffering from delusional infestation (also called delusory parasitosis, delusional parasitosis, or Ekbom Syndrome) are convinced that insects, mites, worms, other parasites, or fibers are present in or on their body, home, office or vehicle, even if nothing is there. As time passes, people suffering from delusional infestations are resistant to alternate explanations for the cause of their irritations.

The University of Tennessee One Health Initiative Delusional Parasitosis Working Group (UT OHI DP WG) and the Southern Region Delusional Infestation Working Group (SRDIWG) have developed materials to help Extension agents work with individuals with unknown irritations suspected as caused by arthropods. These materials apply to diagnosticians too. The publications more clearly define our role in supporting these individuals as determining the presence of arthropods that can cause these sensations. If no such arthropods are found, a factsheet and checklist of potential causes of skin irritation can be shared with these individuals. We also provide a protocol for agents, which includes directions for interacting with these individuals, and steps to use the factsheet and checklist. When no arthropods causing these sensations are found, we suggest wording to help de-escalate and direct the individual to a healthcare provider.

The publications listed below can be viewed or downloaded with the NPDN Outreach & Extension resources in the NPDN website here (login required). These are all a work in progress. If you have suggestions for improvements, send them to Karen Vail, kvail@utk.edu.

Never distribute the Agent protocol documents to the public; however, the questionnaire in the protocol can be shared.
 

The University of Tennessee One Health Initiative Delusional Parasitosis Working Group (UT OHI DP WG)

W1215-A Unknown Skin Irritations (factsheet)

W1215-B A Checklist of Potential Causes of Itchy, Tingly or Irritated Skin Suspected as Caused by Arthropods (checklists)

W1215-C Extension Agents' Protocol for Working with Unknown Skin Irritations or Suspected Delusional Infestation Cases (protocol)
 

Southern Region Delusional Infestation Working Group (SRDIWG)

Unknown Skin Irritations: A General Guide (factsheet with checklists)

Extension Agent Protocol for Unknown Skin Irritations and Suspected DI Cases (protocol)

Guide to Arthropods Associated with Delusional Infestations (publication with color images and descriptions of many arthropods encountered when working with someone suspected of delusional infestation)