HEALTH EFFECTS OF TOXIC MOLD EXPOSURE:
Statistics show that most people spend an average of 90 percent of their
time indoors. We like to think our homes are healthy places to live and
raise our families and that our offices safe to work in. But just how safe
are they?
Molds and other fungi may adversely affect human health through three
processes: 1) allergy; 2) infection; and 3) toxicity. Exposure to mold is
not healthy for anyone. However, the following individuals are at a higher
risk than others for adverse health effects; •
infants •
children • elderly • immune compromised patients • pregnant women •
individuals with existing respiratory conditions and allergies. Airborne
toxic mold spores can affect the immune system, nervous system, liver,
kidneys, blood and cause
brain damage. With so much compelling evidence that enough mold
can kill people,
how much mold is acceptable to you?
Everyone is exposed to mold in the outdoor air but exposure to indoor molds
can accelerate aggravated conditions for some. Some molds are more hazardous
than others. For some people, a small number of mold spores can cause severe
health problems. For others, it may take many more. Mold spores often cause
adverse reactions, much like pollen from plants. Some molds (particularly
toxic molds) can trigger instant and uncontrollable vomiting in mold
sensitive people.
There are many symptoms of mold exposure. As a rule, the extent of symptoms
depends on the sensitivity of the exposed person. Allergic reactions are the
most common and typically include: chronic clogged throat; wheezing and
difficulty breathing; nasal and sinus congestion; burning, watery, reddened
eyes or blurry vision; sore throat; dry cough; nose and throat irritation;
shortness of breath; nausea; and skin irritation.
Other less common effects are: nervous system problems (headaches, memory
loss, moodiness); aches and pains; and fever. If you have any of these
symptoms, and they are reduced or completely gone when you leave the suspect
area, chances are you have been exposed to some sort of allergen, quite
possibly mold.
If you or your co-workers, school mates or family members show signs of
unexplained chronic fatigue, daily headaches, persistent cold-like or
flu-like symptoms, you could be suffering from exposure to volatile organic
compounds (VOC) and should see a physician.
Once mycotoxins or spores are airborne, they can rest on clothing or skin
and become trapped in mucus membranes from normal breathing. They can affect
humans in many different ways. Some people may have immediate reactions, and
others may not notice or exhibit symptoms for several days or weeks.
Effects from exposure to toxic mold can result in any of the following
symptoms:
Headaches - memory loss - problems focusing or concentrating - chronic
fatigue - nose and throat irritation - persistent cold-like symptoms -
burning, itching or watering eyes - dizziness - nausea - tremors - heart
palpitations - shortness of breath (during mild exertion) - exhaustion-
after routine activity - serious swelling in legs, ankles, feet - serious
swelling in torso or stomach - prolonged muscle cramps and joint pain -
sensitivity to- odors - cancer - women who are pregnant could experience
multiple problems.
Because spores are tiny bacteria less than 4 microns in size, so small that
over 250,000 spores can fit on a pin head, they can bypass our built-in
defense mechanisms and accumulate in the lower lungs. Subsequently, the
lungs become a roadway for toxic materials to travel through the bloodstream
with the oxygen. The body's reaction to the toxins permanently affects the
lungs' ability to transfer oxygen into the bloodstream. The lung tissue
becomes permanently scared and each exposure to mold spores increases the
damage. The body's last defense against these tiny invaders is to develop an
allergy producing cold or pneumonia-like symptoms.
The most common response to mold exposure may be allergy. People who are
atopic, that is, who are genetically capable of producing an allergic
response, may develop symptoms of allergy when their respiratory system or
skin is exposed to mold or mold products to which they have become
sensitized. Sensitization can occur in atopic individuals with sufficient
exposure. Allergic Reactions Allergic Reactions can range from mild,
transitory responses, to severe, chronic illnesses. The Institute of
Medicine (1993) estimates that one in five Americans suffers from allergic
rhinitis, the single most common chronic disease experienced by humans.
Additionally, about 14 % of the population suffers from allergy-related
sinusitis, while 10 to 12% of Americans have allergically-related asthma.
About 9% experience allergic dermatitis. A very much smaller number, less
than one percent, suffer serious chronic allergic diseases such as allergic
bronchopulmonary aspergillosis (ABPA) and hypersensitivity pneumonitis
(Institute of Medicine, 1993). Allergic fungal sinusitis is a not uncommon
illness among atopic individuals residing or working in moldy environments.
There is some question whether this illness is solely allergic or has an
infectious component. Molds are just one of several sources of indoor
allergens, including house dust mites, cockroaches, effluvia from domestic
pets (birds, rodents, dogs, cats) and microorganisms (including molds).
While there are thousands of different molds that can contaminate indoor
air, purified allergens have been recovered from only a few of them. This
means that atopic individuals may be exposed to molds found indoors and
develop sensitization, yet not be identified as having mold allergy. Allergy
tests performed by physicians involve challenge of an individual's immune
system by specific mold allergens. Since the reaction is highly specific, it
is possible that even closely related mold species may cause allergy, yet
that allergy may not be detected through challenge with the few purified
mold allergens available for allergy tests. Thus, a positive mold allergy
test indicates sensitization to an antigen contained in the test allergen
(and perhaps to other fungal allergens) while a negative test does not rule
out mold allergy for atopic individuals.
Type 1 Allergies: Immediate type - hypersensitivity. Fungi may cause
allergic rhinitis similar to that caused by pollen grains, and, after
asthmatics become allergically sensitized to one or more of them, they may
trigger asthma attacks. Most asthmatics have multiple allergies.
Type 3 Allergies: Delayed type hypersensitivity. In certain
susceptible individuals, after prolonged, heavy exposure, fungi may cause
hypersensitivity pneumonitis (allergic alveolitis), characterized by wheeze,
shortness of breath, cough, chest tightness, and in some prolonged cases,
pulmonary fibrosis. There has been a custom of giving each new subtype of
hypersensitivity pneumonitis (HP) an evocative medical nickname, such as
farmer's lung, maple bark stripper's disease, and so on. "Humidifier fever"
is the most common such name associated with indoor mold proliferation,
since HP is often associated with contaminated humidifiers. HP has also,
however, been reported from indoor mold proliferations on structural or
furnishing elements, such as walls or shower curtains. A HP patient should
have strong serum precipitins specific to the fungus (or bacterium or
protozoan) which is causing the reaction. Bronchioalveolar lavage or biopsy
will usually show elevated numbers of eosinophil cells, showing eosinophilic
immune activation.
Bronchopulmonary Mycosis: Persons who have been asthmatic for many
years may progress to have their bronchial passages colonized by a fungus,
usually Aspergillus fumigatus, but sometimes another organism such as
Bipolaris hawaiiensis, Wangiella dermatitidis, or Pseudallescheria boydii.
Constant allergic response helps to maintain the fungal colonization, and
first-line therapy is often with steroids: bringing down the level of
inflammation may result in elimination of the colonizing organism. Some
studies have made tentative links between exacerbations of ABPA and moldy
houses. Cystic fibrosis patients also may get allergic bronchopulmonary
mycosis.
Allergic Mycotic Sinusitis: A colonizing infection of mucus adhering
to the sinus walls. Very similar to ABPA otherwise, except that patients
need not necessarily have had asthma or cystic fibrosis. To date no discrete
connection with indoor mold proliferation has been shown in any individual
cases, but that may be from lack of investigation. Infections From molds
that grow in indoor environments is not a common occurrence, except in
certain susceptible populations, such as those with immune compromise from
disease or drug treatment. A number of Aspergillus species that can grow
indoors are known to be pathogens. Aspergillus fumigatus (A. fumigatus) is a
weak pathogen that is thought to cause infections (called aspergilloses)
only in susceptible individuals. It is known to be a source of nosocomial
infections, especially among immune-compromised patients. Such infections
can affect the skin, the eyes, the lung, or other organs and systems. A.
fumigatus is also fairly commonly implicated in ABPA and allergic fungal
sinusitis. Aspergillus flavus has also been found as a source of nosocomial
infections (Gravesen et al., 1994). There are other fungi that cause
systemic infections, such as Coccidioides, Histoplasma, and Blastomyces.
These fungi grow in soil or may be carried by bats and birds, but do not
generally grow in indoor environments. Their occurrence is linked to
exposure to wind-borne or animal borne contamination.
Adverse Reactions to Odor: Odors produced by molds may also adversely
affect some individuals. Ability to perceive odors and respond to them is
highly variable among people. Some individuals can detect extremely low
concentrations of volatile compounds, while others require high levels for
perception. An analogy to music may give perspective to odor response. What
is beautiful music to one individual is unbearable noise to another. Some
people derive enjoyment from odors of all kinds. Others may respond with
headache, nasal stuffiness, nausea or even vomiting to certain odors
including various perfumes, cigarette smoke, diesel exhaust or moldy odors.
It is not know whether such responses are learned, or are time-dependent
sensitization of portions of the brain, perhaps mediated through the
olfactory sense, or whether they serve a protective function. Asthmatics may
respond to odors with symptoms.
Mucous Membrane and Trigeminal Nerve Irritation: A third group of
possible health effects from fungal exposure derives from the volatile
compounds (VOC) produced through fungal primary or secondary metabolism, and
released into indoor air. Some of these volatile compounds are produced
continually as the fungus consumes its energy source during primary
metabolic processes. (Primary metabolic processes are those necessary to
sustain an individual organism's life, including energy extraction from
foods, and the syntheses of structural and functional molecules such as
proteins, nucleic acids and lipids). Depending on available oxygen, fungi
may engage in aerobic or anaerobic metabolism. They may produce alcohols or
aldehydes and acidic molecules. Such compounds in low but sufficient
aggregate concentration can irritate the mucous membranes of the eyes and
respiratory system. Just as occurs with human food consumption, the nature
of the food source on which a fungus grows may result in particularly
pungent or unpleasant primary metabolic products. Certain fungi can release
highly toxic gases from the substrate on which they grow. For instance, one
fungus growing on wallpaper released the highly toxic gas arsine from
arsenic containing pigments.
Fungi can also produce secondary metabolites as needed. These are not
produced at all times since they require extra energy from the organism.
Such secondary metabolites are the compounds that are frequently identified
with typically "moldy" or "musty" smells associated with the presence of
growing mold. However, compounds such as pinene and limonene that are used
as solvents and cleaning agents can also have a fungal source. Depending on
concentration, these compounds are considered to have a pleasant or "clean"
odor by some people. Fungal volatile secondary metabolites also impart
flavors and odors to food. Some of these, as in certain cheeses, are deemed
desirable, while others may be associated with food spoilage. There is
little information about the advantage that the production of volatile
secondary metabolites imparts to the fungal organism. The production of some
compounds is closely related to sporulation of the organism. "Off" tastes
may be of selective advantage to the survival of the fungus, if not to the
consumer.
In addition to mucous membrane irritation, fungal volatile compounds may
impact the "common chemical sense" which senses pungency and responds to it.
This sense is primarily associated with the trigeminal nerve (and to a
lesser extent the vagus nerve). This mixed (sensory and motor) nerve
responds to pungency, not odor, by initiating avoidance reactions, including
breath holding, discomfort, or paresthesias, or odd sensations, such as
itching, burning, and skin crawling. Changes in sensation, swelling of
mucous membranes, constriction of respiratory smooth muscle, or dilation of
surface blood vessels may be part of fight or flight reactions in response
to trigeminal nerve stimulation. Decreased attention, disorientation,
diminished reflex time, dizziness and other effects can also result from
such exposures (Otto et al., 1989). It is difficult to determine whether the
level of volatile compounds produced by fungi influence the total
concentration of common VOCs found indoors to any great extent. A
mold-contaminated building may have a significant contribution derived from
its fungal contaminants that is added to those VOCs emitted by building
materials, paints, plastics and cleaners. Miller and co-workers (1988)
measured a total VOC concentration approaching the levels at which Otto et
al., (1989) found trigeminal nerve effects. At higher exposure levels, VOCs
from any source are mucous membrane irritants, and can have an effect on the
central nervous system, producing such symptoms as headache, attention
deficit, inability to concentrate or dizziness.
Vascular System: Vascular System - increased vascular fragility,
hemorrhage into body tissues, or from lung, e.g., aflatoxin, satratoxin,
roridins
Digestive System: Digestive System - diarrhea, vomiting, intestinal
hemorrhage, liver effects, i.e., necrosis, fibrosis: aflatoxin; caustic
effects on mucous membranes: T-2 toxin; anorexia: vomitoxin.
Respiratory System: Respiratory System - respiratory distress,
bleeding from lungs e.g., trichothecenes Nervous system, tremors,
incoordination, depression, headache, e.g., tremorgens, trichothecenes.
Cutaneous System: Cutaneous System - rash, burning sensation
sloughing of skin, photosensitization, e.g., trichothecenes Urinary system,
nephrotoxicity, e.g. ochratoxin, citrinin.
Reproductive System: Reproductive System - infertility, changes in
reproductive cycles, e.g. T-2 toxin, zearalenone.
Immune System: Immune System - changes or suppression: many
mycotoxins. It should be noted that not all mold genera have been tested for
toxins, nor have all species within a genus necessarily been tested.
Conditions for toxin production varies with cell and diurnal and seasonal
cycles and substrate on which the mold grows, and those conditions created
for laboratory culture may differ from those the mold encounters in its
environment. Toxicity can arise from exposure to mycotoxins via inhalation
of mycotoxin-containing mold spores or through skin contact with the
toxigenic molds. A number of toxigenic molds have been found during indoor
air quality investigations in different parts of the world. Among the genera
most frequently found in numbers exceeding levels that they reach outdoors
are Aspergillus, Penicillium, Stachybotrys, and Cladosporium. Penicillium,
Aspergillus and Stachybotrys toxicity, especially as it relates to indoor
exposure.
Glucan Effects: Glucan Effects - Beta-1, 3-glucan is a major
structural component of almost all fungal cell walls. It is a polymer of
glucose similar to cellulose, but with less tendency to be found in strands.
It bears considerable structural similarity to very toxic molecules known as
endotoxins secreted by some bacteria, particularly some gram-negative
organisms. This similarity caused an endotoxin expert, Dr. Ragnar Rylander,
to investigate it as a possible candidate for the chemically irritating
component found in mold conidia. It was found to activate PAMs, possibly
making the lungs hyperreactive to a wide variety of foreign materials. Also,
in double-blind inhalation exposure trials conducted with human volunteers,
exposure correlated significantly with some non-specific respiratory
symptoms. The most strongly correlating symptom, however, was headache. The
contribution of glucans to indoor mold irritation is still under
investigation; glucan effects may add to or synergize mycotoxin effects, or
may be mistaken for mycotoxin effects in fungi where the actual amount of
mycotoxin present in conidia is not sufficient to cause symptoms.
Volatile Chemical Effects: Volatile Chemical Effects - Most molds,
especially those with dry conidia, produce volatile odor constituents. In a
few cases, these are fruity or flowery and may be adapted to attract
arthropod dispersers (e.g. insects carrying the mold conidia to new growth
sites). Usually they are musty or earthy and are probably adapted to deter
grazing and feeding invertebrates and vertebrates, or at least to give a
distinct "not food" odor to mold colonies and their underlying nutritional
substrates. A few such volatiles have been found to be directly irritating
to vertebrates. Apart from experiencing such direct physiological
irritation, humans and other vertebrates may be adapted to avoid such odors,
and there may be a legitimate "psychological" objection to their presence in
rooms. Mold growth in buildings may be accompanied by the growth of
Streptomyces species, which usually have very strong earthy volatile odors.
In addition, in very wet materials, copious bacteria may grow and may emit
typical rotten or sour smelling odor molecules.
Invasive Pathogenesis: Invasive Pathogenesis - Of the regularly
occurring indoor mold proliferation species, only a few have significant
potential as opportunistic pathogens, and even these usually require a
relatively strongly immuno compromised patient before they can be regarded
as dangerous. Warm, moist environments, such as dirty heating ducts affected
by condensation, or vanes and other apparati near heating system
humidifiers, may grow Aspergillus fumigatus, the best known opportunistic
mold fungus. This species also tends to occur in potted plant soils,
particularly where these have not been exchanged for fresh soils (e.g., by
re-potting) for several years. Usually, a patient needs to have a relatively
high degree of neutropenia (deficit in neutrophil type white blood cells, an
essential component of the immune system) before he or she is seriously
threatened with invasive disease by this organism. Most such patients are
persons taking leukemia chemotherapy or drugs designed to prevent rejection
of transplanted organs. Occasionally other predisposing factors are found,
such as heavy, prolonged corticosteroid use. AIDS patients are at little
risk for such diseases unless they develop lymphomas or are taking
potentially neutropenia-inducing drugs such as ganciclovir. In recent years,
because of the emergence of antibiotic-resistant bacteria in hospitals, some
hospitals have begun to send severely neutropenic patients home. These
patients are at high risk of infection by indoor infestations of A.
fumigatus, A. niger, A. nidulans, A. flavus, A. terreus, Pseudallescheria
boydii, Fusarium solani, F. oxysporum, F. moniliforme, F. proliferatum, and
some other species. People who do not have these specific
immuno-compromising conditions, however, are not at significant risk of
invasive disease from any of these fungi (with the possible exception of P.
boydii punctured into the dermis or the eye).
Community Effects: Community Effects - Fungally colonized materials
often support a large population of arthropods, usually fungivorous
(fungus-eating) mites, but also other arthropods such as booklice,
millipedes and beetles (a recent sticky tape sample sent to this author from
the wall of a moldy house contained a lawn of Cladosporium which was being
grazed on by the drugstore beetle, Stegobium panacaea. The insect's faecal
deposits consisted entirely of mold conidia). The growth of the house dust
mite, Dermatophagoides pteronyssimus, in carpets,mattresses and dust
accumulations may be stimulated by growth of xerotolerant (drought-tolerant)
aspergilli such as A. glaucus on human skin scale litter and other dry
household organic particulates. Arthropod body parts and faeces may be
highly allergenic, and house dust mite in particular is well known to be
highly irritating to most asthmatic children.
Medical Evaluation: Medical Evaluation - Individuals with persistent
health problems that appear to be related to fungi or other bioaerosol
exposure should see their physicians for a referral to practitioners who are
trained in occupational/environmental medicine or related specialties and
are knowledgeable about these types of exposures. Infants (less than 12
months old) who are experiencing non-traumatic nosebleeds or are residing in
dwellings with damp or moldy conditions and are experiencing breathing
difficulties should receive a medical evaluation to screen for alveolar
hemorrhage. Following this evaluation, infants who are suspected of having
alveolar hemorrhaging should be referred to a pediatric pulmonologist.
Infants diagnosed with pulmonary hemosiderosis and/or pulmonary hemorrhaging
should not be returned to dwellings until remediation and air testing are
completed. Clinical tests that can determine the source, place, or time of
exposure to fungi or their products are not currently available. Antibodies
developed by exposed persons to fungal agents can only document that
exposure has occurred. Since exposure to fungi routinely occurs in both
outdoor and indoor environments, this information is of limited value.
NOTE:
This web site was developed only to provide general information about
mold inspections and is not intended to be as valid resource for legal
advice, construction advice or medical advice of any kind. For proper legal
advice contact an attorney. For proper construction and remediation advice
contact a remediation contractor. For proper medical advice contact a
physician.
The following excerpts are taken from the New York City Department of Health
and Mental Hygiene web site. To visit their web site for even more
information, click this link:
http://www.ci.nyc.ny.us/html/doh/html/epi/moldrpt1.html
1.1 Health Effects
Inhalation of fungal spores, fragments (parts), or metabolites (e.g.,
mycotoxins and volatile organic compounds) from a wide variety of fungi may
lead to or exacerbate immunologic (allergic) reactions, cause toxic effects,
or cause infections.11, 12, 24
There are only a limited number of documented cases of health problems from
indoor exposure to fungi. The intensity of exposure and health effects seen
in studies of fungal exposure in the indoor environment was typically much
less severe than those that were experienced by agricultural workers but
were of a long-term duration.5-10, 12, 14, 16-20, 25-27 Illnesses can result
from both high level, short-term exposures and lower level, long-term
exposures. The most common symptoms reported from exposures in indoor
environments are runny nose, eye irritation, cough, congestion, aggravation
of asthma, headache, and fatigue.11, 12, 16-20
The presence of fungi on building materials as identified by a visual
assessment or by bulk/surface sampling results does not necessitate that
people will be exposed or exhibit health effects. In order for humans to be
exposed indoors, fungal spores, fragments, or metabolites must be released
into the air and inhaled, physically contacted (dermal exposure), or
ingested. Whether or not symptoms develop in people exposed to fungi depends
on the nature of the fungal material (e.g., allergenic, toxic, or
infectious), the amount of exposure, and the susceptibility of exposed
persons. Susceptibility varies with the genetic predisposition (e.g.,
allergic reactions do not always occur in all individuals), age, state of
health, and concurrent exposures. For these reasons, and because
measurements of exposure are not standardized and biological markers of
exposure to fungi are largely unknown, it is not possible to determine
"safe" or "unsafe" levels of exposure for people in general.
1.1.1 Immunological Effects
Immunological reactions include asthma, HP, and allergic rhinitis. Contact
with fungi may also lead to dermatitis. It is thought that these conditions
are caused by an immune response to fungal agents. The most common symptoms
associated with allergic reactions are runny nose, eye irritation, cough,
congestion, and aggravation of asthma.11, 12 HP may occur after repeated
exposures to an allergen and can result in permanent lung damage. HP has
typically been associated with repeated heavy exposures in agricultural
settings but has also been reported in office settings.25, 26, 27 Exposure
to fungi through renovation work may also lead to initiation or exacerbation
of allergic or respiratory symptoms.
1.1.2 Toxic Effects
A wide variety of symptoms have been attributed to the toxic effects of
fungi. Symptoms, such as fatigue, nausea, and headaches, and respiratory and
eye irritation have been reported. Some of the symptoms related to fungal
exposure are non-specific, such as discomfort, inability to concentrate, and
fatigue.11, 12, 16-20 Severe illnesses such as ODTS and pulmonary
hemosiderosis have also been attributed to fungal exposures.5-10, 21, 22
ODTS describes the abrupt onset of fever, flu-like symptoms, and respiratory
symptoms in the hours following a single, heavy exposure to dust containing
organic material including fungi. It differs from HP in that it is not an
immune-mediated disease and does not require repeated exposures to the same
causative agent. ODTS may be caused by a variety of biological agents
including common species of fungi (e.g., species of Aspergillus and
Penicillium). ODTS has been documented in farm workers handling contaminated
material but is also of concern to workers performing renovation work on
building materials contaminated with fungi.5-10
Some studies have suggested an association between SC and pulmonary
hemorrhage/hemosiderosis in infants, generally those less than six months
old. Pulmonary hemosiderosis is an uncommon condition that results from
bleeding in the lungs. The cause of this condition is unknown, but may
result from a combination of environmental contaminants and conditions
(e.g., smoking, fungal contaminants and other bioaerosols, and water-damaged
homes), and currently its association with SC is unproven.21, 22, 23
1.1.3 Infectious Disease
Only a small group of fungi have been associated with infectious disease.
Aspergillosis is an infectious disease that can occur in immunosuppressed
persons. Health effects in this population can be severe. Several species of
Aspergillus are known to cause aspergillosis. The most common is Aspergillus
fumigatus. Exposure to this common mold, even to high concentrations, is
unlikely to cause infection in a healthy person.11, 24
Exposure to fungi associated with bird and bat droppings (e.g., Histoplasma
capsulatum and Cryptococcus neoformans) can lead to health effects, usually
transient flu-like illnesses, in healthy individuals. Severe health effects
are primarily encountered in immunocompromised persons.24, 28, 29
1.2 Medical Evaluation
Individuals with persistent health problems that appear to be related to
fungi or other bioaerosol exposure should see their physicians for a
referral to practitioners who are trained in occupational/environmental
medicine or related specialties and are knowledgeable about these types of
exposures. Infants (less than 12 months old) who are experiencing
non-traumatic nosebleeds or are residing in dwellings with damp or moldy
conditions and are experiencing breathing difficulties should receive a
medical evaluation to screen for alveolar hemorrhage. Following this
evaluation, infants who are suspected of having alveolar hemorrhaging should
be referred to a pediatric pulmonologist. Infants diagnosed with pulmonary
hemosiderosis and/or pulmonary hemorrhaging should not be returned to
dwellings until remediation and air testing are completed.
Clinical tests that can determine the source, place, or time of exposure to
fungi or their products are not currently available. Antibodies developed by
exposed persons to fungal agents can only document that exposure has
occurred. Since exposure to fungi routinely occurs in both outdoor and
indoor environments this information is of limited value.
1.3 Medical Relocation
Infants (less than 12 months old), persons recovering from recent surgery,
or people with immune suppression, asthma, hypersensitivity pneumonitis,
severe allergies, sinusitis, or other chronic inflammatory lung diseases may
be at greater risk for developing health problems associated with certain
fungi. Such persons should be removed from the affected area during
remediation (see Section 3, Remediation). Persons diagnosed with fungal
related diseases should not be returned to the affected areas until
remediation and air testing are completed.
Except in cases of widespread fungal contamination that are linked to
illnesses throughout a building, a building-wide evacuation is not
indicated. A trained occupational/environmental health practitioner should
base decisions about medical removals in the occupational setting on the
results of a clinical assessment.
Notes and References
1. Bata A, Harrach B, Kalman U, Kis-tamas A, Lasztity R. Macrocyclic
Trichothecene Toxins Produced by Stachybotrys atra Strains Isolated in
Middle Europe. Applied and Environmental Microbiology 1985; 49:678-81.
2. Jarvis B, "Mycotoxins and Indoor Air Quality," Biological Contaminants in
Indoor Environments, ASTM STP 1071, Morey P, Feely Sr. J, Otten J, Editors,
American Society for Testing and Materials, Philadelphia, 1990.
3. Yang C, Johanning E, "Airborne Fungi and Mycotoxins," Manual of
Environmental Microbiology, Hurst C, Editor in Chief, ASM Press, Washington,
D.C., 1996
4. Jarvis B, Mazzola E. Macrocyclic and Other Novel Trichothecenes: Their
Structure, Synthesis, and Biological Significance. Acc. Chem. Res. 1982;
15:388-95.
5. Von Essen S, Robbins R, Thompson A, Rennard S. Organic Dust Toxic
Syndrome: An Acute Febrile Reaction to Organic Dust Exposure Distinct from
Hypersensitivity Pneumonitis. Clinical Toxicology 1990; 28(4):389-420.
6. Richerson H. Unifying Concepts Underlying the Effects of Organic Dust
Exposures. American Journal of Industrial Medicine 1990; 17:139-42.
7. Malmberg P, Rask-Andersen A, Lundholm M, Palmgren U. Can Spores from
Molds and Actinomycetes Cause an Organic Dust Toxic Syndrome Reaction?.
American Journal of Industrial Medicine 1990; 17:109-10.
8. Malmberg P. Health Effects of Organic Dust Exposure in Dairy Farmers.
American Journal of Industrial Medicine 1990; 17:7-15.
9. Yoshida K, Masayuki A, Shukuro A. Acute Pulmonary Edema in a Storehouse
of Moldy Oranges: A Severe Case of the Organic Dust Toxic Syndrome. Archives
of Environmental Health 1989; 44(6): 382-84.
10. Lecours R, Laviolette M, Cormier Y. Bronchoalveolar Lavage in Pulmonary
Mycotoxicosis. Thorax 1986; 41:924-6.
11. Levetin E. "Fungi," Bioaerosols, Burge H, Editor, CRC Press, Boca Raton,
Florida, 1995.
12. Husman T. Health Effects of Indoor-air Microorganisms. Scand J Work
Environ Health 1996; 22:5-13.
13. Miller J D. Fungi and Mycotoxins in Grain: Implications for Stored
Product Research. J Stored Prod Res 1995; 31(1):1-16.
14. Cookingham C, Solomon W. "Bioaerosol-Induced Hypersensitivity Diseases,"
Bioaerosols, Burge H, Editor, CRC Press, Boca Raton, Florida, 1995.
15. Rautiala S, Reponen T, Nevalainen A, Husman T, Kalliokoski P. Control of
Exposure to Airborne Viable Microorganisms During Remediation of Moldy
Buildings; Report of Three Case Studies. American Industrial Hygiene
Association Journal 1998; 59:455-60.
16. Dales R, Zwanenburg H, Burnett R, Franklin C. Respiratory Health Effects
of Home Dampness and Molds among Canadian Children. American Journal of
Epidemiology 1991; 134(2): 196-203.
17. Hodgson M, Morey P, Leung W, Morrow L, Miller J D, Jarvis B, Robbins H,
Halsey J, Storey E. Building-Associated Pulmonary Disease from Exposure to
Stachybotrys chartarum and Aspergillus versicolor. Journal of Occupational
and Environmental Medicine 1998; 40(3)241-9.
18. Croft W, Jarvis B, Yatawara C. Airborne Outbreak of Trichothecene
Toxicosis. Atmospheric Environment 1986; 20(3)549-52.
19. DeKoster J, Thorne P. Bioaerosol Concentrations in Noncomplaint,
Complaint, and Intervention Homes in the Midwest. American Industrial
Hygiene Association Journal 1995; 56:573-80.
20. Johanning E, Biagini R, Hull D, Morey P, Jarvis B, Landbergis P. Health
and Immunological Study Following Exposure to Toxigenic Fungi (Stachybotrys
chartarum) in a Water-Damaged Office Environment. Int Arch Occup Environ
Health 1996; 68:207-18.
21. Montana E, Etzel R, Allan T, Horgan T, Dearborn D. Environmental Risk
Factor Associated with Pediatric Idiopathic Pulmonary Hemorrhage and
Hemosiderosis in a Cleveland Community. Pediatrics 1997; 99(1)
22. Etzel R, Montana E, Sorenson W G, Kullman G, Allan T, Dearborn D. Acute
Pulmonary Hemorrhage in Infants Associated with Exposure to Stachybotrys
atra and Other Fungi. Ach Pediatr Adolesc Med 1998; 152:757-62.
23. CDC. Update: Pulmonary Hemorrhage/Hemosiderosis Among Infants ---
Cleveland, Ohio, 1993 - 1996. MMWR 2000; 49(9): 180-4.
24. Burge H, Otten J. "Fungi," Bioaerosols Assessment and Control, Macher J,
Editor, American Conference of Industrial Hygienists, Cincinnati, Ohio,
1999.
25. do Pico G. Hazardous Exposure and Lung Disease Among Farm Workers.
Clinics in Chest Medicine 1992; 13(2):311-28.
26. Hodgson M, Morey P, Attfield M, Sorenson W, Fink J, Rhodes W, Visvesvara
G. Pulmonary Disease Associated with Cafeteria Flooding. Archives of
Environmental Health 1985; 40(2):96-101.
27. Weltermann B, Hodgson M, Storey E, DeGraff, Jr. A, Bracker A, Groseclose
S, Cole S, Cartter M, Phillips D. Hypersensitivity Pneumonitis: A Sentinel
Event Investigation in a Wet Building. American Journal of Industrial
Medicine 1998; 34:499-505.
28. Band J. "Histoplasmosis," Occupational Respiratory Diseases, Merchant J,
Editor, U.S. Department of Health and Human Services, Washington D.C., 1986.
29. Bertolini R. "Histoplasmosis A Summary of the Occupational Health
Concern," Canadian Centre for Occupational Health and Safety. Hamilton,
Ontario, Canada, 1988.
30. Yang C. P&K Microbiology Services, Inc. Microscopic Examination of
Sticky Tape or Bulk Samples for the Evaluation and Identification of Fungi.
Cherry Hill, New Jersey.
31. American Society of Heating, Refrigerating and Air-Conditioning
Engineers, Inc. Thermal Environmental Conditions for Human Occupancy -
ASHRAE Standard (ANSI/ASHRAE 55-1992). Atlanta, Georgia, 1992.
Aspergillus fumigatus, a well documented allergen, is a common cause of fungal disease in humans and animals causing acute or chronic respiratory tract infections. These fungal balls (masses) were removed with surgery from lungs.