Acute Pulmonary Hemorrhage in Infants Associated With Exposure to Stachybotrys atra and Other Fungi

Etzel, Ruth A.; Montaña, E; Sorenson, W. G.; Kullman, Greg; Allan, Terrence; Dearborn, Dorr Gellatly

doi:10.1001/archpedi.152.8.757

Cited by 248 publications

(146 citation statements)

References 26 publications

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“…The vast majority of cases occurred within a very small geographic area of the city. Case homes tended to have a higher prevalence of water damage (22) and higher quantities of toxigenic S. chartarum (23). Strains of S. chartarum isolated from both case and control homes were shown to be toxigenic, but there was no correlation between toxigenicity of the isolate and source, i.e., case versus control.…”

Section: Mycotoxins and Mycotoxigenic Fungimentioning

confidence: 89%

Fungal spores: hazardous to health?

Sorenson

1999

Environ Health Perspect

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Fungi have long been known to affect human well being in various ways, including disease of essential crop plants, decay of stored foods with possible concomitant production of mycotoxins, superficial and systemic infection of human tissues, and disease associated with immune stimulation such as hypersensitivity pneumonitis and toxic pneumonitis. The spores of a large number of important fungi are less than 5 microm aerodynamic diameter, and therefore are able to enter the lungs. They also may contain significant amounts of mycotoxins. Diseases associated with inhalation of fungal spores include toxic pneumonitis, hypersensitivity pneumonitis, tremors, chronic fatigue syndrome, kidney failure, and cancer.

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Section: Mycotoxins and Mycotoxigenic Fungimentioning

confidence: 89%

Fungal spores: hazardous to health?

Sorenson

1999

Environ Health Perspect

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“…A series of articles linking environmental exposure to fungi (especially Stachybotrys atra) in water-damaged houses in Cleveland, OH, USA and infantile pulmonary haemosiderosis led to an extensive investigation of possible infectious or mycotoxigenic pathogenesis [46][47][48][49][50][51][52][53][54][55][56][57][58]. The postulated mechanism is that fungal toxins called trichotecens, which are potent protein synthesis inhibitors, impede the angiogenesis underneath the rapidly forming alveolar membranes, making the acinar region prone to bleeding.…”

Section: Environmental Theorymentioning

confidence: 99%

“…During the remission, the alveolar infiltrates tend to be reabsorbed and interstitial reticular and micronodular patterns of opacities ensue in the same areas, with variable degree of fibrosis [80]. Tc-or 51 Cr-based perfusion scans can demonstrate intraalveolar bleeding [81][82][83][84][85][86], but their utility in clinical practice remains extremely low.…”

Section: Imaging Studiesmentioning

confidence: 99%

Idiopathic pulmonary haemosiderosis revisited

Ioachimescu¹,

Sieber²,

Kotch³

2004

European Respiratory Journal

205

199

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Idiopathic pulmonary haemosiderosis is a rare cause of diffuse alveolar haemorrhage of unknown aetiology. It occurs most frequently in children, has a variable natural history with repetitive episodes of diffuse alveolar haemorrhage, and has been reported to have a high mortality. Many patients develop iron deficiency anaemia secondary to deposition of haemosiderin iron in the alveoli.Examination of sputum and bronchoalveolar lavage fluid can disclose haemosiderinladen alveolar macrophages (siderophages), and the lung biopsy shows numerous siderophages in the alveoli, without any evidence of pulmonary vasculitis, nonspecific/ granulomatous inflammation, or deposition of immunoglobulins. Contrary to earlier reports, corticosteroids alone or in combination with other immunosuppressive agents may be effective for either exacerbations or maintenance therapy of idiopathic pulmonary haemosiderosis.

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“…High exposure levels of airborne pathogenic fungi in the work environment have been reported among farmers, woodworkers, and composting waste workers but may also be found among hospital and office workers or occupants of homes with significant water damage or with defective ventilation systems (4)(5)(6)(7). In recent medical/epidemiologic investigations, an association has been described between high exposure to S. chartarum and toxic inflammatory effects in infants (8)(9)(10), in office workers handling moldy paper materials and breathing fungal-contaminated air (11,12), and in courthouse workers (13). These effects are thought to be related to toxic metabolites (mycotoxins) produced by certain fungi such as those in the genera Stachybotrys, Aspergillus versicolor, Penicillium, Trichoderma, and Fusarium. S. chartarum appears clinically important because it produces biologically very potent mycotoxins such as trichothecenes (i.e., satratoxins) and spirolactons that interfere with protein synthesis on the DNA level and the cellular or humoral immune system in in vitro systems (14,15).…”

mentioning

confidence: 99%

Clinical experience and results of a Sentinel Health Investigation related to indoor fungal exposure.

Johanning

Landsbergis

Gareis

et al. 1999

Environ Health Perspect

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This is a review of exposure conditions, clinical presentation, and morbidity of children and adults with indoor fungal exposure such as toxic Stachybotrys chartarum. Indoor exposure was characterized using different methods including microscopic, culture, cytotoxicity screening tests, and chemical analyses. Clinical case histories and physical and laboratory findings are presented of children (age < 18 years, n = 22; mean age 9 years; 60% females) and adults (age > 18 years, n = 125; mean age 39 years, 67% females) who consulted an environmental health specialty clinic. In the pediatric patients' exposure history, widespread fungal contamination of water-damaged building materials with known toxic or allergic fungi was identified. Primarily disorders of the respiratory system, skin, mucous membranes, and central nervous system were reported. Some enumeration and functional laboratory abnormalities, mainly of the lymphatic blood cells, were observed, although no statistically significant differences were found. IgE or lgG fungi-specific antibodies, used as exposure markers, were positive in less than 25% of all tested cases. In an evaluation of a symptomatic girl 11 years of age (sentinel case investigation) living in an apartment with verified toxigenic fungi (i.e., S. chartarum), several health indicators showed improvement after exposure cessation.

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Acute Pulmonary Hemorrhage in Infants Associated With Exposure to Stachybotrys atra and Other Fungi

Cited by 248 publications

References 26 publications

Fungal spores: hazardous to health?

Fungal spores: hazardous to health?

Idiopathic pulmonary haemosiderosis revisited

Clinical experience and results of a Sentinel Health Investigation related to indoor fungal exposure.

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