Implications of Detecting the Mold Syncephalastrum in Clinical Specimens of New Orleans Residents After Hurricanes Katrina and Rita

Abstract

After the extensive flooding in New Orleans following Hurricanes Katrina and Rita, thousands of homes in the flooded areas had significant growth of mold. The potential health effects from exposures to these extraordinary environments are unknown. In February 2006, we investigated a cluster of patients with clinical specimens yielding Syncephalastrum, a zygomycete that rarely causes infection. We identified the cases of eight patients from September 12, 2005, to January 12, 2006, with specimens from sputum, bronchoalveolar lavage, endotracheal aspirate, ear swab, and nasal swab. All patients appeared to be transiently colonized without evidence of infection, even among immunosuppressed patients. Only one patient reported significant exposure to mold (working on mold remediation without wearing a respirator) on the day of his incident culture.

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

“…Syncephalastrum spp. were the only thermotolerant Mucormycetes detected in 47% of indoor air samples from heavily damaged houses and in none of the mildly damaged houses in the flooded areas of New Orleans after Hurricanes Katrina and Rita (272,273). Workers in farm operations, particularly those who handle, harvest, and process food and feed after harvest, may be particularly predisposed to exposure to airborne S. racemosum (2).…”

“…The ability of Syncephalastrum species to cause ear infections and mycotic keratitis and isolation of these organisms in wound culture are not clear, as reports have not provided details about such cases (238,324,345). Also, researchers identified a cluster of eight patients with clinical specimens yielding Syncephalastrum isolates after natural disasters (272). All of these patients appeared to have transient colonization of Syncephalastrum spp.…”

“…S. racemosum is considered the only pathogenic species of the genus Syncephalastrum, although three additional taxa have been described (http: //Zygomycetes.org/index.php?idϭ49). Until recently, it has been debated whether this fungus is a true pathogen (301) or merely a contaminant or transient colonizer of the human upper respiratory tract (272,279). The first documented Syncephalastrum infection was described as a cutaneous infection that progressed to arteritis in the dermal vessels and contiguous osteomyelitis in a 50-year-old diabetic man who worked in a tea plantation in India, where Syncephalastrum spp.…”

“…All of these patients appeared to have transient colonization of Syncephalastrum spp. without evidence of infection, even those who were immunosuppressed (272). S. racemosum caused onychomycosis in a 45-year-old man who had injured the nail 7 months before (256) and intra-abdominal infection with a large abdominal wound in a previously healthy 23-year-old man who fell and was impaled on a steel reinforced rod (301).…”

Mold Exposure and Health Effects Following Hurricanes Katrina and Rita

“…A case series by Rao et al showed an increase in the isolation of Syncephalastrum spp. in clinical specimens of New Orleans residents in one area hospital following the hurricanes (40). All eight of the clinical specimens were believed to be colonization and not true infection because all patients improved with treatment for other illnesses and without appropriate treatment for Syncephalastrum.…”