Sick Building Syndrome. III.Stachybotrys chartarum

Abstract

Increasingly, physicians are being asked to evaluate patients with putative environmentally associated illnesses. These can include a variety of problems, including infectious illnesses (Legionnaire's disease), chemical exposure in the workplace, and sick building syndromes. The latter has been an issue particularly in asthma because of the association of mold and increased bronchial responsiveness. Recently, attention has been focused on the mold Stachybotrys in human disease. Stachybotrys was first identified more than 60 years ago following an epidemic of stomatitis, rhinitis, conjunctivitis, pancytopenia, neurologic disorders, and death in horses. Since then, Stachybotrys has been identified in several outbreaks of disease in animals. It has also attracted attention as a possible agent in idiopathic pulmonary hemorrhage in infants. Stachybotrys is a relatively uncommon fungus but has been isolated from a variety of sources, including contaminated grains, tobacco, indoor air, insulator foams, and water-damaged buildings with high humidity. This fungus is particularly important because it is one of a series of fungi that produces trichothecenes mycotoxins; these mycotoxins are biologically active and can produce a variety of physiological and pathologic changes in humans and animals, including modulation of inflammation and altered alveolar surfactant phospholipid concentrations. The presence of Stachybotrys in a building does not necessarily imply a cause-and-effect relationship with illness, but should alert physicians and healthcare professionals to do more vigorous environmental testing. Guidelines are presented herein for intervention measures in the maintenance of heating, ventilation, and air-conditioning systems.

Indoor Mold, Toxigenic Fungi, andStachybotrys chartarum: Infectious Disease Perspective

“…Brunekreef et al (47) found a similar pattern in Ͼ6,000 children in six states in the United States and reported home dampness was a strong predictor of respiratory and other illness in this age group. The list of putative symptoms generally consists of upper respiratory complaints, including headache, eye irritation, epistaxis, nasal and sinus congestion, cough, "cold and flu" symptoms, as well as generalized gastrointestinal complaints (240). Taskinen et al (409,410) reported an increased prevalence of asthma in moisture-affected schools, although there were no objective measurements of respiratory disease.…”

“…Many purported fungal volatiles are in fact common and are not unequivocally fungal in origin (267). While some true mycotoxins have been detected in indoor air, this has usually been in the context of heavy industrial contamination (240,295). Although it is occasionally possible to collect mycotoxins by using air filters followed by extraction (318,388), they are usually isolated from inert dust or building materials (9, 79,111,267,294).…”

“…The American Association of Pediatrics produced guidelines in the wake of the Cleveland IPH story (7a), again without substantial evidence. More moderate recommendations (while recognizing that the presence of fungi does not necessarily imply illness) would appear reasonable (240). These could include maintaining heating, ventilation, and air conditioning (HVAC) systems, controlling humidity, inspecting and repairing water damage and other sources of contamination, regularly cleaning the home environment with dust removal, cleaning carpets, removing visible mold growth, and formulating guidelines to standardize the levels of fungal and bacterial contamination.…”

Effect of Chlorine Dioxide Gas on Fungi and Mycotoxins Associated with Sick Building Syndrome

“…These organisms have been found in buildings with indoor air quality problems (3,12,13). We also looked at the effect of the gas treatment on mycotoxins produced by S. chartarum.…”

Mold Hysteria: Origin of the Hoax

“…The Sick Building Syndrome is a poorly defined clinical entity that is used to describe a constellation of complaints that occur in groups of office workers, in which the complaints are attributed to being present in the building (Chang et al 1993, Ueno et al 1986, Chang et al 1994, Mahmoudi and Gershwin 2000, Assoulin-Daya et al 2002, Tsai and Gershwin 2002. The symptoms described are numerous, and are frequently different from person to person.…”