Toxic Molds - The Killer Within Us

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Toxic Molds - The Killer Within Us

Indoor Toxic Molds And Their Symptoms

by Nachman Brautbar, M.D, Experts.com

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In the outdoor environment molds are ubiquitous. Moist conditions

involving drywall, wood, carpeting, or paper material are the

proliferation medium in the indoor environment for toxic molds.

Since Americans spend 75 to 90% of their time indoors, the risk of

exposure to toxic molds that may grow indoors is increased (R- 1).

Toxic molds enter the indoor environment through doorways, windows,

heating and ventilation systems, and air conditioning systems, given

the appropriate circumstances. Spores from toxic molds in the air

deposit on people, animals, clothing, shoes, and bags, turning them

into common and potential carriers of toxic molds into the indoor

environments (home and office) (R-2).

Indoor environments that contain excessive moisture such as leakage

from roofs, walls, plant pots, or pet urine cause proliferation and

development of molds. The most common molds which are found indoor

are Cladosporium, Penicillium, and Aspergillus. In order to

proliferate, molds need nutrients which are commonly present in

building environments such as cellular substrates in paper, paper

products, cardboard, ceiling tiles, wood, wood products, drywall,

carpet, fabric, insulation materials, wallpaper, paints, and dusts.

Some of the indoor molds have the potential to produce extremely

toxic materials called toxic mycotoxins (R-3, 4). Those toxic molds

which have the potential of producing toxic materials include

Fusarium and Stachybotrys, among others.

Depending on the quantities produced and consumed, mycotoxins can

cause acute or chronic toxicity in animals and humans. Home dampness

with resulting mold growth may be associated with several medical

conditions (one or sometimes all) including immediate

hypersensitivity reaction, hypersensitivity pneumonia, or what has

been described as & quot;humidifier fever & quot;. Clinically, I see

these patients with recent onset asthma, recent onset sinusitis,

and/or recent onset skin rashes (R-5, 6). Several studies have shown

a clear correlation and association between the occurrence of molds

in the inside air environment, dampness in the indoor environment,

and the symptomatology of the skin, and respiratory tract,

especially in children. This has been summarized in an interesting

study published in the American Journal of Epidemiology by E.

Dales (R-7).

Since the symptoms in this study were comparable to the symptoms

described with humidifier fever and mycotoxicosis, the authors

suggested a common pathogenic and etiological mechanism (R-7, 8),

toxic molds being one.

The role of indoor molds, especially the most toxic one -

Stachybotrys, has been shown recently in a scientific paper

published in the journal Pediatrics R-9). The authors described a

child with pulmonary hemorrhaging where Stachybotrys was isolated

from the lung. Indeed, epidemiological data to support the

connection between toxic mold exposure and lung hemorrhage was

published in the scientific literature from Cleveland, Ohio, which

was later examined by the Center for Disease Control (R-10, 11).

The scientific data clearly demonstrates a high spore count of the

toxic mold Stachybotrys in 9 out of 10 of the houses where these

infants lived, and 5 infants had recurrence of the bleeding of the

lungs on reentry to their homes, implicating that the fungus is a

potential agent in the pathogenesis of infantile pulmonary

hemorrhage. The study by Okan Alidemir, et al, (R-9) shows the

isolation of the toxic mold Stachybotrys atra from the BAL fluid of

a child with pulmonary hemorrhage, thus connecting the

epidemiological data and the historical data in this case report

with objective findings of Stachybotrys from lung fluids. In the

scientific paper entitled & quot;Stachybotrys: Mycotoxin Producing

Fungus of Increasing Toxicological Importance & quot; (R-12), the

investigators concluded & quot;Current data on the toxicology of

mycotoxins produced by Stachybotrys demonstrates that this group of

mycotoxins is capable of producing immunosuppression and

inflammatory insults to the gastrointestinal and pulmonary

system & quot;.

While it is an ideal situation to have & quot;statistical

firmness & quot;, in medicine the clinician establishes a diagnosis

and causation based an known and accepted factors where statistical

firmness is not a prerequisite. (R-13, 14). The causal clinical

association between allergic reaction to the sinuses in the form of

rhinitis, sinusitis, or asthma and indoor air mold exposure has been

very well documented in the scientific literature in an early review

by Gravesen (R 15).

That indoor moisture and toxic molds represents a public health

issue is described in the scientific paper by Hodgson (R- 16). These

authors report an outbreak of disease associated with exposure to

these toxic molds in 2 buildings in Florida.

The specific buildings were a new court house and office building

which were constructed between 1986 and 1989. Within weeks after

moving in patients described mucous: membrane irritation fatigue.

headaches. and chest tightness. Moisture problems such as window and

roof leaks have been described as starting in 1987 and persisting

through 1992. Utilizing epidemiological methodology the

investigators concluded that this outbreak represents a likely human

response to inhaled fungal toxins in indoor air environments.

What to do when you suspect toxic molds as a cause for

symptomatology.

First and most importantly is to see a doctor who specializes in the

fields of internal medicine, occupational medicine and toxicology

with the understanding of building-related illnesses and, toxic

molds. The doctor will have to rule out other diseases, perform

laboratory studies, and provide an opinion as to whether these

symptoms can be and have been described with toxic molds. Upon

determination that these symptoms may be related to mold exposure,

you should have an industrial hygienists inspect your residence or

alternatively office/work place (depending on where the suspected

mold resides) to do a careful investigation of any water damages,

and air counts both inside and outside at several locations for

toxic molds and spores.

A well-trained industrial hygienist will not only take air counts

but also will go under and behind the walls and/or carpeting where

the water damage is anticipated to be in order to further evaluate

for mold spores and mold growth. Once toxic molds are discovered,

depending on the damage that occurred, either expert remediation

(with appropriate protective devices and removal of the inhabitants

from the area) or at times destruction and rebuilding of the damaged

house or building area is necessary.

During the last 5 years I have treated patients with various mold

related illnesses contracted at either industrial buildings such as

old buildings, schools, and governmental offices, as well as

residences, all of which have suffered either faulty ventilation,

water damages, or both. The most common presenting symptoms are

those of 1) cough, 2) asthma, atypical asthma, 3) nasal congestion,

4) sinusitis/rhinitis, 5) skin rashes, and 6) generalized fatigue.

On many occasions the patients presented with neurological symptoms

such as headaches, reduced concentration ability, and memory loss.

The patients may present with only one symptom (such as sinusitis)

or a combination of symptoms. For causation determination the doctor

should use the methodology commonly used in diagnosing and treating

this condition and utilize, among others, careful review of other

causes, temporal relationship, and a biological plausibility that

mold can cause these types of diseases.

References

Leibowitz MD, Health Effects of Indoor Pollutants, Annual Review of

Public Health, I 983, Volume 4, 203-221

JD, Fungi as Contaminants in Indoor Air, Atmospheric

Environment 1992, Volume 26, 2163-2172

Burge HA, Toxicogenic Potential of Indoor Microbial Indoor Aerosols,

In: Short-Term BioAssays in the Analysis of Complex Environmental

Mixtures, NY, NY, Plano Press, 1987

Henry KM, et al, A Review of Mycotoxins in Indoor Air, Journal of

Toxicology and Environmental Health, 1993, Volume 38, pages 183-198

JH, et al, Humidifier Fever, Thorax, 1977, Volume 32, 653-663

Arundel AV, et al, Indirect Health Effects of Relative Humidity in

Indoor Environment, Environmental Health Perspective, 1986, Volume

65, pages 351-361

Dales RE, Respiratory Health Effects of Home Dampness and Molds

Among Canadian Children, American Journal of Epidemiology, Volume

134, Number 2, pages 196-203

May JJ, et al, Organic Dust Toxicity, Pulmonary Mycotoxicosis

Associated with Silo Unloading, Thorax, 1986, Volume 41, pages 919-

923

Okan Alidemir, et al, Pediatrics, 1999, Volume 104, pages 964-966

Montana E, et al, Pediatrics, 1997, Volume 99(1)

Atzel RA, et al, Acute Pulmonary Hemorrhage in Infants Associated

with Exposure to Stachvbotrys, Stachybotrys Atra and Other Fungi.

Archives of Pediatrics and Adolescent Medicine, 1998, Volume 152,

pages 757-762

Stachybotrys: Mycotoxin Producing Fungus of Increasing Toxicological

Importance, Clinical Toxicology, Volume 36, pages 79-86, 1998

Brautbar N, Science and the Law: Scientific Evidence, Causation,

Admissibility, Reliability - " Daubert " Decision Revisited,

Toxicology and Industrial Health, 1999, Volume 15, pages 532-551

Brautbar N, Scientific Evidence, Chapter 15, pages 92- 121, In:

Ethics in Forensic Science and Medicine, MA Schiffman (ed),

C. Publisher, Ltd, 2000

Gravesen S, Fungi as a Cause for Allergic Disease, Review Article,

Allergy, 1979, Volume 34, pages 135-154 Hodgson, Building-Associated

Pulmonary Disease from Exposure to Stachybotrys Chartarum and

Aspergillus Versicolor, Journal of Occupational and Environmental

Medicine, Volume 14, Number 3, March 1998, pages 241-249

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Nachman Brautbar, M.D. is a board-certified internist and

nephrologist, with a specialization in toxicology. His list of

academic appointments include Associate Professor of Pharmacology

and Clinical Professor of Medicine at the University of Southern

California, School of Medicine. He specializes in the toxicological

and internal medicine aspects of injury in the workplace, product

liability, personal injury, standard of care.

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