Pulmonary hemorrhage/hemosiderosis

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Pulmonary hemorrhage/hemosiderosis due to a fungal agent (Stachybotrys

atra ) is not included in CCDM. This newly recognized disease in infants,

reported below, has been associated with mold growth in homes damaged by

water. During the winter of 1996-97, several regions of the United States

have experienced severe storms and/or extensive flooding so the possibility

of additional cases of pulmonary hemorrhage in infants due to Stachybotrys

atra may occur. Public health and medical workers should be aware of this

potential risk to infants.

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PULMONARY HEMORRHAGE/HEMOSIDEROSIS AMONG INFANTS

Between January 1993 and December 1994, 10 cases of acute pulmonary

hemorrhage/hemosiderosis were identified in eastern metropolitan Cleveland.

All required hospitalization and one infant died. Active surveillance by

Rainbow Babies and Childrens Hospital identified an additional 11 cases of

pulmonary hemorrhage/hemosiderosis during January 1995-December 1996, and of

these 2 infants died.

A case-control study was made to determine the risk factors for acute

pulmonary hemorrhage among the first cluster of 10 cases. A case was defined

as an episode of acute, diffuse pulmonary hemorrhage of unknown etiology

during the first year of life in a previously healthy infant that required

hospitalization. All 10 cases and 7 of 30 controls resided in homes where

major water damage--due either to chronic plumbing leaks or flooding--had

occurred during the previous 6 months. This finding prompted a visual

inspection and quantitative air sampling for microscopic identification of

fungi in the study homes. The quantity of fungi, including the toxigenic

fungus Stachybotrys atra, was higher in the homes of case-infants than in

those of controls. Health authorities in Cleveland recommended prompt

clean-up and disposal of all moldy materials in the water damaged homes.

The water damage in the homes of cases may have promoted the growth of

fungi, including S. atra. Because S. atra requires water-saturated cellulose

based materials for growth, it is not commonly found in homes. Although S.

atra has been associated with gastrointestinal hemorrhaging in animals that

had consumed moldy grain, the fungus previously has not been associated with

disease in infants.

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REFERENCES

1. CDC. Update: pulmonary hemorrhage/hemosiderosis among infants--Cleveland,

Ohio, 1993-1996. MMWR 1997; 46:33-35

2. CDC. Acute pulmonary hemorrhage/hemosiderosis among infants--Cleveland,

January 1993-November 1994. MMWR 1994; 43:881-883.

3. Hintikka E-L. Stachybotryotoxicosis as a veterinary problem. In: Rodricks

JV, Hesseltine CW, Mehlman MA, eds. Mycotoxins in human and animal health.

Park Forest South, Illinois: Pathotox Publishers, 1977:277-284.