Building-associated pulmonary disease from exposure to stachybotrys
chartarum and aspergillus versicolor
MJ, Morey P, Leung W-Y, Morrow L, Miller D, Jarvis BB, Robbins H, Halsey
JF, Storey E. Journal of Occupational and Environmental Medicine.
March, 1998; 40(3):241-249.
Purpose: The authors investigate the outbreak of discomfort
related to Stachybotrys chartarum and Aspergillus species among
employees of the same building.
Design: Case series. A courthouse and two office buildings
underwent wall and air sampling throughout its heating, ventilation, and
air conditioning ("HVAC") systems. Over 90% of employees answered a
simple questionnaire. Employees complaining of health problems underwent
full pulmonary function testing. Additional subsets of employees
received antibody workups and psychological testing. Two buildings of
similar size and age were used as controls, although they were not
evaluated in the same fashion as the case buildings (i.e., the
ventilation systems were not evaluated in one control building and air
quality was not systematically evaluated in either control building).
Data for subjects in the control buildings were collected when
Outcome: The authors described a series of building problems,
which they perceived as leading to water intrusion through the walls and
condensation in the HVAC system over a five year period. Mold was
detected visually and by odor throughout the buildings. They also
reported reservoirs and growth sites of A. versicolor and S. chartarum
occurring in many areas of the ceiling, perimeter walls, and flooring of
the courthouse complex. The authors also stated that Satratoxins G and H
were identified on moldy ceiling tiles. The patients reported symptoms
including lethargy, headache, dry throat, stuffy nose, eye dryness and
irritation, and difficulty breathing. The authors stated that the
employees from the courthouse were much more likely to pick several of
these symptoms than those who were taken from the control buildings. The
authors were unable to document objective findings in the individuals
with complaints. Three subjects reported asthma-like symptoms, although
only one had a decreased FEF25-75. Seven of the sixteen workers
reporting symptoms of interstitial lung disease ("ILD") were smokers.
There was no correlation between any of the immunology tests and any of
the agents detected in air or wall samples. There was no radiologic
evidence of fibrosis. There was no measurable evidence of cognitive
disfunction in individuals from the contaminated buildings, although
patients with ILD symptoms reported more stress, anxiety and depression.
Significant Quotes: "Chemical analyses demonstrated the presence
of satratoxins G and H. Cytotoxic laboratory analyses demonstrated the
presence of agents with biological effectiveness in bulk materials. This
outbreak represents a likely human response to inhaled fungal toxins in
indoor environments. Moisture indoors represents a public health issue
currently inadequately addressed by building, health, or housing codes."
"Overall, the results do not support the hypothesis of lower cognitive
function among cases." (p. 246).
Peer Review: Yes.
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