Indoor Mold, Toxigenic Fungi, and Stachybotrys chartarum

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http://cmr.asm.org/cgi/content/abstract/16/1/144

JAMA

Indoor Mold, Toxigenic Fungi, and Stachybotrys chartarum: Infectious

Disease Perspective

D. M. Kuhn1,2,3 and M. A. Ghannoum2,3*

Division of Infectious Diseases, Department of Medicine,1 Center for

Medical Mycology, Department of Dermatology,2 University Hospitals of

Cleveland, and Case Western Reserve University, Cleveland, Ohio 441063

Damp buildings often have a moldy smell or obvious mold growth; some

molds are human pathogens. This has caused concern regarding health

effects of moldy indoor environments and has resulted in many studies

of moisture- and mold-damaged buildings. Recently, there have been

reports of severe illness as a result of indoor mold exposure,

particularly due to Stachybotrys chartarum. While many authors

describe a direct relationship between fungal contamination and

illness, close examination of the literature reveals a confusing

picture. Here, we review the evidence regarding indoor mold exposure

and mycotoxicosis, with an emphasis on S. chartarum. We also examine

possible end-organ effects, including pulmonary, immunologic,

neurologic, and oncologic disorders. We discuss the Cleveland infant

idiopathic pulmonary hemorrhage reports in detail, since they

provided important impetus for concerns about Stachybotrys. Some

valid concerns exist regarding the relationship between indoor mold

exposure and human disease. Review of the literature reveals certain

fungus-disease associations in humans, including ergotism (Claviceps

species), alimentary toxic aleukia (Fusarium), and liver disease

(Aspergillys). While many papers suggest a similar relationship

between Stachybotrys and human disease, the studies nearly uniformly

suffer from significant methodological flaws, making their findings

inconclusive. As a result, we have not found well-substantiated

supportive evidence of serious illness due to Stachybotrys exposure

in the contemporary environment. To address issues of indoor mold-

related illness, there is an urgent need for studies using objective

markers of illness, relevant animal models, proper epidemiologic

techniques, and examination of confounding factors.

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* Corresponding author. Mailing address: Center for Medical Mycology,

University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH

44106. Phone: (216) 844-8580. Fax: (216) 844-1076. E-mail:

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