Re: Chronic Environmental exposure to Alternaria tenuis may manifest symptoms of neuropsychological illnesses: A study of 12 Cases.

[Guest guest]

This study should be named, A ROLLING UTERUS GATHERS MOSS, JUST NOT

FROM THE INDOOR WORKPLACE

B.

--- In , LiveSimply <quackadillian@...>

wrote:

>

> Journal of Applied Sciences & Environmental Management, Vol. 9, No.

3,

> 2005, pp. 45-51

>

> http://www.bioline.org.br/request?ja05057

>

> Chronic Environmental exposure to Alternaria tenuis may manifest

> symptoms of neuropsychological illnesses: A study of 12 Cases.

>

> 1*ANYANWU, E C; 2KANU, I, 1NWACHUKWU, N C; 1SALEH, M A

>

> 1Department of Chemistry, Environmental Toxicology Program, Texas

> Southern University, Houston, Texas, USA.

> 2Department of Microbiology, AbiaStateUniversity, Uturu, Abia

StateNigeria

>

> Code Number: ja05057

>

> ABSTRACT:

>

> Toxigenic mold exposures are shown to lead to illnesses most of

which

> are just being unraveled. This paper reports the findings in cases

of

> 12 white female office workers who presented with symptoms of

> neuropsychological illnesses, most likely, due to indoor

environmental

> toxigenic mold exposures. Their major complaints were: weakness and

> numbness in legs, dizziness, loss of memory, light-headedness and

> vertigo, fatigue, getting lost in familiar territory, and confused

> thoughts. The subjects were evaluated by testing immunologic, basic

> EEG, and comprehensive neuropsychological tests. Abnormal

antibodies

> to Alternaria tenuis, Pullularia pullulans, and Epicoccum nigrum

> antigens were found in all the subjects' serum, and they were quite

> different from the abnormal levels of Aspergillus, Stachybotrys, and

> Penicillium, Cladiosporium genera found in their indoor environment.

> EEG examination was abnormal all the subjects with 10 Hz posterior

> dominant activities in 6 out of 12, which were synchronous,

> symmetrical and attenuated on eye opening and eye-closure. There was

> an evidence of tremor of the extremities in 3 subjects. These

> particular subjects' reflex was abnormal, and they had accommodation

> paresis. Gross neuropsychological abnormalities including those

> observed in the brain-damaged population and significantly below

> non-brain damaged functioning was observed. These findings seem to

> indicate that chronic exposures to Alternaria tenuis, Pullularia

> pullulans, and Epicoccum nigrum might have neuropsychological

effects,

> and that most likely, only one abnormal antibody to toxigenic mold

> antigen could have the most dominant adverse toxic exertion leading

to

> the observed neuropsychological effects. It is concluded therefore,

> that chronic exposures to certain toxigenic molds might lead to

> neuropsychological manifestations and that although, it is

> acknowledged that the contaminations of the indoor environment by

> toxigenic molds are directly related to the adverse health effects

on

> the occupants, there could be a situation where such relationship

does

> not exist. @JASEM

>

> Indoor environmental air quality has taken a center stage in public

> health discussions to which chronic exposures to toxigenic molds

share

> greater concerns than other indoor environmental contaminants.

Hence,

> there is increasing evidence of health risks associated with damp

> buildings and homes in which high levels of toxigenic molds are

found

> to grow. Pieces of evidence are also accumulating that support the

> views that certain toxigenic molds are particularly a risk factor

for

> adverse human health through exposure and inhalation of fungal

spores

> (Jarvis, 2002). Several residential homes are contaminated by these

> toxigenic molds consequent upon which illnesses such as pulmonary

> hemosiderosis in infants have been reported (Jarvis et al., 1996;

> Flappan et al., 1999). It is also believed that such illnesses are

> due, at least in greater part, to the mycotoxins produced by the

> toxigenic molds. Although, the extent to which mycotoxins affect

the

> human health is still emerging, certain mold mycotoxins could be

> contributory to a significant number of neuropsychological illnesses

> than one would have imagined.

>

> For infants, the elderly, and persons living or working in " at high

> risk " urban areas the occurrence of illnesses due to toxigenic mold

> exposures may be high, depending on the type of mold and the

> individual health variations. However, what makes a full

> understanding of the processes that lead to the action mechanism of

> mycotoxins in humans very difficult is the fact that there are

several

> species of toxigenic molds that produce different toxic metabolites

> that are capable of exerting different toxicological effects.

>

> Cases of 12 white female office workers aged between 24 and 52 years

> who presented with symptoms of neuropsychological illnesses, most

> likely, due to indoor environmental toxigenic mold exposures were

> comprehensively investigated. They all complained of weakness and

> numbness in both legs and had some episodes of vagal experiences

with

> exertion. She described symptoms of dizziness and loss of memory,

> light-headedness and vertigo, fatigue and a general cognitive

> dysfunction. Four out 12 subjects had seen therapists in the past

for

> depression. Eight out of 12 complained of getting lost in a

familiar

> territory and had troubles getting words out at times and putting

> their thoughts together. Initial clinical impression was subjective

> memory dysfunction and possible aphasic symptoms without obvious

> abnormality and pseudodementia.

>

> In the year 2000, she moved into a home that was found to contain

> abnormal levels of toxigenic molds that included: Aspergillus,

> Stachybotrys, and Penicillium, and Cladiosporium genera. A private

> environmental laboratory that used microscopic, culture, and

chemical

> techniques performed the toxigenic mold exposure characterization

and

> quantification. What was very unique about the patient was that all

> the members of her family including their pet dog manifested similar

> behavioral changes. On the advice of Insurance r and the

> company that tested the home, she consequently moved out of her home

> almost 2 months later. She was initially placed on Wellbutrin and

> later she was tried on Topomax to which she complained of feeling

> dizzy and so, stopped the medication. Although, she found a

temporary

> relief at that time, her major conditions persisted with increasing

> loss of memory, neuropsychological problems, and allergic reactions.

>

> The patient reported that she had marital difficulties and that the

> family business where she worked was sold without her knowledge and

> felt she did not have any meaningful occupational satisfaction. She

> had sleep disturbances and was stressed out significantly as a

> consequence. She reported being tested at the age of 30 for

learning

> disability. She had problems with muscular weakness, muscle and

joint

> ache, twitching muscles, painful lymph nodes and short of breath.

It

> was not inconceivable at that time she might have had mild cognitive

> impairment associated with an early dementing illness or metabolic

> encephalopathy. MRI investigation found herniated disc with no

other

> explanation, although, there was an indication of significant damage

> to the parietal and frontal lobes of the brain.

> MATERIALS AND METHODS

>

> The patient was given comprehensive examinations to make sure that

> their health conditions were fully evaluated. These examinations

> included: the review of the patients' medical records, basic EEG

> examinations including awake and asleep, photic stimulation, and

> hyperventilation. Immunologic examination of the patient's blood

> samples was done, using enzyme-linked immunoabsorbent assay (ELISA)

> methods, Johanning et al., 1996). The psychological evaluation was

> administered using a number of tests within the following cognitive

> and neuropsychological domains (Wechsler1981; 1987; Rosenberg et

al.,

> 2002): the Wechsler Adult Intelligence Test-III, Wechsler Memory

> Scale, Luria-Nebraska Neuropsychological Battery, Trail making B

Test,

> Stroop Neuropsychological Test, Rey Auditory Memory Test, Mental

> status Examination, Beck Depression Scale, the Minnesota multiphasic

> personality inventory (MMPI), and Test of Proverbs. The reason for

> the comprehensive test battery was to measure the intellectual

> functioning yields (verbal), performance (nonverbal), and Full-Scale

> IQ scores. The outcomes of these tests played a greater role in

> ascertaining whether the patient's condition was due to an

underlying

> biogenic brain abnormality or attributable to the chronic toxigenic

> mold exposures alone.

> RESULTS

>

> Immunologic examination: Most of the immunologic parameters, though,

> outside the purpose of this paper, were abnormal. However, abnormal

> IgG antibodies to Alternaria tenuis, Epicoccum nigrum, and

Pullularia

> pullulans antigens, but none of the toxigenic molds found indoor

were

> observed. Hence, there was no correlation between the toxigenic

molds

> found indoor with the abnormal antibodies to the three toxigenic

mold

> antigens found in the patient's serum (Table 1). IgG titers greater

>

> 1600 found in the patient were suggestive of chronic exposure to all

> the three fungi.

>

> Table 1. Abnormal antibodies to Alternaria tenuis, Pullularia

> pullulans, and Epicoccum nigrum mycotoxins mold antigens found in

the

> patient with neuropsychological impairments. Antibodies to all other

> toxigenic molds were within normal values.

>

> Test for antibodies

>

>

> Abnormal values

>

>

> ReferenceRange

>

> IgG Alternaria tenuis

>

>

> 4800

>

>

> 0-1600

>

> IgG Epicoccum nigrum

>

>

> 10600

>

>

> 0-1600

>

> IgG Pullularia pullulans

>

>

> 2700

>

>

> 0-1600

>

> Physiological examination: EEG examination showed 10 Hz posterior

> dominant activities, which were synchronous, symmetrical and

> attenuated on eye opening and eye-closure. Neither lateralized and

> generalized background slowing, nor spike or sharp wave discharges

> foci were identified. Also, hyperventilation did not alter the

> background rhythm. Stage I sleep was recorded and the Awake EEG was

> apparently normal. Her grip meter readings were L = 29; R = 30 and

she

> was unable to hold steady against the grid. There was an evidence of

> tremor of the extremities. Her reflex was abnormal, and she had

> accommodation paresis, arthralgia/joint pain, cough, fatigue,

> headache, immune mechanism disorder, memory loss, mycosis, severe

> muscular weakness, mood swing, intolerance to alcohol, personality

> changes, anxiety, attention disturbances. She had speech

disturbances,

> frequently saying the wrong word, depression, dizziness, nausea, and

> blurred vision.

>

> Neuropsychological Evaluation:Summary of the patient's

> neuropsychological performance is presented in Tables 2 and 3.

Patient

> had average intellectual abilities, which were about what could be

> expected from her academic background and work role. Her working

> memory on the intelligence test indicated a problem with short term

> and immediate recall. Her memory score was significantly below other

> index scores, and indicated some deterioration. Her processing speed

> was her highest index score. Extreme anxiety and agitation was

> observed throughout the tests. The Luria-Nebraska evaluation

indicated

> impairment in intellectual process, which reinforced the belief that

> her general functioning was within that observed in the brain

damaged

> population and was significantly below non-brain damaged

functioning.

>

> Table 2: IQ measures for the patient with chronic exposures to

> Alternaria tenuis, Pullularia pullulans, and Epicoccum nigrum

> mycotoxins

>

> IQ Measures

>

>

> Scores

>

>

> %

>

> Verbal

>

>

> 101

>

>

> 53

>

> Performance

>

>

> 104

>

>

> 61

>

> Full-Scale score

>

>

> 102

>

>

> 55

>

> Processing speed

>

>

> 108

>

>

> 70

>

> Verbal comprehension

>

>

> 105

>

>

> 66

>

> Perceptual Oriental

>

>

> 101

>

>

> 53

>

> Lowest working memory

>

>

> 92

>

>

> 30

>

> She indicated a general impairment, which demonstrated that she had

> not compensated or adjusted appropriately for her cognitive

> impairment. She demonstrated a probable arithmetic learning problem

> and an indication of not being very academically oriented. There was

> specific localization of injury found. Her memory quotient was 76,

> which was extremely poor and indicated significant impairment. It

was

> significantly below her intellectual abilities in general. Her

scores

> on other memory tests were both good and poor and indicated an

> intermittent lapse of memory rather than a consistent problem. She

was

> capable of learning given repetition. Hence, her impairment appeared

> to be more attention and concentration oriented and thus might be

more

> of frontal, than temporal lobe of the brain in nature. However, she

> indicated mild frontal lobe impairment primarily with attention,

> concentration, mental agility and abstract reasoning. She appeared

to

> have a major depressive affective disorder of a moderate to severe

> nature. She was agitated, with lagging attention and has unusual

> beliefs that were unconventional. She presented with difficulty

> concentrating and thinking. She had some unique somatic and bodily

> delusions and was immobilized by multiple symptoms. She had chronic

> relationship problems and was an underachiever for most of her life.

> It seemed as though she was her own worst enemy. She presented with

> some symptoms such as dizziness, light-headedness, which could be

both

> medical and psychological in nature. She presented with other

anxiety

> symptoms that gave credence to a functional diagnosis. Although it

was

> believed that she had an early dementia and major depression of

> unknown etiology, pseudo-dementia was probably ruled out. Her

weakness

> and dizziness could also be a product of molecular encephalopathy.

>

> Table 3:The summary of the neuropsychological findings in the

patient

> with chronic exposures to Alternaria tenuis, Pullularia pullulans,

and

> Epicoccum nigrum mycotoxins [(+++) = very high; (++) = high; (+) =

> relatively low)].

> Test Measures Overall Outcome Ranking

>

> WAIS-III

>

>

> Significant general impairment

>

>

> + + +

>

> Luria-Nebraska

>

>

> Intellectual process impairment

>

>

> + + +

>

> MMPI

>

>

> High level of impairment

>

>

> + + +

>

> Stroop

>

>

> Language impairment

>

>

> + +

>

> Trait Making B Test

>

>

> Multiple errors (70 sec)

>

>

> + + +

>

> Beck Scale

>

>

> Moderate depression

>

>

> + +

>

> Test of Proverbs

>

>

> Impaired abstract reasoning

>

>

> + + +

>

> Behavioral observations:The patient presented as a cordial and

> outgoing individual, well groomed, and appeared to be significantly

> anxious with indications of mild to moderate depression. Her thought

> processes appeared vague at times, and was high strung with

agitation.

> She indicated good cohesion between ideas and thoughts and her

> judgment and decision-making appeared appropriate. There was an

> indication of short term and immediate recall problems and she

> appeared to have a concentration and attention deficit. She did not

> make connection between her emotional state and physical symptoms

and

> appeared depressed with accompanying agitation and anxiety to

warrant

> a psychological diagnosis. She appeared somewhat " dazed " and

> disconnected during some of the testing.

>

> The patient was probably of average intellectual abilities and had

> some difficulty with abstract reasoning and higher order thinking.

Her

> visual memory and perception was hampered with mild indication of

word

> loss. The patient may have a learning disability of a hyperactive

> nature and appeared impulsive and easily distracted. There was an

> indication of dyslexic behavior involving sequencing events in a

> picture story right to left instead of left to right. The mini-

mental

> status examination yielded a mild to moderate problem thinking

clearly

> and reasoning in a rational fashion.

>

> Intelligence tests: The WAIS-III indicated a verbal IQ of 101 at the

> 53%. Her performance IQ was 104 at the 61% and her full-scale score

> was 102 at the 55%. There was no significant difference between the

> verbal and performance scores. All scores were within the average

> range of scores. Her highest index score was in processing speed at

> 108 and the 70%. Verbal comprehension was 105 at the 66%, perceptual

> oriental was 101 at 53% and the lowest was working memory at 92 and

> the 30%. Her working memory was significantly lower than other index

> scores and indicates a problem with short term and immediate recall.

> The working memory score is significantly below other index scores.

> The average scaled score is 10. The patient scored 103 on verbal and

> 10.6 on performance. Both scores are at or slightly above the

national

> average. Her IQ scores are about what could be expected given her

> academic background and occupational track.

>

> Intellectual processes: The patient indicated her scores

discriminate

> between brain damaged and non-brain damaged individuals. Generally

her

> score fell within the brain damaged category. It is heavily

influenced

> by left hemisphere activity. She generally performed below those

> without brain damage. However, her performance supported the MRI

> observation of a possible damage to the parietal lobe or frontal

lobe

> of the brain.

>

> Working memory: The Wechsler Memory Scales indicated a memory

quotient

> of 76. This is extremely poor and indicates a score within the

> borderline category. This score is significantly below her

> intellectual abilities and thus indicates a cognitive impairment.

She

> indicates problems with mental control, logical memory, digit span,

> and visual memory. The Rey Verbal Learning Test indicated no

> impairment in auditory learning. Her scores were all average in

> immediate and short-term verbal recall. Her digits span scores

> indicated a problem with attention and concentration. Her short term

> and immediate recall was appropriate. Her letter-number score on the

> WAIS was significantly above the norm. This is both an immediate

> recall and attention measure. The patient indicated significant

> intermittent problems with short-term memory and in particular

> attention and concentration. She does perform significantly better

> with repetition and thus is capable of learning new material with

> repetition. She indicated significant attention and concentration

> difficulties.

>

> Frontal lobe and executive functioning: The Trail making B Test

> indicated multiple errors involving mental agility and planning. Her

> score of 70 seconds indicated a minimal impairment and confusion

> involving right hemisphere activity. The Stroop test indicated no

> impairment of a language nature involving mental agility. This was a

> left hemisphere task. The similarities score on the WAIS indicated a

> score above the national average. The matrix reasoning score was

> slightly above the national average. There was an indication of

> attention and concentration problem. The Test of Proverbs indicated

a

> mild impairment in abstract reasoning. She indicated a mild

impairment

> of the frontal lobe primarily with attention and concentration,

mental

> agility and abstract reasoning.

>

> Personality:The Beck Scale indicated moderately depressed

individual.

> She felt sad, discouraged and had a sense of failure. She did not

> enjoy things like she used to and had become annoyed and irritated

> much more easily. Her decision-making skills had suffered and she

got

> tired much more easily now. She lacked a drive and motivation. She

> indicated some feelings of dizziness and light-headedness

frequently.

> She was jumpy and had a fear of dying. She felt a weakness and was

> unable to relax. She was highly nervous. The MMPI indicated a

> significant psychological disorder in the form of agitation, lagging

> attention in the midst of crisis. She has unusual beliefs and is

> alienated and unconventional. She had identity confusion and had

> difficulty with concentration and thinking. She overemphasized

> pathology and was cynical. She possessed some unique bodily or

somatic

> delusions and was immobilized by multiple symptoms. She had problems

> with authority and might have had recurrent work and family

problems.

> She had a history of underachievement and relationship problems. She

> probably was insecure, anxious, a worrier and was indecisive. She

was

> an exhibitionist. Her behavior appeared to be functional or

> psychological in nature rather than attributed to primary organic

> concerns.

>

> Treatment: Treatment of mycosis in general is a serious challenge to

> health care personnel and requires the understanding of the basic

> pathophysiological mechanisms that underlie their drug resistance.

In

> some patients, the symptomology is more persistent due to patient

> susceptibility, fungal growth patterns that resist treatment and the

> occurrence of dormant fungal spores. Although new antimycotic agents

> are far more promising than the ones used in earlier treatments,

> relapse rates still remain high. Treatment can include systemic

> antifungal therapies as well as nonpharmaceutical methods. A number

of

> modern treatment strategies are available and are generally well

> tolerated and effective. However, the MedicalCenter for Immune and

> Toxic Disorders devised a systematic treatment approach that takes

> into account the sensitivity of drug to fungal organism,

> adverse-effects profile, dosage schedule, and duration of therapy,

> concomitant medical conditions, and concurrent medications (,

> 2001). Nevertheless, complete treatment will depend on several

> factors, including appropriate spectrum of activity, adverse

effects,

> and potential drug interactions plus patient preferences for

specific

> dosing regimens.

> DISCUSSION

>

> Considering the findings in this patient's test analyses, it

appeared

> that three major complex factors might have played a role in her

> clinical conditions. First, the patient's indoor environment was

> contaminated with toxigenic molds that were different from those

found

> in her serum. Secondly, there were three toxigenic molds found in

the

> patient's serum to which the synergistic contribution of each

> toxigenic mold to the patient's psychological condition was

difficult

> to ascertain. Thirdly, the patient had significant traumatic

> experiences involving her work and marriage, each of which was

capable

> of exerting psychological influence on her well being. The question

> then is, which of these factors was responsible for the patient's

> condition? The first factor is ruled out completely, since there was

> no relationship between the toxigenic mold contamination of the

indoor

> environment, and the toxigenic mold antigens found in the patient's

> serum. Therefore, the last two factors are most likely responsible

for

> the patient's condition, but the time and sequence of cause-effect

is

> difficult to say without a proper analysis of individual likelihood

of

> exerting psychological effects. Consequently, we looked in depth, at

> the abnormal antibodies to three toxigenic mold antigens found in

the

> patient's serum to identify the most likely species that might have

> exerted the most psychological effects on the patient.

>

> Mycotoxins produced by Alternaria tenuis: Alternaria tenuis

occurring

> in isolates from tomato, and polished rice produces tenuazonic acid

> mycotoxin with two isomeric forms namely: standard tenuazonic acid

and

> isotenuazonic acid. Some species of toxigenic Alternaria tenuis

> produce alternariol (AOH), alternariol methyl ether (AME) (Bjeldanes

> et al., 1978), and tenuazonic acid mycotoxins, and it was shown that

> small amounts of tenuazonic acid have pronounced mutagenic activity

> (Bjeldanes et al., 1978; and Kanhere, 1980).

>

> Pullularia pullulans lack mutagenic and or carcinogenic potential,

> therefore, lack significant toxicological activity (Velcosvsky and

> Graubner, 1981; Tarabasz-Szymanska and Galas, 1993; Kimoto et al.,

> 1997), even though, acute exogenous allergic alveolitis with the

> typical symptoms of unproductive cough, dyspnoea on exertion, fever,

> weight loss, headache, and limb pains was observed in a 24-year-old

> bank employee. Also, pullulans have been implicated in leucocytosis,

> hypoxemia, and marked restrictive ventilatory defects (Velcosvsky

and

> Graubner, 1981). Kimoto et al. (1997) found no indications of an

> adverse effect of pullulans on hematology and clinical chemistry

> values of treated animals and there was no indication of

> pullulan-related toxicity in terminal organ and body weights.

>

> Epicoccum nigrum synthesizes extracellular fungal polysaccharide,

> called epiglucan (Schmidt et al., 2001). The Epicoccum nigrum

extracts

> used in allergy disorders exhibit batch-to-batch variations in

protein

> composition and allergenic potency (Bisht et al., 2000).

Ambivalently,

> Epicoccum nigrum (EN) was obtained consistently from four patients

who

> were having allergic fungal sinusitis (AFS), indicating that E.

nigrum

> can colonize nasal sinuses and cause AFS (Schmidt et al., 2001), and

> that EN is a significant allergen in urban communities (Dixit et

al.,

> 1992; Schmidt et al., 2001). However, Epicoccum nigrum has

antibiotic

> properties (e.g., epicorazine A), hence, was found to exhibit an

> activity against Staphylococcus aureus (Baute et al., 1978; Deffieux

> et al., 1978; Deffieux et al., 1978).

>

> Which toxigenic mold was responsible for the patient's health

> condition? The question here is, which toxigenic mold antigen was

> responsible for the patient's condition? It is rather difficult to

say

> with greater confidence without further experimental evaluation of

the

> physiological and toxicological effects of these antigens. However,

> from the background literature that was stated thus far, it appeared

> that each of these antigens must have contributed in different

> measures, to the patient's conditions. Considering the structural

and

> functional groups in the metabolites of the three toxigenic molds,

one

> would suggest that Alternaria tenuis probably has the most damaging

> effects since it exhibits mutagenicity and carcinogenicity.

Pullularia

> pullulans, on the other hand, no such effects besides allergenicity,

> which was the patient's main health problem. Epicoccum negrum

produces

> metabolites that are more of antibiotics than mycotoxins. Therefore,

> it is more likely that Alternaria tenuis may have major contributory

> psychological effects than the other two toxigenic molds.

>

> Relationship between patient's physical experience and toxigenic

> molds: It is true that the human brain has the ability to maintain

its

> normal function even when the mind is placed under a severe physical

> pain. However, if the brain is anatomically damaged, such an

endowment

> is compromised and the individual becomes susceptible to

psychological

> changes. It is possible therefore that the time sequence of events

> that led to the patient's psychological conditions probably began

with

> the chronic toxigenic mold antigens in the serum that in turn, led

to

> the changes in the brain structure consequent upon which the mind

and

> behavior were affected.

>

> Conclusion: In several cases reported in the literature, it was

often

> obvious to observe an association between indoor environmental

> toxigenic mold exposures with the patients' relevant seromycological

> positives. However, this " axiom " is not always true because, as we

> have found in this case, the identity of the abnormal levels of

> toxigenic molds observed in the indoor environment were different

from

> those observed immunologically in the patient's blood. Clinical

> neuropsychological impairments associated with chronic exposures to

> those toxigenic molds (Alternaria tenuis, Pullularia pullulans, and

> Epicoccum nigrum) have been reportned. The overall findings seemed

> support the views that certain toxigenic molds are particularly a

risk

> factor for adverse human health, including neuropsychological

> disorders. In addition, abnormal antibodies to toxigenic molds in

the

> serum of the patients may reflect the adverse health conditions

> synergistically, however, only one abnormal antibody to toxigenic

mold

> antigen could have the most adverse toxicity leading to

> neuropsychological effects. It is concluded therefore, that

although,

> it is acknowledged that the contamination of the indoor environment

by

> toxigenic molds directly related to adverse the health effects on

the

> occupants, however, there could be a situation where such

relationship

> does not exist. Here, we have reported such a situation.

>

> Acknowledgement:

>

> We are grateful to the MedicalCenter for Immune and Toxic Disorders,

> Spring, Texas, USA.

>

> REFERENCES

>

> *

> Baute MA, Deffieux G, Baute R. (1978), Neveu Anew antibiotics

> from the fungus Epicoccum nigrum. I. Fermentation, isolation and

> antibacterial properties. J Antibiot (Tokyo) 31 (11): 1099-1101

> *

> Bisht V, Singh BP, Arora N, Sridhara S, Gaur SN. (2000)

> Allergens of Epicoccum nigrum grown in different media for quality

> source material. Allergy 55(3): 274-280

> *

> Bjeldanes LF, Chang GW, Thomson SV. (1978) Detection of

mutagens

> produced by fungi with the Salmonella typhimurium assay. Appl

Environ

> Microbiol. 35 (6): 1150-4

> *

> Deffieux G, Baute MA, Baute R, Filleau MJ. (1978) New

> antibiotics from the fungus, Epicoccum nigrum. II. Epicorazine A:

> structure elucidation and absolute configuration. J Antibiot (Tokyo)

> 31(11): 1102-5

> *

> Deffieux G, Filleau MJ, Baute R. (1978) New antibiotics from

the

> fungus Epicoccum nigrum. III. Epicorazine B: structure elucidation

and

> absolute configuration. J Antibiot (Tokyo) 31(11): 1106-9

> *

> DixitAB, WH, Wedner HJ. (1992) The allergens of

Epicoccum

> nigrum Link. I. Identification of the allergens by immunoblotting. J

> Allergy Clin Immunol. 90(1): 11-20

> *

> , E.G. (2001) The rationale for combination therapy. Br.

J.

> Dermatol. 145 (Suppl. 60): 9-13.

> *

> Flappan SM, Portnoy J, P, C. (1999) Infant

> pulmonary hemorrhage in a suburban home with water damage and mold

> (Stachybotrys atra). Environ Health Perspect. 107 (11): 927-30

> *

> Jarvis BB, Zhou Y, Jiang J, Wang S, Sorenson WG, Hintikka EL,

> Nikulin M, Parikka P, Etzel RA, Dearborn DG. (1996) Toxigenic molds

in

> water-damaged buildings: dechlorogriseofulvins from Memnoniella

> echinata. J Nat Prod. 59(6): 553-4

> *

> Jarvis BB. (2002) Chemistry and toxicology of molds isolated

> from water-damaged buildings. Adv Exp Med Biol. 504:43-52

> *

> Johanning E, Biagini R, Hull D, Morey P, Jarvis B, Landsbergis

> P. (1996) Health and immunology study following exposure to

toxigenic

> fungi (Stachybotrys chartarum) in a water-damaged office

environment.

> : Int Arch Occup Environ Health 1996; 38(4): 207-18

> *

> Kimoto T, Shibuya T, Shiobara S. (1997) Safety studies of a

> novel starch, pullulan: chronic toxicity in rats and bacterial

> mutagenicity. Food Chem Toxicol. 35 (3-4): 323-9

> *

> Noble JA, Crow SA, Ahearn DG, Kuhn FA. (1997) Allergic fungal

> sinusitis in the southeastern USA: involvement of a new agent

> Epicoccum nigrum Ehrenb. ex Schlecht. 1824. J Med Vet Mycol. 35 (6):

> 405-9

> *

> Rosenberg NL, Grigsby J, Dreisbach J, Busenbark D, Grigsby P.

> (2002) Neuropsychologic impairment and MRI abnormalities associated

> with chronic solvent abuse. J Toxicol Clin Toxicol. 40 (1): 21-34.

> *

> Schmidt F, Stone BA, McDougall BM, Bacic A, KL,

Brownlee

> RT, Chai E, Seviour RJ. (2001) Structure of epiglucan, a highly

> side-chain/branched (1 - -> 3;1 - -> 6)-beta-glucan from the micro

> fungus Epicoccum nigrum Ehrenb. ex Schlecht. Carbohydr Res. 331 (2):

> 163-71

> *

> PM, Kanhere SR. (1980) Liquid chromatographic

> determination of tenuazonic acids in tomato paste. J Assoc Off Anal

> Chem. 63(3); 612-21

> *

> Tarabasz-Szymanska L, Galas E. (1993) Two-step mutagenesis of

> Pullularia pullulans leading to clones producing pure pullulan with

> high yield. : Enzyme Microb Technol. 15(4): 317-20

> *

> Tournas VH, Stack ME. (2001) Production of alternariol and

> alternariol methyl ether by Alternaria alternata grown on fruits at

> various temperatures. J Food Prot. 64 (4); 528-32

> *

> Velcovsky HG, Graubner M. (1981) Allergic alveolitis following

> inhalation of mould spores from pot plant earth (author's transl)]

> Dtsch Med Wochenschr. 106 (4): 115-20

> *

> Wechsler, D. Wechsler Adult Intelligence Scale †" Revised:

> Manual; Psychological Corp: New York, 1981.

> *

> Wechsler, D. (1987) Wechsler Memory Scale †" Revised: Manual;

> Psychological Corp: San .

>