Guest guest Posted March 1, 2008 Report Share Posted March 1, 2008 This one statement by NIAD in 1996 says alot:isolated outbreaks of other fungal diseases in people with normal immune systems have occurred recently in the United States. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Exposure to Mold Information for Pregnant and Breastfeeding Women This sheet talks about the risks that exposure to mold can have during pregnancy. With each pregnancy, all women have a 3% to 5% chance of having a baby with a birth defect. This information should not take the place of medical care and advice from your health care provider. http://www.otispregnancy.org/pdf/mold.pdf CASE DEFINITION Chemical Emergencies Trichothecene Mycotoxins Clinical description March 17, 2005 Trichothecene mycotoxins might be weaponized and dispersed through the air or mixed in food or beverages. Initially, route-specific effects are typically prominent. Dermal exposure leads to burning pain, redness, and blisters, and oral exposure leads to vomiting and diarrhea. Ocular exposure might result in blurred vision, and inhalational exposure might cause nasal irritation and cough. Systemic symptoms can develop with all routes of exposure and might include weakness, ataxia, hypotension, coagulopathy, and death (1). This document is based on CDC's best current information. It may be updated as new information becomes available. For more information, visit www.bt.cdc.gov/chemical, or call CDC at 800-CDC-INFO (English and Spanish) or 888-232-6348 (TTY). Mold Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes and Major Floods June 9, 2006 / 55(RR08);1-27 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5508a1.htm? s_cid=rr5508a1_e How Persons Are Exposed to Mold Mold exposure can produce disease in several ways. Inhalation is usually presumed to be the most important mechanism of exposure to viable (live) or nonviable (dead) fungi, fungal fragments or components, and other dampness-related microbial agents in indoor environments. The majority of fungal spores have aerodynamic diameters of 2--10 µm, which are in the size range that allow particles to be deposited in the upper and lower respiratory tract (5). Inhalation exposure to a fungal spore requires that the spore be initially aerosolized at the site of growth. Aerosolization can happen in many ways, ranging from disturbance of contaminated materials by human activity to dispersal of fungi from contaminated surfaces in heating, ventilating, and air-conditioning (HVAC) systems. Fungal spores also can be transported indoors from outdoors. Overall, the process of fungal-spore aerosolization and related issues (e.g., transport, deposition, resuspension, and tracking of fungi to other areas) are poorly understood. Persons can be exposed to mold through skin contact, inhalation, or ingestion. Factors That Cause Disease from Mold Numerous species of mold cause infection through respiratory exposure. In general, persons who are immunosuppressed are at increased risk for infection from mold (11). Immunosuppression can result from immunosuppressive medication, from medical conditions and diseases that cause immunosuppression, or from therapy for cancer that causes transient immunosuppression. Although certain species of mold cause infection (5,8,11), many mold species do not cause infection. Infections from mold might be localized to a specific organ or disseminated throughout the body. Many of the major noninfectious health effects of mold exposure have an immunologic (i.e., allergic) basis (6). Exposure to mold can sensitize persons, who then might experience symptoms when re- exposed to the same mold species. For sensitized persons, hay fever symptoms and asthma exacerbations are prominent manifestations of mold allergy (6). Although different mold species might have different propensities to cause allergy, available data do not permit a relative ranking of species by risk for creating or exacerbating allergy. In addition, exposure to beta glucans might have an inflammatory effect in the respiratory system (12). Prolonged exposure to high levels of mold (and some bacterial species) can produce an immune-mediated disease known as hypersensitivity pneumonitis (13). Clinically, hypersensitivity pneumonitis is known by the variety of exposures that can cause this disorder (e.g., farmer's lung, woodworker's lung, and malt worker's lung). Population-Specific Recommendations for Protection From Exposure to Mold in Buildings CDC 2005 moldtable Footnotes 1. Significant mold contamination is assumed if the building's interior was saturated with water for more than 48 hours, extensive water damage is present, extensive mold growth is visible, or " mildew " odors are clearly stronger than before Hurricanes Katrina and Rita. 2. A visible dust cloud suggests high potential for exposure. However, activities can be associated with high fungal exposure even without visible dust. Consider more protective interventions for activities of longer duration or greater frequency. 3. Recommended respiratory protection for residents is a respirator at least as protective as an N-95 filtering face piece. Respirator protection for workers in isolated areas of mold contamination (100 square feet or less) or small isolated areas of heating, ventilation, and air conditioning (HVAC) systems (10 square feet or less) where mold is disturbed is a respirator at least as protective as an N-95 filtering face piece. For working in areas of extensive contamination (greater than 100 contiguous square feet) or HVAC systems with large areas of contamination (greater than 10 square feet) and significant mold-containing dust, full face-piece respirators with N100, R100, P100 particulate filters (or for powered air-purifying respirators – HEPA filters) are recommended. Gloves and dermal protection. 4. Occlusive eye protection (safety goggles, not regular eyeglasses); see discussion of personal protective equipment (PPE) in Chapter 4 of CDC's report, Mold: Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes Katrina and Rita. Available at: http://www.bt.cdc.gov/disasters/mold/report/. 5. Transplant recipients, including organ or hematopoietic stem cell recipients within 6 months of transplant or during periods of substantial immunosuppression; neutropenia (neutrophil count < 500/ & #956;L) due to any cause (including neoplasm, cancer chemotherapy); CD4+ lymphopenia (lymphocyte count < 200/ & #956;L) due to any cause, including HIV infection. Affected individuals should consult with their physicians before entering the affected area. 6. Includes immunosuppressant drug therapy, such as cancer chemotherapy, corticosteroid, or other immunosuppressive drug therapy; and diseases impairing host defense such as leukemia or lymphoma. Affected individuals should consult with their physicians before entering the affected area. Duration and frequency of exposures should be minimal. 7. Such diseases include COPD, asthma not exacerbated by mold, cystic fibrosis, and cavitary tuberculosis. Risk of airway colonization and subsequent diseases following mold exposure is unknown. Recommendations are based on best professional judgment. 8. The optimal treatment for allergic rhinitis, allergic asthma, or hypersensitivity pneumonitis is avoidance of the sensitizing agent. If symptoms occur despite the recommended preventive measures, avoidance of exposure is indicated. In many cases, allergic etiology of rhinitis or asthma needs to be inferred from clinical information, since the available diagnostic reagents for documenting IgE-sensitization to fungi are mostly unstandardized. Similarly, the precise antigenic agent causing hypersensitivity pneumonitis is often unclear. 9. The level of risk associated with exposure activities and the potential benefit of recommended PPE are unknown for these vulnerable populations. Due caution is recommended. 10. Exposure-reducing behavior and respiratory protection are problems for this group. Important: See Table on first page. Centers for Disease Control and Prevention http://www.bt.cdc.gov/disasters/pdf/flyer-get-rid-of-mold.pdf by the way, regarding inhaled: From the Website of the Center for Disease Control: Mold Toxins (Mycotoxins) Molds can produce toxic substances called mycotoxins. Some mycotoxins cling to the surface of mold spores; others may be found within spores. More than 200 mycotoxins have been identified from common molds, and many more remain to be identified. Some of the molds that are known to produce mycotoxins are commonly found in moisture-damaged buildings. Exposure pathways for mycotoxins can include inhalation, ingestion, or skin contact. Although some mycotoxins are well known to affect humans and have been shown to be responsible for human health effects, for many mycotoxins, little information is available. Aflatoxin B1 is perhaps the most well known and studied mycotoxin. It can be produced by the molds Aspergillus flavus and Aspergillus parasiticus and is one of the most potent carcinogens known. Ingestion of aflatoxin B1 can cause liver cancer. There is also some evidence that inhalation of aflatoxin B1 can cause lung cancer. Aflatoxin B1 has been found on contaminated grains, peanuts, and other human and animal foodstuffs. However, Aspergillus flavus and Aspergillus parasiticus are not commonly found on building materials or in indoor environments. Much of the information on the human health effects of inhalation exposure to mycotoxins comes from studies done in the workplace and some case studies or case reports.* Many symptoms and human health effects attributed to inhalation of mycotoxins have been reported including: mucous membrane irritation, skin rash, nausea, immune system suppression, acute or chronic liver damage, acute or chronic central nervous system damage, endocrine effects, and cancer. More studies are needed to get a clear picture of the health effects related to most mycotoxins. However, it is clearly prudent to avoid exposure to molds and mycotoxins. http://www.cdc.gov/ncidod/eid/vol3no2/miller.htm Synopses Polycystic Kidney Disease: An Unrecognized Emerging Infectious Disease? Marcia A. -Hjelle,* J. Hjelle,* ,* R. Mayberry,† Ann Dombrink-Kurtzman,‡ W. ,‡ Deborah M. Nowak,* and S. Darras* *University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA; †East Tennessee State University, City, Tennessee, USA; and ‡U.S. Department of Agriculture, Agricultural Research Service, Peoria, Illinois, USA Subject: CDC, IOM Damp Indoor Spaces, Mold Associated Illnesses Summary of Institute of Medicine's Damp Indoor Spaces and Health Review (2004) Evidence of Association Table 1: Association between Damp Indoor Environments and Mold Health Outcomes Health outcome or symptom Exposure to damp indoor environments Presence of mold/other agents in damp indoor environments Upper respiratory tract symptoms_1_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#1) Sufficient evidence of an association_7_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#7) Cough_2_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#2) Sufficient evidence of an association Wheeze_2_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#2) Sufficient evidence of an association Asthma symptoms in sensitized persons with asthma Sufficient evidence of an association Hypersensitivity pneumonitis_3_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#3) in susceptible persons Studied in relation to specific agents Sufficient evidence of an association Shortness of breath (dyspnea)_2_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#2) Limited or suggestive evidence_8_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#8) Inadequate or insufficient evidence_9_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#9) Respiratory illness in otherwise healthy children Limited or suggestive evidence Respiratory illness in otherwise healthy adults Inadequate or insufficient evidence _Acute idiopathic pulmonary hemorrhage in infants_ (http://www.cdc.gov/nceh/airpollution/mold/AIPHIcasedef.htm) Inadequate or insufficient evidence Fungal sinusitis_4_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#4) No specific studies associated the condition with damp or moldy indoor spaces Severe respiratory infections in people whose immune system is severely immunocompromised_5_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#5) Not applicable_10_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#10) Sufficient evidence of an association Fungus-related illnesses in people whose immune system is severely immunocompromised_5_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#5) and who have _chronic obstructive pulmonary disease (COPD)_ (http://www.cdc.gov/nceh/airpollution/copd/default.htm) Not applicable_10_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#10) Sufficient evidence of an association Colonization and potential lung infection in people with some chronic pulmonary disorders_6_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#6) Not applicable_10_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#10) Sufficient evidence of an association Notes: 1. Upper respiratory tract symptoms include nasal congestion, rhinitis, allergic rhinitis “hay fever " , sneezing, runny or itchy nose, sinusitis and sore throat. 2. Lower respiratory tract symptoms include cough with or without production of phlegm, wheeze, chest tightness, and shortness of breath. 3. Hypersensitivity pneumonitis is a lung disease that is the result of exposure and sensitization to antigens inhaled with a variety of organic dusts. Symptoms include dry cough, dyspnea, and fever and sometimes acute bronchospasm. 4. Fungal sinusitis is associated with molds but molds may come from the indoor or the outdoor environment. 5. Immunocompromised persons are at increased risk for fungal colonization or opportunistic infections. * It is well established that fungal exposures causes opportunistic cutaneous and subcutaneous fungal infections of the skin of severely immunocompromised persons. * Respiratory infections can result from exposure to fungi, including Aspergillus spp. and Fusarium spp. * Severely immunocompromised persons include persons who undergo high-dose cancer chemotherapy, are recent recipients of a solid-organ transplant, or are otherwise immunocompromised. 6. Chronic pulmonary disorders include cystic fibrosis, asthma, and COPD. Colonization and infections result from exposure to fungi such as Aspergillus. 7. " Sufficient evidence of an association " means that studies show an association between the agent and disease and chance, bias, and confounding were ruled out with reasonable confidence. 8. " Limited or suggestive evidence of an association " means that evidence is suggestive of an association between the agent and the disease but is limited because chance, bias, and confounding cannot be ruled out with confidence. 9. " Inadequate or insufficient evidence to determine whether an association exists " means that the available studies are of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence of an association. Alternatively, no studies exist that examine the relationship. 10. Respiratory infections, fungus-related illnesses, and colonization with lung infection relating to specific organisms. Source: Institute of Medicine’s " _Damp Indoor Spaces and Health_ (http://www.nap.edu/books/0309091934/html/) " (_http://www.nap.edu/books/0309091934/html/_ (http://www.nap.edu/books/0309091934/html/) ). _top_ (http://www.cdc.gov/nceh/airpollution/mold/iom_sum.htm#top) ____________________________________ _Air Pollution and Respiratory Health_ (http://www.cdc.gov/nceh/airpollution/default.htm) _Environmental Public Health Tracking_ (http://www.cdc.gov/nceh/tracking) _Asthma_ (http://www.cdc.gov/asthma/default.htm) _Health Studies_ (http://www.cdc.gov/nceh/hsb/) _Division of Laboratory Sciences_ (http://www.cdc.gov/nceh/dls) _Mold_ (http://www.cdc.gov/nceh/airpollution/mold/default.htm) _Emergency and Environmental Health Services_ (http://www.cdc.gov/nceh/divisions/eehs.htm) _Radiation Studies_ (http://www.cdc.gov/nceh/radiation/default.htm) _U.S.-Mexico Border Environmental Health_ (http://www.cdc.gov/nceh/hsb/borders.htm) _Environmental Hazards and Health Effects_ (http://www.cdc.gov/nceh/ehhe/default.htm) _NCEH Home_ (http://www.cdc.gov/nceh/) | _Programs_ (http://www.cdc.gov/nceh/programs.htm) | _Publications_ (http://www.cdc.gov/nceh/publications.htm) | _Contact Us_ (http://www.cdc.gov/nceh/Information/contact.htm) | _Privacy_ (http://www.cdc.gov/nceh/privacy/privacy.htm) | _About NCEH_ (http://www.cdc.gov/nceh/Information/about.htm) _ CDC Home_ (http://www.cdc.gov/) | _CDC Search_ (http://www.cdc.gov/search.htm) | _Health Topics A-Z_ (http://www.cdc.gov/health/diseases.htm) This page last reviewed March 03, 2005 Air Pollution and Respiratory Health Branch National Center for Environmental Health Centers for Disease Control and Prevention http://www.niaid.nih.gov/publications/dateline/0996/page11.htm NIAID Semptember 1996 ------------ New Fact Sheets on Emerging Fungal Diseases Although still outnumbered by their bacterial and viral counterparts, fungal pathogens are responsible for an increasing number of emerging infectious diseases. They account for a growing proportion of nosocomial, or hospital-acquired, infections, particularly among organ transplant recipients and other patients receiving immunosuppressive treatments. Fungal diseases also have become common among AIDS patients. In addition, isolated outbreaks of other fungal diseases in people with normal immune systems have occurred recently in the United States. NIAID plays a vital role in the effort to reverse the recent inroads made by these diseases, and supports an increasing number of studies to improve the prevention, diagnosis, and treatment of fungal diseases, also known as mycoses. Between 1985 and 1995, the number of fungal disease research grants and contracts supported by the Institute increased from 42 to 95. Over the same period, NIAID funding for mycoses research rose more than fourfold, from $6.5 million to slightly less than $29 million. --by Bowersox Quote Link to comment Share on other sites More sharing options...
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