Pulmonary Hemorrhage in an Infant Following 2 Weeks of Fungal Exposure

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http://archpedi.ama-assn.org/cgi/content/full/154/3/271

Pulmonary Hemorrhage in an Infant Following 2 Weeks of Fungal Exposure

E. Novotny, MD; Anupma Dixit, PhD

Arch Pediatr Adolesc Med. 2000;154:271-275.

ABSTRACT

Background Exposure to indoor fungus growth and tobacco smoke has

been epidemiologically linked to unexplained pulmonary hemorrhage in

infants.

Objective To describe the 40-day-old male infant who had been exposed

to fungi for a discrete 2-week period followed by acute exposure to

environmental tobacco smoke prior to development of a life-threatening

pulmonary hemorrhage.

Patient and Methods History and clinical evaluation of the infant

immediately followed the pulmonary hemorrhage. Air and surface

sampling for isolation and identification of fungal growth in the

dwelling where the infant resided before the acute hemorrhage was

accomplished when the homeowner returned from vacation 4 months after

the clinical event.

Results Two fungi associated with mycotoxin production were cultured

from surface samples collected in the residence: Penicillium (possibly

Penicillium purpurogenum) and a Trichoderma species. Stachybotrys atra

was not isolated from air or surface samples. Environmental tobacco

smoke exposure occurred over a discrete several-hour period prior to

onset of the acute pulmonary hemorrhage.

Conclusions Avoidance of unnecessary exposure of infants to fungus

growth in water-damaged environments or exposure to tobacco smoke is

prudent. Further investigation into the toxic effects of indoor fungi

as causes of infantile pulmonary hemorrhage is warranted.

INTRODUCTION

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• Introduction

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PULMONARY HEMORRHAGE has been reported in infants following exposure

to water-damaged environments and tobacco smoke. The epidemiological

association of unexplained acute infantile pulmonary hemorrhage and

exposure to mold has been most closely linked to the fungus

Stachybotrys atra. Temporality and duration of exposure to toxigenic

fungi that typically precede onset of acute infantile pulmonary

bleeding is unknown. We describe an infant who had pulmonary

hemorrhage after exposure to fungi other than S atra for a discrete

2-week period prior to the onset of clinically evident,

life-threatening disease.

REPORT OF A CASE

In November 1997 a 40-day-old Hispanic-Filipino boy who lived in Key

West, Fla, visited his grandfather's home in St Louis, Mo, for a

2-week period. He was healthy and growing on a cow-milk protein–based

formula supplemented by breast milk. Throughout the visit to St Louis

the infant's health continued to be excellent. During the return trip

home the infant suffered a sudden onset of life-threatening pulmonary

hemorrhage...

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