Stages of Mycotoxicosis

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Stages of Mycotoxicosis: For Inhalation of Mycotoxin

By Dr. Croft

(Mycotoxicosis is caused by exposure to toxic molds)

The three Stages (1-3) ranging from lower to higher severity of poisoning were

modified according to exposure via the air as opposed to ingestion already

established (Forgacs et al., 1962; Joffe, 1971). A separate Stage of

convalescence occurs when a patient is completely removed from the contaminated

premises and the source of mycotoxin or mold spores.

Stage 1: The primary changes are in the brain, respiratory and immune systems,

mucus membranes and gastrointestinal tract. Signs and symptoms may include

burning sensation in the mouth, tongue, throat, palate, esophagus, and stomach,

which is a result of the action of the toxin on the mucous membranes and skin in

the exposed areas. Moist areas of the body armpits, under breasts, belt line and

groin are more sensitive or first affected. Patients may report burning within

the eyes, ears and nose. Patients also reported that their tongues felt swollen

and stiff. Mucosa of the oral cavity may be hyperemic. Mild gingivitis,

stomatitis, glositis, and esophagitis developed. Inflammation, in addition to

gastric and (small and large) intestinal mucosal, resulted in vomiting, diarrhea

and abdominal pain. Excessive salivation, headache, dizziness, weakness, fatigue

and tachycardia were also present.

There may be fever and sweating. The respiratory system develops burning

sensations and congestion. Severe exposure to mycotoxin within the lungs may

lead to congestion, edema and failure, due to caustic action. Body temperature

remains normal and controllable by the patient. The poisoning appears and

disappears relatively quickly in this Stage with the exception of, lungs and

central nervous system. Initially (Stage 1), the patient’s symptoms are very

uncomfortable or painful. As the poisoning continues and the patient progress

toward Stage 2, he or she becomes accustomed to the presence of the mycotoxin

and a quiescent period follows due to lack of nerve sensation. Depending on

exposure levels, the first Stage may last from 3 - 9 days. In scoring the 50

signs and symptoms listed in Tables-1 and 2, an average score range of 20-45

represents Stage 1..

Stage 2 : This Stage is often called the latent Stage or incubation period

because the patient feels apprehensive, but is capable of normal activity in the

beginning of this Stage. Every organ of the body is affected by degeneration and

necrosis with continued exposure. The primary target organs for an individual

become evident over time, due to biological variation. These are disturbances in

the central and autonomic nervous systems resulting in headaches, mental

depression, loss of short-term memory, loss of problem-solving ability, various

neuropsychiatric manifestations, meningism, severe malaise and fatigue,

narcolepsy, loss of temperature control, hyperesthesia or numbness of body

areas, and cerebellar dysfunction including hypotonia, attitude and gait,

dysmetria, asthenia, vertigo, disturbances of speech, and loss of balance (Best,

1961). Spinal cord degeneration may also be observed in gait and reflex

abnormalities, such as the ability to drive vehicles, ride

bicycles or pass sobriety tests (inability to tolerate ethyl alcohol).

Attention deficient disorder may be observed in children. Various systems may

include: Eyes: visual disturbances, floating objects, light sensitive, lack of

tears, burning and itching.. Ears: burning, itching, and loss of hearing. Immune

and hematopoietic: progressive loss of white and red cells including a decrease

of platelets and hemoglobin, and high susceptibility to bacterial, mycotic and

viral infections, debilitating chemical and allergies. Gastrointestinal:

metallic taste in mouth, tooth loss, gum problems, stomatitis, sores in gums and

throat, nausea, vomiting, diarrhea or constipation, excessive flatulence,

abdominal distention, hepatitis, pancreatitis, and diabetes mellitus.

Respiratory : burning and bleeding from nasal membranes, respiratory difficulty,

asthma, extreme susceptibility to cold, flu and pneumonia. Skin: thinning of

hair on head, burning on face, rashes, irritation, and edema..

Renal: proteinuria, possible hematuria. Reproductive: irregular ovarian cycles,

increased menstrual flow, fibroid growths in uterus, cystic development in

mammary glands, and tumors of mammary and prostate glands. Musculoskeletal :

somatitis, muscle weakness, spasms, cramps, joint pain, enlargement of joints in

hand, and clubbing of fingers. Cardiovascular: chest pain, palpitations,

ruptures of atrial walls, myocardial infection and aneurysm of arteries.

The skin and mucous membranes may be icteric, pupils dilated, the pulse soft

and labile, and blood pressure may decrease or increase. The body temperature

does not exceed 38 degree C and the patient may be afebrile, or chilled. Visible

hemorrhagic spots may appear on the skin. Thoughts of suicide may be prominent

in the person’s mind at this time or anytime in Stage 2. Human bonding is very

important for survival.

Degeneration and hemorrhages of the vessels marks the transition from the

second to the third Stage of the disease and may not be consistently observed.

The degeneration of the vital organs including serious respiratory insufficiency

or asthma and CNS degeneration will take the patient into Stage three along with

development of necrotic angina. If exposure continues, depending on exposure

levels, Stage 2 may continue from weeks to months or even years until the

symptoms of the third Stage develop. Evaluating the 50 signs and symptoms

(Table-1 and 2) by assigning a score (0-least intense to 5-most intense or

severe) to each symptom, we have determined that an average score range of

45-180 represents Stage 2.

Stage 3: Severe degeneration of the vital organs. The transition from the

second to the third Stage is sudden. In this Stage, the patient’s resistance

is

already low, and violent severe symptoms are present, especially under the

influence of stress, or associated with physical exertion and fatigue. The first

visible sign of this Stage may be lung, brain or heart failure (heart attack),

with or without the appearance of petechial hemorrhage on the skin of the trunk,

the axillary and inguinal areas, the lateral surfaces of the arms and thighs,

the face and head, and in serious Cases, the chest. The petechial hemorrhages

vary from a few millimeters to a few centimeters in diameter. There is increased

capillary fragility and any slight trauma may cause the hemorrhages to increase

in size.

Aneurysms of the brain or aorta may be observed by angiography. Hemorrhages

may also be found on the mucous membranes of the mouth and tongue, and on the

soft palate and tonsils. There may be severe interstitial thickening or scarring

of the lungs, or respiratory failure. Nasal, gastric and intestinal hemorrhages

and hemorrhagic diathesis may occur.. Necrotic angina begins in the form of

catarrhal symptoms and necrotic changes soon appear in the mouth, throat, and

esophagus with difficulty and pain on swallowing. Severe degeneration of the

skin on the face, eyelids, and loss of lashes is also often present.

Necrotic lesions may extend to the uvula, gums, buccal mucosa, larynx, vocal

cords, lungs, stomach, and intestines and other internal organs such as the

liver and kidneys and are usually contaminated with a variety of avirulent

bacteria. Bacteria infection causes an unpleasant odor from the mouth due to the

enzymatic activity of bacteria on proteins. Areas of necrosis may also appear on

the lips and on the skin of the fingers, nose, jaws, and eyes. Regional lymph

nodes are frequently enlarged. Esophageal lesions may occur and involvement of

the epiglottis may cause laryngeal edema and aphonia (loss of voice). Death may

occur by strangulation.

Patients may suffer an acute parenchymatous hepatitis accompanied by jaundice.

Bronchopneumonia, pulmonary hemorrhages, and lung abscesses are frequent

complications. Tumors may develop of various organs, including skin, urinary

bladder, brain, mammary gland, bone, immune, liver, prostate, possibly resulting

in death. The most common cause of death is brain failure due to both direct

effects of the mycotoxin on the central nervous system and indirect effects due

to respiratory failure or lack of oxygen to the brain caused by the severe

caustic inflammation (fibrinous exudation) reaction with the lung tissue,

rendering it non-functional. Again, using the scoring system represented in

Tables-1 and 2, an average score of greater or equal 180 represents Stage 3.

Stage of Convalescence: The course and duration of this Stage 3 depends on the

intensity of the poisoning and complete removal of the patient from the premises

or source of mycotoxin. Therefore, the duration of the recovery period is

variable. There is considerable cellular necrosis and scarring to all major

organs of the body in which cells will not regenerate, including the brain,

spinal cord, eyes, lung, heart, liver, pancreas, kidney, adrenal, and blood

vessels. If the disease is diagnosed during the first Stage, hospitalization is

usually unnecessary, but allergies and asthma should be monitored closely. If

the disease is diagnosed during the second Stage and even at the transition from

the second to third Stages, early hospitalization may preserve the patient’s

life. If however, the disease is only detected during the third Stage, death

cannot be prevented in most Cases.

1. Croft, W. A., Jastromski, B. M., Croft, A. L., and s, H. A.,

“Clinical

Confirmation of Trichothecene Mycotoxicosis in Patients Urineâ€, In:

Journal of

Environmental Biology 23(3), 301-320 (2002)

2. .Forgacs, J., and W. T. Carll : Mycotoxicoses. In : Advances in

Veterinary

Science. Academic Press, New York and London, pp 273-372 (1962).