Clinical findings related to indoor fungal exposure - review of clinic data of a specialty clinic
Johanning, E., Landsbergis, P.
2001 In "Bioaerosols, Fungi and Mycotoxins: Health Effects, Assessment, Prevention and Control", Edited by Johanning, E., Boyd Printing, Albany, New York
Johanning, E., Landsbergis, P., (2001), "Clinical findings related to indoor fungal exposure - review of clinic data of a specialty clinic", In "Bioaerosols, Fungi and Mycotoxins: Health Effects, Assessment, Prevention and Control", Edited by Johanning, E., Boyd Printing, Albany, New York.
Abstract:
Objective: Review of symptoms, clinical abnormalities and laboratory findings of building occupants with abnormal indoor fungal exposure, primarily allergenic and toxigenic fungi (Stachybotrys atra, Penicillium, Aspergillus).
Design: Descriptive review of 151 cases evaluated at a specialty clinic. Analyses of a standardized health symptom questionnaire and immunological laboratory data.
Subjects: Pediatric and adult specialty clinic population with verified abnormal indoor fungal exposure.
Main outcome measures: Self-reported symptom-complexes, Immunoglobulin E and G, T- lymphocyte enumeration and function.
Results: Widespread contamination of water-damaged building materials primarily with toxin producing fungi were identified in the patients exposure history, who are reporting from a variety of nonspecific"sick building"-like complaints to a history of more serious morbidity of the respiratory system, skin, eye, chronic fatigue-like symptoms (CFIDS) and central nervous system dysfunctions (vertigo, memory, irritability, concentration, verbal dysfunctions). In some cases abnormalities of enumeration and functional laboratory tests (flow-cytology), mainly of the white blood cell system were identified. IgE or IgG antibodies used as exposure markers, were positive in about less than 25% of all cases. Removal from exposure typically resulted in improvement in the majority of cases.
Conclusion: Indoor air exposure to mycotoxin and allergen producing fungi results in a high frequency of health complaints, variant multi-organ and laboratory abnormalities requiring a detailed exposure assessment and clinical evaluation. Removal from fungal exposure and symptomatic treatment generally results in noticeable improvement of most patients. I propose to name these presentations and clinical findings-if certain criteria are met: "fungal syndrome".
Key messages:
Many patients with fungal indoor exposure have a variety of symptoms, primarily the skin, mucous membrane, respiratory organs, central nervous system and constitutional symptoms.
Laboratory results suggest other than type I allergy, IgE mediated health responses.
Diagnosis of fungal disease should be based on exposure history, medical history and clinical findings.
The prognosis appears good provided the exposure can be stopped.
Bioaerosols, Fungi and Mycotoxins, Ed. by Johanning, E. "papers presented at the September, 1998 Third International Conference in Saratoga Springs, New York. clinical and epidemiological studies and technical reports on an emerging public health topic affecting people in indoor environments at work and at home."
