Bioaerosols - Aerosols: Measurement, Dosimetry, and Health Effects - page 302

that indoor exposure to Stachybotrys chartarum was a factor in a cluster of acute IPH in ten infants
presenting in 1993-1994 at a children's hospital in Cleveland, OH. 108-110 One infant died of severe
respiratory failure, and the episode received wide press coverage. The indings were criticized and
the CDC reassessed the data because of shortcomings in differential diagnosis and data collection,
analysis, and reporting. 111
A hemolytic protein (stachylysin) has since been identiied in S. chartarum , and the role of this
fungus in disrupting pulmonary surfactant synthesis has been explored in animal models. 112 The
inlammatory, allergic, and cytotoxic potential of the S. chartarum -associated mycotoxins and pro-
tein factors (hemolysins, proteases, glucans, and spirocyclic drimanes) and interaction with other
co-factors (glucans and endotoxins) have also been discussed. 113
Reports from the U.S. Institute of Medicine (IOM) and WHO concluded that available case-
report information, taken together, constituted inadequate or insuficient information to determine
whether an association exists between acute IPH and exposure to S. chartarum . 78,79 To date the role
of S. chartarum in adverse health problems is unresolved and controversial. 114 Despite the enormous
media attention and the seriousness of pulmonary hemorrhage, it is important to note that in terms
of public health relevance the Cleveland cluster and other incidents of infant IPH are extremely rare.
This is in sharp contrast with other well-established and much more common respiratory health
effects associated with damp buildings.
12.2.3 o tHer a dverse H ealtH e FFects
12.2.3.1 Building-Related Illnesses and Symptoms
Building-related illnesses (BRIs) are diagnosable diseases with known etiologies that are fre-
quently accompanied by documented physical signs and laboratory indings, for example, acute
viral infections, legionellosis, or tuberculosis; carbon monoxide poisoning; irritant-induced or
exacerbated asthma or rhinitis; or HP. BRSs or SBS are a combination of nonspeciic symptoms,
in the absence of diagnosed disease, related to the building in which people live or work. 78 BRSs
commonly include (but are not limited to) irritation of the skin and eyes, nasal itching and dryness,
headache, fatigue, prolonged sore throat, hoarseness, dry cough, and chest discomfort. Less com-
mon are nausea, vomiting, dificulty with concentration, joint pain, and low-grade fever. A high
frequency of respiratory tract infections and enhanced or abnormal odor perception also can be a
component of BRS. Although BRSs are believed to be relatively common, no accurate estimates of
the incidence or prevalence are available due primarily to the lack of objective criteria to diagnose
the syndrome.
BRSs may be related to the inlammatory effects of inhaled indoor particles, including bacteria,
fungi, their structural components, and other organic substances (i.e., the organic fraction of indoor
dust) causing localized and systemic nonspeciic inlammation, but the evidence for this is weak. 115
Reactive chemistry involving indoor-generated oxidants such as ozone has been suggested as a con-
tributing cause. 116 Environmental factors (chemical contaminants, inadequate ventilation, odor, and
thermal discomfort) and personal factors (gender as well as stress and other psychological factors)
are likely contributing causes. 117
12.2.3.2 Cancer
Workers frequently exposed to livestock and grain (farmers) as well as to animal carcasses being
processed for meat (abattoir workers and butchers) are at increased risk for several cancers includ-
ing lung, hematologic, lip, stomach, prostate, connective tissue, and brain cancer. Hypothesized
explanations involve exposure to pesticides, zoonotic viral or bacterial agents that are able to cross
species barriers (e.g., herpes, avian leucosis, and papilloma viruses and Brucella and Leptospira
species), mycotoxins, and other yet unidentiied biological exposures. 86