Mold health issues

Light micrograph of the hyphae and spores of the human pathogen Aspergillus fumigatus

Mold health issues are potentially harmful effects of molds.

Molds (also spelled "moulds") are ubiquitous in the biosphere, and mold spores are a common component of household and workplace dust. The United States Centers for Disease Control and Prevention reported in its June 2006 report, 'Mold Prevention Strategies and Possible Health Effects in the Aftermath of Hurricanes and Major Floods,' that "excessive exposure to mold-contaminated materials can cause adverse health effects in susceptible persons regardless of the type of mold or the extent of contamination."^[1] When mold spores are present in abnormally high quantities, they can present especially hazardous health risks to humans, including allergic reactions or poisoning by mycotoxins,^[2] or causing fungal infection (mycosis).

Health effects

Molds are ubiquitous in nature, and mold spores are a common component of household and workplace dust. However, when spores are present in large quantities, they are a health hazard to humans, potentially causing allergic reactions and respiratory problems.

Some molds also produce mycotoxins that can pose serious health risks to humans and animals. The term "toxic mold" refers to molds that produce mycotoxins, such as Stachybotrys chartarum, not to all molds.^[3] Exposure to high levels of mycotoxins can lead to neurological problems and in some cases death. Prolonged exposure, e.g., daily workplace exposure, can be particularly harmful.

Symptoms of mold exposure

Symptoms of mold exposure can include:^[4]

• Nasal and sinus congestion, runny nose
• Eye irritation, such as itchy, red, watery eyes
• Respiratory problems, such as wheezing and difficulty breathing, chest tightness
• Cough
• Throat irritation
• Skin irritation, such as a rash
• Headache
• Sneezing / Sneezing fits

Health effects linking to asthma

Infants may develop respiratory symptoms as a result of exposure to a specific type of fungal mold, called Penicillium. Signs that an infant may have mold-related respiratory problems include (but are not limited to) a persistent cough and/or wheeze. Increased exposure increases the probability of developing respiratory symptoms during their first year of life. Studies have shown that a correlation exists between the probability of developing asthma and increased exposure Penicillium. The levels are deemed no mold to low level, from low to intermediate, from intermediate to high.^[5]

Mold exposures have a variety of health effects depending on the person, some people are more sensitive to mold than others. Exposure to mold can cause a number of health issues such as; throat irritation, nasal stuffiness, eye irritation, cough and wheezing, as well as skin irritation in some cases. Exposure to mold may also cause heightened sensitivity depending on the time and nature of exposure. People at higher risk for mold allergies are people with chronic lung illnesses, which will result in more severe reactions when exposed to mold.

There has been sufficient evidence that damp indoor environments are correlated with upper respiratory tract symptoms such as; coughing, and wheezing in people with asthma.^[6]

Mold-associated conditions

Health problems associated with high levels of airborne mold spores include^[7] allergic reactions, asthma episodes, irritations of the eye, nose and throat, sinus congestion, and other respiratory problems, although it should be noted that mold spores won't actually cause asthma, just irritate existing conditions. For example, residents of homes with mold are at an elevated risk for both respiratory infections and bronchitis.^[8] When mold spores are inhaled by an immunocompromised individual, some mold spores may begin to grow on living tissue,^[9] attaching to cells along the respiratory tract and causing further problems.^[10][11] Generally, when this occurs, the illness is an epiphenomenon and not the primary pathology. Also, mold may produce mycotoxins, either before or after exposure to humans, potentially causing toxicity.

Fungal infection

A serious health threat from mold exposure for immunocompromised individuals is systemic fungal infection (systemic mycosis). Immunocompromised individuals exposed to high levels of mold, or individuals with chronic exposure may become infected.^[12][13] Sinuses and digestive tract infections are most common; lung and skin infections are also possible. Mycotoxins may or may not be produced by the invading mold.

Dermatophytes are the parasitic fungi that cause skin infections such as athlete's foot and tinea cruris. Most dermataphyte fungi take the form of a mold, as opposed to a yeast, with appearance (when cultured) that is similar to other molds.

Opportunistic infection by molds^[14] such as Penicillium marneffei and Aspergillus fumigatus is a common cause of illness and death among immunocompromised people, including people with AIDS or asthma.^[15][16]

Mold-induced hypersensitivity

The most common form of hypersensitivity is caused by the direct exposure to inhaled mold spores that can be dead or alive or hyphal fragments which can lead to allergic asthma or allergic rhinitis.^[17] The most common effects are rhinorrhea (runny nose), watery eyes, coughing and asthma attacks. Another form of hypersensitivity is hypersensitivity pneumonitis. Exposure can occur at home, at work or in other settings.^[18][17] It is predicted that about 5% of people have some airway symptoms due to allergic reactions to molds in their lifetimes.^[19]

Hypersensitivity may also be a reaction toward an established fungal infection in allergic bronchopulmonary aspergillosis.

Mycotoxin toxicity

Molds excrete toxic compounds called mycotoxins, secondary metabolites produced by fungi under certain environmental conditions. These environmental conditions affect the production of mycotoxins at the transcription level. Temperature, water activity and pH, strongly influence mycotoxin biosynthesis by increasing the level of transcription within the fungal spore. It has also been found that low levels of fungicides can boost mycotoxin synthesis.^[20][21] Certain mycotoxins can be harmful or lethal to humans and animals when exposure is high enough.^[22][23]

Extreme exposure to very high levels of mycotoxins can lead to neurological problems and in some cases death; fortunately, such exposures rarely to never occur in normal exposure scenarios, even in residences with serious mold problems.^{[citation needed]} Prolonged exposure, e.g. daily workplace exposure, can be particularly harmful.^{[citation needed]}

The health hazards produced by mold have been associated with sick building syndrome, but no validated studies have been able to demonstrate that normal indoor exposures to these common organisms pose a significant threat.^{[citation needed]}

It is thought^{[citation needed]} that all molds may produce mycotoxins and thus all molds may be potentially toxic if large enough quantities are ingested, or the human becomes exposed to extreme quantities of mold. Mycotoxins are not produced all the time, but only under specific growing conditions. Mycotoxins are harmful or lethal to humans and animals only when exposure is high enough.

Mycotoxins can be found on the mold spore and mold fragments, and therefore they can also be found on the substrate upon which the mold grows. Routes of entry for these insults can include ingestion, dermal exposure and inhalation.

Some mycotoxins cause immune system responses that vary considerably, depending on the individual. The duration of exposure, the frequency of exposure and the concentration of the insult (exposure) are elements in triggering immune system response.

Aflatoxin is an example of a mycotoxin. It is a cancer-causing poison produced by certain fungi in or on foods and feeds, especially in field corn and peanuts.^[24]

Originally, toxic effects from mold were thought to be the result of exposure to the mycotoxins of some mold species, such as Stachybotrys chartarum. However, studies are suggesting that the so-called toxic effects are actually the result of chronic activation of the immune system, leading to chronic inflammation.^{[citation needed]} Studies indicate that up to 25% of the population have the genetic capability of experiencing chronic inflammation to mold exposure, but it's unknown how many actually experience such symptoms due to common misdiagnosis. A 1993–94 case study based on cases of pulmonary hemorrhage in infants in Cleveland, Ohio originally concluded there was causal relationship between the exposure and the disease. The investigators revisited the cases and established that there was no link to the exposure to S. chartrum and the infants in their homes.^{[citation needed]}

Exposure sources and prevention

The main sources of mold exposure are from the indoor air in buildings with substantial mold growth, and from ingestion of food with mold growths.

Air

Prevention of mold exposure and ensuing health issues include prevention of mold growth in the first place by avoiding a mold-supporting environment such as humid air. Extensive flooding and water damage can support huge numbers of mold growth. Following hurricanes, homes with greater flood damage, especially those with more than 3 feet of indoor flooding, demonstrated higher levels of mold growth compared with homes with little or no flooding.^[25][26] The aftermath of a hurricane is the worst case scenario, but the concept of water damage supporting widespread mold growth is more generally applicable.

It is useful to perform an assessment of the location and extent of the mold hazard in a structure. Various practices of remediation can be followed to mitigate mold issues in buildings, the most important of which is to reduce moisture levels.^[27] Removal of affected materials after the source of moisture has been reduced and/or eliminated may be necessary.^[28] Thus, the concept of mold growth, assessment, and remediation is essential in prevention of mold health issues.

A common issue with mold hazards in the household is the placement of furniture, and the lack of ventilation which this provides to certain parts of the wall. The simplest method of avoiding mold in the home is to move the furniture in question.

Adverse respiratory health effects are associated with occupancy in buildings with moisture and mold damage.^[29] Asthma can be aggravated or even induced with exposure to certain fungal species and some fungi cause skin infections such as athletes foot or ring worm.^[27]

Molds may excrete liquids or low-volatility gases, but the concentrations are so low that frequently they cannot be detected even with sensitive analytical sampling techniques. Sometimes these by-products are detectable by odor, in which case they are referred to as "ergonomic odors" meaning the odors are detectable, but do not indicate toxicologically significant exposures.

Food

Moldy nectarines that were in a refrigerator. The nectarine with black mold is also affecting the nectarine underneath.

Molds that are often found on meat and poultry include members of the genera Alternaria, Aspergillus, Botrytis, Cladosporium, Fusarium, Geotrichum, Mortierella, Mucor, Neurospora,Paecilomyces, Penicillium and Rhizopus.^[30] Grain crops in particular incur considerable losses both in field and storage due to pathogens, post-harvest spoilage and insect damage. A number of common microfungi are important agents of post-harvest spoilage, notably members of the genera Aspergillus, Fusarium and Penicillium.^[30] A number of these produce mycotoxins (soluble, non-volatile toxins produced by a range of microfungi that demonstrate specific and potent toxic properties on human and animal cells^[31]) that can render foods unfit for consumption. When ingested, inhaled, or absorbed through skin, mycotoxins may cause or contribute to a range of effects from reduce appetite and general performance to acute illness or death in rare cases.^[32][33][34] Mycotoxins may also contribute to cancer. Dietary exposure to the mycotoxin aflatoxin B1, commonly produced by growth of the fungus Aspergillus flavus on improperly stored ground nuts in many areas of the developing world, is know to independently (and synergistically with Hepatitis B virus) induce liver cancer.^[35] Mycotoxin-contaminated grain and other food products have a significantly impact on human and animal health globally. According to the World Health Organization, roughly 25 % of the world's food may be contaminated by mycotoxins.^[32]

Prevention of mold exposure from food is generally to not buy or to discard food that has mold growths on it.^[24] Also, mold growth in the first place can be prevented by the same concept of mold growth, assessment, and remediation that prevents air exposure. In addition, it is especially useful to clean the inside of the refrigerator, and having clean dishcloths, towels, sponges and mops.^[24]

Ruminants are considered to have increased resistance to some mycotoxins, presumably due to their superior mycotoxin-degrading capabilities of their gut microbiota.^[32] This suggests that since mycotoxins are difficult to digest by human microbes due to better degradation by rumen microbes as compared to mono-gastric animals like humans. The passage of mycotoxins through the food chain may also have important consequences on human health.^[36] For example, in China in December 2011, high levels of carcinogen aflatoxin M1 in mengniu brand milk were found to be associated with the consumption of mold-contaminated feed by cattle.^[37]

History

In the 1930s, mold was identified as the cause behind the mysterious deaths of farm animals in Russia and other countries. Stachybotrys chartarum was found growing on wet grain used for animal feed. The illnesses and deaths also occurred in humans when starving peasants ate large quantities of rotten food grains and cereals that were heavily overgrown with the Stachybotrys mold.^{[citation needed]}

In the 1970s, building construction techniques changed in response to the changing economic realities including the energy crisis. As a result, homes and buildings became more airtight. Also, cheaper materials such as drywall came into common use. The newer building materials reduced the drying potential of the structures making moisture problems more prevalent. This combination of increased moisture and suitable substrates contributed to increased mold growth inside buildings.^{[citation needed]}

Today, the US Food and Drug Administration and the agriculture industry closely monitor mold and mycotoxin levels in grains and foodstuffs in order to keep the contamination of animal feed and human food supplies below specific levels. In 2005 Diamond Pet Foods, a US pet food manufacturer, experienced a significant rise in the number of corn shipments containing elevated levels of aflatoxin. This mold toxin eventually made it into the pet food supply, and dozens of dogs and cats died before the company was forced to recall affected products.^{[citation needed]}

See also

• Building biology
• Environmental engineering
• Environmental health
• Occupational asthma
• Occupational safety and health
• Ventilation issues in houses

References

External links

• Barrett JR (January 2000). "Mycotoxins: of molds and maladies". Environ. Health Perspect. 108 (1): A20–3. PMC 1637848. PMID 10620533. 
• MSI Mold and Spore Information: Toxic Mold Symptoms
• CDC: http://www.cdc.gov/mold/default.htm
• US EPA: Mold Information — U.S. Environmental Protection Agency
• US EPA: EPA Publication #402-K-02-003 "A Brief Guide to Mold, Moisture, and Your Home"
• NIBS: Whole Building Design Guide: Air Decontamination
• NPIC: Mold Pest Control Information — National Pesticide Information Center
• Mycotoxins in grains and the food supply:
  • http://www.indianacrop.org/Mycotoxin.htm
  • http://cropwatch.unl.edu/aflatoxin.html
  • http://agbiopubs.sdstate.edu/articles/FS907.pdf