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Published on: March 6, 2019
Overview of investigations into pulmonary hemorrhage among infants in Cleveland, Ohio
D G Dearborn1, I Yike, W G Sorenson
1Department of Pediatrics, Case Western Reserve University, Cleveland, OH 44106-5000, USA. dxd9@po.cwru.edu
Insights
Idiopathic pulmonary hemorrhage in infants is linked to household exposure to toxic mold, Stachybotrys chartarum. Environmental tobacco smoke may trigger acute bleeding in vulnerable infants.
Area of Science:
- Environmental Health
- Pediatric Medicine
- Toxicology
Background:
- Idiopathic pulmonary hemorrhage (IPH) is a rare, severe condition in infants.
- A cluster of IPH cases occurred in Cleveland, Ohio, between 1993 and 1998.
- Previous cases were misdiagnosed, including some as sudden infant death syndrome.
Purpose of the Study:
- To investigate the cause of idiopathic pulmonary hemorrhage in infants.
- To identify environmental risk factors associated with IPH.
- To describe the clinical presentation and pathophysiology of IPH.
Main Methods:
- Epidemiological investigation of infant cases in Cleveland.
- Environmental sampling and analysis for mold and fungi.
- Review of clinical data and case histories.
- Toxicological assessment of Stachybotrys chartarum.
Main Results:
- An association was found between IPH and household exposure to Stachybotrys chartarum and other fungi.
- Most affected infants were African American and lived in older housing in eastern metropolitan Cleveland.
- Environmental tobacco smoke was common in homes and may act as a trigger for bleeding.
- Stachybotrys chartarum is a toxigenic mold with a wide geographic distribution.
Conclusions:
- Household exposure to toxigenic mold, particularly Stachybotrys chartarum, is a significant risk factor for infant idiopathic pulmonary hemorrhage.
- Infant lungs are particularly vulnerable to mold toxins.
- Environmental tobacco smoke may exacerbate the condition.
- Further research and public health interventions are needed to address mold exposure in homes.
Abstract:
Idiopathic pulmonary hemorrhage was diagnosed in 37 infants in the Cleveland, Ohio, area between 1993 and 1998. This rare disorder has been related to 12 deaths, including 7 originally thought to be sudden infant death syndrome. Thirty of the infants were African American, all of whom lived in a limited geographic area of eastern metropolitan Cleveland, an area of older housing stock. An investigation led by the Centers for Disease Control and Prevention has found an association with household exposure to a toxigenic mold, Stachybotrys chartarum, and other fungi. The rapidly growing lungs of young infants appear to be especially vulnerable to the toxins made by toxigenic molds. Environmental tobacco smoke was frequently present in the infants' homes and may be a trigger precipitating the acute bleeding. Stachybotrys, although not thought to be a common mold, is known to have a wide geographic distribution. An additional 101 cases of acute, idiopathic pulmonary hemorrhage have been reported in infants in the United States over the past 5 years. In this overview, the investigations are summarized, the clinical profile is described, the toxicity of S. chartarum is discussed, and pathophysiologic concepts are presented.
