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Indoor mold, toxigenic fungi, and Stachybotrys chartarum: infectious disease perspective
1Division of Infectious Diseases, Department of Medicine, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio 44106, USA.
Abstract:
Damp buildings often have a moldy smell or obvious mold growth; some molds are human pathogens. This has caused concern regarding health effects of moldy indoor environments and has resulted in many studies of moisture- and mold-damaged buildings. Recently, there have been reports of severe illness as a result of indoor mold exposure, particularly due to Stachybotrys chartarum. While many authors describe a direct relationship between fungal contamination and illness, close examination of the literature reveals a confusing picture. Here, we review the evidence regarding indoor mold exposure and mycotoxicosis, with an emphasis on S. chartarum. We also examine possible end-organ effects, including pulmonary, immunologic, neurologic, and oncologic disorders. We discuss the Cleveland infant idiopathic pulmonary hemorrhage reports in detail, since they provided important impetus for concerns about Stachybotrys. Some valid concerns exist regarding the relationship between indoor mold exposure and human disease. Review of the literature reveals certain fungus-disease associations in humans, including ergotism (Claviceps species), alimentary toxic aleukia (Fusarium), and liver disease (Aspergillys). While many papers suggest a similar relationship between Stachybotrys and human disease, the studies nearly uniformly suffer from significant methodological flaws, making their findings inconclusive. As a result, we have not found well-substantiated supportive evidence of serious illness due to Stachybotrys exposure in the contemporary environment. To address issues of indoor mold-related illness, there is an urgent need for studies using objective markers of illness, relevant animal models, proper epidemiologic techniques, and examination of confounding factors.
Insights
Indoor mold exposure, especially from Stachybotrys chartarum, raises health concerns. However, current evidence for serious illness, like mycotoxicosis, is inconclusive due to flawed studies, necessitating further research.
Area of Science:
- Environmental Health
- Mycology
- Toxicology
Background:
- Damp buildings can harbor molds, leading to health concerns and investigations into indoor mold exposure.
- Recent reports link severe illnesses to indoor mold, particularly Stachybotrys chartarum, fueling public and scientific interest.
Purpose of the Study:
- To review and critically evaluate the evidence linking indoor mold exposure, specifically Stachybotrys chartarum, to human health effects and mycotoxicosis.
- To examine potential end-organ effects (pulmonary, immunologic, neurologic, oncologic) associated with indoor mold exposure.
Main Methods:
- Comprehensive literature review of studies on indoor mold, Stachybotrys chartarum, and associated human illnesses.
- Detailed examination of specific case reports, such as the Cleveland infant idiopathic pulmonary hemorrhage, to assess their contribution to understanding Stachybotrys-related risks.
Main Results:
- While some fungus-disease associations are established (e.g., ergotism, alimentary toxic aleukia, Aspergillys-induced liver disease), studies on Stachybotrys chartarum and contemporary human illness lack robust evidence.
- Many studies investigating Stachybotrys and human disease exhibit significant methodological flaws, rendering their conclusions inconclusive.
- No well-substantiated evidence was found for serious illness directly caused by Stachybotrys exposure in current indoor environments.
Conclusions:
- Valid concerns exist regarding indoor mold and human health, but current evidence for severe illness from Stachybotrys chartarum is weak.
- There is an urgent need for rigorous scientific studies employing objective markers, appropriate animal models, and sound epidemiologic methods to clarify the risks of indoor mold exposure.