BUILDING-ASSOCIATED PULMONARY-DISEASE FROM EXPOSURE TO STACHYBOTRYS CHARTARUM AND ASPERGILLUS VERSICOLOR

The authors present an outbreak of disease associated with exposure to Stachybotrys chartarum and Aspergillus species. A courthouse and two associated office buildings had generated discomfort among employees f or two years since initial occupancy. Multiple interventions had been unsuccessful. An initial evaluation of 14 individuals identified three with potential asthma and three with symptoms consistent with interst itial lung disease A clinical screening protocol to identify individua ls who should be removed from work identified three likely and seven p ossible cases of building-related asthma. Detailed environmental and e ngineering assessments of the building identified major problems in me chanical system design, building construction, and operational strateg ies lending to excess moisture and elevated relative humidities. Moist ure-damaged interior surfaces in both buildings were contaminated with S. chartarum, A. versicolor, and Penicillium species. Aspergillus spe cies, especially A. versicolor, at concentrations of 10(1) to 10(4)/m( 3) dominated the indoor air under normal operating conditions. Bulk sa mples also revealed large quantities of Stachybotrys. A questionnaire survey of the three case and two control buildings documented between three-and 15-fold increases in symptoms. A nested case-control study s uggested emphysematous-like disease in individuals meeting questionnai re definitions for cases. Replication of analysis strategies used in s imilar previous investigations suggested an association between worsen ing symptoms and decreased diffusing capacity of the lung. Performance on neuropsychological measures was similar for both cases and control s, although workers with symptoms reported increased levels of current but not past psychiatric symptomatology. Chemical analyses demonstrat ed the presence of satratoxins G and H. Cytotoxic laboratory analyses demonstrated the presence of agents with biological effectiveness in b ulk materials. No association was seen between IgE or IgG antibodies a nd the presence of disease. This outbreak represents a likely human re sponse to inhaled fungal toxins in indoor environments. Moisture indoo rs represents a public health issue currently inadequately addressed b y building, health, or housing codes.