Clinical experience and results of a sentinel health investigation relatedto indoor fungal exposure

This is a review of exposure conditions, clinical presentation, and morbidi ty of children and adults with indoor fungal exposure such as toxic Stachyb otrys chartarum. Indoor exposure was characterized using different methods including microscopic, culture, cytotoxicity screening tests, and chemical analyses. Clinical case histories and physical and laboratory findings are presented of children (age < 18 years, n = 22; mean age 9 years; 60% female s) and adults (age >18 years, n = 125, mean age 39 years, 67% females) who consulted an environmental health specialty clinic. In the pediatric patien ts' exposure history. widespread fungal contamination of water-damaged buil ding materials with known toxic or allergic fungi was identified. Primarily disorders of the respiratory system, skin, mucous membranes, and central n ervous system were reported. Some enumeration and functional laboratory abn ormalities, mainly of the lymphatic blood cells, were observed, although no statistically significant differences were found. IgE or IgG fungi-specifi c antibodies, used as exposure markers, were positive in less than 25% of a ll tested cases. In an evaluation of a symptomatic girl 11 years of age (se ntinel case investigation) living in an apartment with verified toxigenic f ungi (i.e., S. chartarum), several health indicators showed improvement aft er exposure cessation. Key words: allergy, bioaerosol, exposure, fungi, hea lth, morbidity, mycotoxins, Stachybotrys, toxicity.