Water-damaged Environments Research Articles

Treatable metabolic and inflammatory abnormalities in Post COVID Syndrome (PCS) define the transcriptomic basis for persistent symptoms: Lessons from CIRS

Within three months of the onset of acute SARS-CoV-2 (COVID-19) infections, new and persistent symptoms were noted in survivors. While the world’s medical and research communities focus on saving lives following COVID-19 infection, a relentless march of new cases of Post-COVID Syndrome (PCS) continues to spread around the globe as a second COVID-related pandemic. Efforts to define the physiology of PCS, a multisystem, multi-symptom illness, continue without success, in part due to the markedly different case presentations. Using a transcriptomic assessment of persistently ill cases of PCS, we show the presence of (i) molecular hypometabolism (MHM) and proliferative physiology; (ii) elevated levels of ribosomal stress responses and a concomitant increase in gene activation of TGFBR; and (iii) common co-expression of CD14 and Toll Receptor 4, correlated to exposure of amplified microbial growth in a water-damaged environment, specifically Actinobacteria and endotoxin, respectively, compared to recovered PCS cases. Total symptom scores and visual contrast sensitivity (VCS) results showed statistically significant differences. The data reported here supports the concept that PCS occurs in patients with additional environmental exposures and enhanced TGF signaling. In a strikingly similar condition called Chronic Inflammatory Response Syndrome (CIRS), named in 2010, the transcriptomic abnormalities were identified to respond to treatment with FDA-cleared medications, with salutary benefits for affected cases. Though sparsely reported, PCS cases share proteomic findings with CIRS. While additional studies are indicated, a new approach to the treatment of PCS is suggested.

A Review of the Mechanism of Injury and Treatment Approaches for Illness Resulting from Exposure to Water‐Damaged Buildings, Mold, and Mycotoxins

Physicians are increasingly being asked to diagnose and treat people made ill by exposure to water-damaged environments, mold, and mycotoxins. In addition to avoidance of further exposure to these environments and to items contaminated by these environments, a number of approaches have been used to help persons affected by exposure to restore their health. Illness results from a combination of factors present in water-damaged indoor environments including, mold spores and hyphal fragments, mycotoxins, bacteria, bacterial endotoxins, and cell wall components as well as other factors. Mechanisms of illness include inflammation, oxidative stress, toxicity, infection, allergy, and irritant effects of exposure. This paper reviews the scientific literature as it relates to commonly used treatments such as glutathione, antioxidants, antifungals, and sequestering agents such as Cholestyramine, charcoal, clay and chlorella, antioxidants, probiotics, and induced sweating.

Comparison of work‐related symptoms and visual contrast sensitivity between employees at a severely water‐damaged school and a school without significant water damage

The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation (HHE) of a water-damaged school in New Orleans (NO), Louisiana. Our aim in this evaluation was to document employee health effects related to exposure to the water-damaged school, and to determine if VCS testing could serve as a biomarker of effect for occupants who experienced adverse health effects in a water-damaged building. NIOSH physicians and staff administered a work history and medical questionnaire, conducted visual contrast sensitivity (VCS) testing, and collected sticky-tape, air, and dust samples at the school. Counting, culturing, and/or a DNA-based technology, called mold-specific quantitative PCR (MSQPCR), were also used to quantify the molds. A similar health and environmental evaluation was performed at a comparable school in Cincinnati, Ohio which was not water-damaged. Extensive mold contamination was documented in the water-damaged school and employees (n = 95) had higher prevalences of work-related rashes and nasal, lower respiratory, and constitutional symptoms than those at the comparison school (n = 110). VCS values across all spatial frequencies were lower among employees at the water-damaged school. Employees exposed to an extensively water-damaged environment reported adverse health effects, including rashes and nasal, lower respiratory, and constitutional symptoms. VCS values were lower in the employees at the water-damaged school, but we do not recommend using it in evaluation of people exposed to mold. Am. J. Ind. Med. 55:844-854, 2012. This article is a U.S. Government work and is in the public domain in the USA.

Influence of various growth parameters on fungal growth and volatile metabolite production by indoor molds

A Penicillium polonicum, an Aspergillus ustus and a Periconia britannica strain were isolated from water-damaged environments and the production of microbial volatile organic compounds (MVOCs) was investigated by means of headspace solid-phase microextraction followed by GC–MS analysis. The most important MVOCs produced were 2-methylisoborneol, geosmin and daucane-type sesquiterpenes for P. polonicum, 1-octen-3-ol, 3-octanone, germacrene D, δ-cadinene and other sesquiterpenes for A. ustus and the volatile mycotoxin precursor aristolochene together with valencene, α-selinene and β-selinene for P. britannica. Different growth conditions (substrate, temperature, relative humidity) were selected, resembling indoor parameters, to investigate their influence on fungal metabolism in relation with the sick building syndrome and the results were compared with two other fungal strains previously analyzed under the same conditions. In general, the range of MVOCs and the emitted quantities were larger on malt extract agar than on wallpaper and plasterboard, but, overall, the main MVOC profile was conserved also on the two building materials tested. The influence of temperature and relative humidity on growth and metabolism is different for different fungal species, and two main patterns of behavior could be distinguished. Results show that, even at suboptimal conditions for growth, production of fungal volatiles can be significant.

Spore trap analysis and MSQPCR in evaluating mold burden a flooded gymnasium case study

A school gymnasium was accidentally flooded by the fire-suppression sprinkler system. The surface water was removed immediately and, after 10 days, a professional firm engaged to dry the environment. Twenty five days after the flooding, the school decided to evaluate whether there was any mold growth in the gymnasium. The inspector used two approaches, traditional air samples or a DNA-based analysis of dust samples. Thirty five-minute air samples (for total of 75 L of air each sample) were collected with Air-O-Cell™ (AOC) cassettes and the mold structures (MS) were quantified by microscopy. These samples were compared to two identical outdoor air samples. As an alternative, two dust samples were collected and quantified by mold specific quantitative PCR (MSQPCR). Comparisons of indoor to outdoor mold concentrations in air samples were inconclusive, but applying MSQPCR to the investigation of this water-damaged environment provided a more reliable and useful answer to the extent of mold contamination than did the spore trap analysis.

The relative allergenicity of Stachybotrys chartarum compared to house dust mite extracts in a mouse model

A report by the Institute of Medicine suggested that more research is needed to better understand mold effects on allergic disease, particularly asthma development. The authors compared the ability of the fungus Stachybotrys chartarum (SCE) and house dust mite (HDM) extracts to induce allergic responses in BALB/c mice. The extracts were administered by intratracheal aspiration (IA) at several doses (0, 2.5, 5, 10, 20, 40, and 80 µg) 4 times over a 4-week period. Three days after the last IA exposure, serum and bronchoalveolar lavage fluid (BALF) were collected. The relative allergenicity of the extracts was evaluated based on the lowest dose that induced a significant response compared to control (0 μg) and the linear regression slope analysis across the dose range. SCE induced a more robust response than HDM for BALF some inflammatory cells (macrophage and neutrophils), whereas HDM induced more robust BALF lymphocyte and eosinophil responses. Although SCE induced a more robust serum total immunoglobulin E (IgE) response than did HDM, the induction of a similar response in a functional, antigen-specific IgE assay required approximately twice as much SCE as HDM. Even though SCE demonstrates the ability to induce allergic responses in the mouse model, considering the importance and relevance of eosinophil, lymphocyte, and antigen-specific IgE in allergic airway disease, it is concluded that HDM is more potent than SCE in the induction of allergic responses. These data suggest a threshold dose for SCE allergy induction. Furthermore, in damp water-damaged environments, exposure to S. chartarum might easily exceed the sensitization threshold for a susceptible population.

ELISA measurement of stachylysin in serum to quantify human exposures to the indoor mold Stachybotrys chartarum.

The goal of this research was to develop a measurable indicator of human exposure to Stachyborys chartarum. Antibodies were produced against the hemolytic agent stachylysin obtained from the mold S. chartarum. These antibodies were used to develop two enzyme-linked immunosorbent assay methods for the analysis of stachylysin in human and rat sera and environmental samples. Stachylysin was measured in rat pups that received nasal instillations of S. chartarum conidia but not in control rat serum. Stachylysin in the serum of five human adults exposed to S. chartarum in water-damaged environments was 371 ng/mL but none was detected in the control serum. Stachylysin was also quantified in spore, wallboard, mycelial, and dust samples. The measurement of stachylysin may be a useful indicator in assessing human exposure to S. chartarum and in determining the presence of this indoor mold.

Toxigenic fungi in a water-damaged building: an intervention study.

In an investigation of health complaints among employees of a water-damaged office building, the environment showed evidence of fungal contamination with the isolation of Stachybotrys chartarum in one of five bulk samples tested for fungal growth. In response, a public health official recommended that employees be relocated from the building. Employees were subsequently moved to a different environment. A focused environmental investigation of microbial growth within the building followed, revealing moderate to high levels of fungi (Penicillium, Aspergillus versicolor) and bacteria in bulk and surface samples. S. Chartarum was identified in one of 19 (5%) environmental samples using Czapek agar. A health survey of building occupants revealed a high prevalence of multiple symptoms, with the predominance of neurobehavioral and upper respiratory tract complaints. The majority of symptoms were significantly less prevalent after relocation from the water-damaged environment. The initial hypothesis that exposure to toxigenic fungi was responsible for the high prevalence of reported symptoms is difficult to investigate and confirm given the current limits of epidemiological knowledge regarding exposure to these organisms and building-related illness. Future interventions where mycotoxin exposure is suspected should emphasize the importance of risk assessment and risk communication.