Indicators of airborne fungal concentrations in urban homes: understanding the conditions that affect indoor fungal exposures

Risk of fungal exposure in the homes of patients with hematologic malignancies

BACKGROUND

Patients with hematological malignancies are at a high risk of developing invasive fungal infections (IFI) because they undergo several cycles of treatment leading to episodes of neutropenia. In addition, they alternate between hospital stays and periods spent at home. Thus, when an IFI is diagnosed during their hospital stays, it is highly challenging to identify the origin of the fungal contamination. The objective of this study was to analyze at home fungal exposure of 20 patients with leukemia by taking air and water samples in their living residence.

METHODS

Air was sampled in 3 rooms of each home with a portable air system impactor. Tap water was collected at 3 water distribution points of each home. For positive samples, fungi were identified by mass spectrometry or on the basis of their morphological features.

RESULTS

85 % of homes revealed the presence in air of Aspergillus spp. and those belonging to the section Fumigati presented the highest concentrations and the greatest frequency of isolation. Concerning mucorales, Rhizopus spp. and Mucor spp. were isolated in air of 20 % and 5 % of dwellings, respectively. In 4 homes, more than 70 % of the fungal species identified in air were potential opportunists; these were mainly Aspergillus spp. with concentrations greater than 20 cfu/m3. The water samples revealed the presence of Fusarium in 3 dwellings, with concentrations up to 80 cfu/L. Finally, for one patient, fungal species isolated during a period of hospitalization were phenotypically similar to those isolated in samples taken at home. For a second patient, a PCR Mucorale was positive on a sample of bronchoalveolar fluid while air samples taken at his home also revealed also the presence of mucorales.

CONCLUSION

The presence of opportunistic fungal species in the air of all the explored homes suggests the need for strengthened preventive measures in the home of immunocompromised patients. It would be interesting to compare the fungi isolated (from patients and from their environment) by genotyping studies aimed at specifying the correspondence existing between fungal species present in the patients' homes and those responsible for IFI in the same patients.

Association of exposure to indoor molds and dampness with allergic diseases at water-damaged dwellings in Korea

This study aims to characterize levels of molds, bacteria, and environmental pollutants, identify the associations between indoor mold and dampness exposures and childhood allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, using three different exposure assessment tools. A total of 50 children with their parents who registered in Seoul and Gyeonggi-do in Korea participated in this study. We collated the information on demographic and housing characteristics, environmental conditions, and lifestyle factors using the Korean version of the International Study of Asthma and Allergies in Childhood questionnaire. We also collected environmental monitoring samples of airborne molds and bacteria, total volatile organic compounds, formaldehyde, and particulate matter less than 10 µm. We evaluated and determined water damage, hidden dampness, and mold growth in dwellings using an infrared (IR) thermal camera and field inspection. Univariate and multivariate regression analyses were performed to evaluate the associations between prevalent allergic diseases and exposure to indoor mold and dampness. Indoor mold and bacterial levels were related to the presence of water damage in dwellings, and the mean levels of indoor molds (93.4 ± 73.5 CFU/m3) and bacteria (221.5 ± 124.2 CFU/m3) in water-damaged homes were significantly higher than those for molds (82.0 ± 58.7 CFU/m3) and for bacteria (152.7 ± 82.1 CFU/m3) in non-damaged dwellings (p < 0.05). The crude odds ratios (ORs) of atopic dermatitis were associated with < 6th floor (OR = 3.80), and higher indoor mold (OR = 6.42) and bacterial levels (OR = 6.00). The crude ORs of allergic diseases, defined as a group of cases who ever suffered from two out of three allergic diseases, e.g., asthma and allergic rhinitis, and allergic rhinitis were also increased by 3.8 and 9.3 times as large, respectively, with water damage (+) determined by IR camera (p < 0.05). The adjusted OR of allergic rhinitis was significantly elevated by 10.4 times in the water-damaged dwellings after adjusting age, sex, and secondhand smoke. Therefore, a longitudinal study is needed to characterize dominant mold species using DNA/RNA-based sequencing techniques and identify a causal relationship between mold exposure and allergic diseases in the future.

Deciphering the distribution of microbial communities and potential pathogens in the household dust

The reliance of modern society on indoor environments increasing has made them crucial sites for human exposure to microbes. Extensive research has identified ecological drivers that influence indoor microbial assemblages. However, few studies have examined the dispersion of microbes in different locations of identical indoor environments. In this study, we employed PacBio Sequel full-length amplicon sequencing to examine the distribution of microbes at distinct locations in a single home and to identify the potential pathogens and microbial functions. Microbial communities differed considerably among the indoor sampling sites (P < 0.05). In addition, bacterial diversity was influenced by human activities and contact with the external environment at different sites, whereas fungal diversity did not significantly differ among the sites. Potential pathogens, including bacteria and fungi, were significantly enriched on the door handle (P < 0.05), suggesting that door handles may be hotpots for potential pathogens in the household. A high proportion of fungal allergens (34.37 %-56.50 %), which can cause skin diseases and asthma, were observed. Co-occurrence network analysis revealed the essential ecological role of microbial interactions in the development of a healthy immune system. Overall, we revealed the differences in microbial communities at different sampling sites within a single indoor environment, highlighting the distribution of potential pathogens and ecological functions of microbes, and providing a new perspective and information for assessing indoor health from a microbiological viewpoint.

Development of a cockroach (Blattella germanica) qPCR for the objective measurement of exposure at home

Cockroach allergens have a greater impact on asthma morbidity than those from dust mites, cats, and dogs. The American cockroach (Periplaneta americana) and the German cockroach (Blattella germanica) are most frequently responsible for sensitization. The worldwide prevalence of allergic sensitization has been estimated at 2 to 26 % and is influenced by unfavorable socioeconomic conditions. Exposure is generally measured by determining antigen levels in dust or through insect trapping. We developed a real-time quantitative PCR (qPCR) method to provide an objective measurement of B. germanica levels in dwellings. The specificity of the qPCR primers and TaqMan® hydrolysis probe was validated in silico with 18S rRNA sequences. No amplification was observed for other species of cockroaches, with the exception of Blattella nipponica, which is not common indoors. From 2018 to 2021, exposure to B. germanica was detected and quantified in 27 of 389 dwellings in Bourgogne-Franche-Comté (mean = 333.8; median = 9.1 and maximum = 5304 copy number equivalents) and in 236 of 3193 ELFE cohort dwellings in mainland France in 2011 (mean = 15.6; median < 1 and maximum = 1275 copy number equivalents). The distribution of dwellings testing positive for cockroaches (7 %) differed among the 12 regions of France: <1 % in two regions, between 1 and 5 % in eight regions, 16.5 % in two regions and 35 % around Paris. Exposure measurements by the EDC sampling and qPCR methods are effective ways to assess the exposure to cockroaches in dwellings. A knowledge of the level of exposure to cockroaches is particularly important for asthmatic patients, particularly those not allergic to other common antigens.

Assessing the health risk of living near composting facilities on lung health, fungal and bacterial disease in cystic fibrosis: a UK CF Registry study

AIM

To explore the health risk of living near permitted composting sites (PCSs) on disease severity in children and adults with cystic fibrosis (CF) across the UK.  METHODS: A semi-individual cross-sectional study was used to examine the risk of disease severity in people with CF (pwCF) within and beyond 4 km of PCSs in the UK in 2016. All pwCF registered in the UK CF Registry were eligible for this study. Linear and Poisson regressions, adjusted for age, gender, genotype, BMI, Pseudomonas aeruginosa and deprivation, were used to quantify associations between distance to a PCS and percent predicted forced expiratory volume in one second (ppFEV₁), pulmonary exacerbations (#IVdays), and fungal and bacterial infections.

RESULTS

The mean age of the 9,361 pwCF (3,931 children and 5,430 adults) studied was 20.1 (SD = 14.1) years; 53.3% were male; and 49.2% were homozygous F508del. Over 10% of pwCF (n = 1,015) lived within 4 km of a PCS. We found no statistically significant difference in ppFEV₁ and #IVdays/year in children. However, in adults, ppFEV₁ was -1.07% lower (95% confidence interval (CI): -2.29%, 0.16%) and #IVdays/year were 1.02 day higher (95%CI: 1.01, 1.04) within 4 km of a PCS. Furthermore, there were statistically significant differences in mean ppFEV₁ in CF adults with Aspergillus fumigatus (58.2.% vs 62.0%, p = 0.005) and Candida spp. (56.9% vs 59.9%, p = 0.029) residing within 4 km of a PCS. No associations were identified for allergic bronchopulmonary aspergillosis, P. aeruginosa or Staphylococcus aureus.

CONCLUSIONS

This novel national study provides evidence that adults with CF living near a PCS may experience small reductions in lung function, an increased risk of pulmonary exacerbations, and more frequent fungal infections. If confirmed by studies using refined exposure assessment methods accounting for bioaerosol dispersion, these results could have important implications for the living environment of pwCF.

Surface fungal diversity and several mycotoxin-related genes' expression profiles during the Lunar Palace 365 experiment

BACKGROUND

Chinese Lunar Palace 1 (LP1) is a ground-based bio-regenerative life support system (BLSS) test bed integrating highly efficient plant cultivation, animal protein production, urine nitrogen recycling, and bioconversion of solid waste. To date, there has been no molecular method-based detailed investigation of the fungal community and mycotoxin potential in BLSS habitats. To ensure safe BLSS design for actual space missions, we analyzed the LP1 surface mycobiome and mycotoxin potential during the Lunar Palace 365 project through internal transcribed spacer region 1 (ITS1) amplicon sequencing and quantitative polymerase chain reaction (qPCR) with primers specific for idh, ver1, nor1, tri5, and ITS1.

RESULTS

The LP1 system exhibited significant differences in fungal community diversity compared to other confined habitats, with higher fungal alpha diversity and different community structures. Significant differences existed in the surface fungal communities of the LP1 habitat due to the presence of different occupant groups. However, there was no significant difference between fungal communities in the plant cabin with various occupants. Source tracker analysis shows that most of the surface fungi in LP1 originated from plants. Regardless of differences in occupants or location, there were no significant differences in mycotoxin gene copy number.

CONCLUSIONS

Our study reveals that plants are the most crucial source of the surface fungal microbiome; however, occupant turnover can induce significant perturbations in the surface fungal community in a BLSS. Growing plants reduced fungal fluctuations, maintaining a healthy balance in the surface fungal microbiome and mycotoxin potential. Moreover, our study provides data important to (i) future risk considerations in crewed space missions with long-term residency, (ii) an optimized design and planning of a space mission that incorporates crew shifts and plant growth, and (iii) the expansion of our knowledge of indoor fungal communities with plant growth, which is essential to maintain safe working and living environments. Video Abstract.

Characteristics of annual mold variations and association with childhood allergic symptoms/diseases via combining surveys and home visit measurements

The presence of dampness and visible molds leads to concerns of poor indoor air quality which has been consistently linked with increased exacerbation and development of allergy and respiratory diseases. Due to the limitations of epidemiological surveys, the actual fungal exposure characteristics in residences has not been sufficiently understood. This study aimed to characterize household fungal diversity and its annual temporal and spatial variations. We developed combined cross-sectional survey, repeated air sampling around a year, and DNA sequencing methods. The questionnaire survey was conducted in 2019, and 4943 valid cases were received from parents; a follow-up case-control study (11 cases and 12 controls) was designed, and onsite measurements of indoor environments were repeated in typical summer, transient season, and winter; dust from floor and beddings in children's room were collected and ITS based DNA sequencing of totally 68 samples was conducted. Results from 3361 children without changes to their residences since birth verified the significant associations of indoor dampness/mold indicators and prevalence of children-reported diseases, with increased adjusted odd ratios (aORs) >1 for studied asthma, wheeze, allergic rhinitis, and eczema. The airborne fungal concentrations from air sampling were higher than 1000 CFU/m³ in summer, regardless of indoors and outdoors, indicating an intermediate pollution level. The DNA sequencing for dust showed the Aspergillus was the predominant at genus level and the Aspergillus_penicillioides was the most common at species level; while the fungal community and composition varied significantly in different homes and seasons, according to α and β diversity analyses. The comprehensive research methods contribute to a holistic understanding of indoor fungal exposure, including the concentrations, seasonal variations, community, and diversity, and verifies the relations with children's adverse health outcomes. The study further elucidates the role of microbiome in human health, which helps setting health-protective thresholds and managing mold treatments in buildings, to promote indoor air quality and human well-beings.

Airborne bacterial and fungal concentrations and fungal diversity in bedrooms of infant twins under 1 year of age living in Porto

Exposure to airborne microorganisms has been linked to the development of health detriments, particularly in children. Microbial pollution can constitute a relevant health concern indoors, where levels of airborne microorganisms may be specially increased. This work aimed to characterize the airborne bacterial levels, and fungal concentration and diversity to which twins are exposed in their bedrooms (n = 30) during the first year of life. Bacterial and fungal levels varied widely across the studied bedrooms, with 10% of the rooms presenting values exceeding the national limit for both indoor bacterial and fungal counts. Cladosporium was the predominant genera, but Penicillium, Aspergillus, Alternaria, Trichoderma and Chrysonilia were also identified in the samples collected. In addition, two toxicogenic species, A. flavus and T. viride, were identified at counts that exceeded the established limit (12 CFU/m³) in 3 and 7% of the bedrooms surveyed, respectively. Based on indoor-to-outdoor concentration ratios, outdoor air seemed to be the main contributor to the total load of fungi found indoors, while airborne bacteria appeared to be mainly linked to indoor sources. Higher indoor nitrogen dioxide levels were negatively correlated with indoor fungi concentrations, whereas particulate matter and volatile organic compounds concentrations were associated with an increase in fungal prevalence. In addition, rooms with small carpets or located near outdoor agriculture sources presented significantly greater total fungal concentrations. Multiple linear regression models showed that outdoor levels were the single significant predictor identified, explaining 38.6 and 53.6% of the Cladosporium sp. and total fungi counts, respectively. The results also suggest the existence of additional factors contributing to airborne biologicals load in infants' bedrooms that deserve further investigation. Findings stress the need for investigating the existence of declared interactive effects between chemical and biological air pollutants to accurately understand the health risk that the assessed levels can represent to infants.

Transcriptome Responses to Defined Insecticide Selection Pressures in the German Cockroach (Blattella germanica L.)

Cockroaches are important global urban pests from aesthetic and health perspectives. Insecticides represent the most cost-effective way to control cockroaches and limit their impacts on human health. However, cockroaches readily develop insecticide resistance, which can quickly limit efficacy of even the newest and most effective insecticide products. The goal of this research was to understand whole-body physiological responses in German cockroaches, at the metatranscriptome level, to defined insecticide selection pressures. We used the insecticide indoxacarb as the selecting insecticide, which is an important bait active ingredient for cockroach control. Six generations of selection with indoxacarb bait produced a strain with substantial (>20×) resistance relative to inbred control lines originating from the same parental stock. Metatranscriptome sequencing revealed 1,123 significantly differentially expressed (DE) genes in ≥two of three statistical models (81 upregulated and 1,042 downregulated; FDR P < 0.001; log2FC of ±1). Upregulated DE genes represented many detoxification enzyme families including cytochrome-P450 oxidative enzymes, hydrolases and glutathione-S-transferases. Interestingly, the majority of downregulated DE genes were from microbial and viral origins, indicating that selection for resistance is also associated with elimination of commensal, pathogenic and/or parasitic microbes. These microbial impacts could result from: (i) direct effects of indoxacarb, (ii) indirect effects of antimicrobial preservatives included in the selecting bait matrix, or (iii) selection for general stress response mechanisms that confer both xenobiotic resistance and immunity. These results provide novel physiological insights into insecticide resistance evolution and mechanisms, as well as novel insights into parallel fitness benefits associated with selection for insecticide resistance.

Assessment of fungal bioaerosols and particulate matter characteristics in indoor and outdoor air of veterinary clinics

Veterinary staff are frequently exposed to various occupational hazards. The present study was aimed to investigate the air characteristics of veterinary clinics in terms of fungal bioaerosols and particulate matters. Air samples were taken every six days from the operating room, examination room and outdoor air of three veterinary clinics in Shiraz, southwest Iran. The concentrations of fungal bio-aerosols ranged from 8.05 CFU/m ³ in the outdoor air of clinic B to 47.21 CFU/m ³ in the operating room of clinic A. The predominant fungal genera identified in the studied clinics were Penicillium and Aspergillus niger, respectively. The concentrations of PM_2.5 ranged from 41.88 μg/m ³ in the operating room of clinic C to 60.31 μg/m ³ in the outdoor air of the same clinic. The corresponding values for PM₁₀ ranged from 114.40 μg/m ³ in the operating room of clinic C to 256.70 μg/m ³ in the outdoor air of the same clinic. The results of this study showed a positive correlation between the concentration of fungal bioaerosols and relative humidity (p < 0.05; r = 0.622). Besides, a negative correlation was found between the concentration of fungal bioaerosols and temperature (p < 0.05; r = 0.369). To better assess the individual exposure of veterinarians and staff in veterinary clinics, tests including nasopharyngeal sampling are recommended.

Contribution of Visible Surface Mold to Airborne Fungal Concentration as Assessed by Digital Image Quantification

The rapid monitoring of total fungi, including air and surface fungal profiling, is an important issue. Here, we applied air and surface sampling, combined with digital image quantification of surface mold spots, to evaluate the contribution of surface fungi to airborne fungal concentrations. Cladosporium, Penicillium, Aspergillus, and yeast often appeared in the air or on wall surfaces during sampling. The indoor/outdoor concentration ratios (I/O ratios) demonstrated that the airborne concentrations of commonly found fungal genera outdoors were higher than those indoors (median I/O ratio = 0.65-0.91), excluding those of Penicillium and yeast. Additionally, the surface density (fungal concentration/area) of individual fungi showed no significant correlation with the airborne concentration, excluding that of Geotrichum. However, if a higher surface ratio (>0.00031) of mold spots appeared in the total area of an indoor environment, then the concentrations of Aspergillus and Geotrichum in the air increased significantly. Our results demonstrated that the airborne concentration of indoor fungi is significantly correlated with the outdoor concentration. A higher density of surface fungi does not necessarily contribute to a high fungal concentration in the air. In contrast to fungal density, quantification of the surface fungal area is recommended to assess the risk of surface fungi propelling into the air.

Temporal variation of airborne fungi in university library rooms and its relation to environmental parameters and potential confounders

Indoor airborne fungi have been associated with adverse human health effects. Therefore, it is important to understand the causes of underlying variation in airborne fungi in indoor environments. This study consequently aimed to investigate the association between indoor fungi with temporal variation, environmental parameters, and potential confounders over 10 months in four library rooms using Andersen samplers. Indoor fungal concentrations peaked in October and were lowest in March in both stack rooms, whereas the highest concentrations in both reading rooms were observed in September with lowest concentrations in July. Nonparametric analyses revealed higher fungal concentrations in the rooms that were significantly associated with relative humidity ≥ 60%, PM_2.5 ≥ 35 μg/m³, number of people ≥ 16, open windows, working air conditioners, and room area < 400 m². Multiple linear regression modeling for the library building considering only continuous variables revealed that relative humidity, PM_2.5, and the number of people were significant predictors of fungal concentrations. Additionally, the model with continuous and categorical variables suggested that relative humidity, PM_2.5, the number of people, ceiling fan condition, window state, and air conditioner operating status were significant predictor variables of concentrations. Outdoor fungal concentrations were a significant predictor for the two models of indoor fungal concentrations for each room. Ceiling fan or air conditioner operation was associated with altered fungal particle concentrations. These results provide a deeper understanding of indoor air fungal quality.

Resistance development characteristics of reared German cockroach (Blattodea: Blattellidae) to chlorpyrifos

Understanding the process of resistance development of German cockroach, Blattella germanica (L.), in detail is necessary to potentially delay the development of insecticides resistance by rotation or discontinuation of insecticides at the right time. In this study, we investigated the resistance development of the reared German cockroach to chlorpyrifos (CPF) for 23 generations from susceptible cockroaches. CPF 50% lethal dose (LD₅₀) and resistance ratio of each generation cockroaches were determined. The CPF LD₅₀ to each generation cockroaches was used as the insecticide selection pressure of this generation by topical application. The resistance development curve was depicted according to the CPF LD₅₀ to all 23 generations of cockroaches. As a result, a highly resistant German cockroach cohort to CPF, which the resistance ratio was 21.63, was obtained after 23 generations’ selection. During the selection, the cockroaches developed low resistance from F1 to F5, moderate resistance from F6 to F12, and high resistance from F13 to F23. There was a rapid resistance increase every 5–7 generations. The resistance growing showed relatively slow from F1 to F11. The fastest growing phase of the resistance was from F12 to F20, in which accounted for more than 80% of the total resistance increase in 23 generations. The development of resistance to CPF tended to slow down from F21 to F23. These findings may provide a basis for the rational use of insecticides, delaying the development of resistance by rotation or discontinuation.

Post-Flood Impacts on Occurrence and Distribution of Mycotoxin-Producing Aspergilli from the Sections Circumdati, Flavi, and Nigri in Indoor Environment

Mycotoxin-producing Aspergilli (Circumdati, Flavi, and Nigri), usually associated with contaminated food, may also cause respiratory disorders and are insufficiently studied in water-damaged indoor environments. Airborne (N = 71) and dust borne (N = 76) Aspergilli collected at post-flood and control locations in Croatia resulted in eleven different species based on their calmodulin marker: A. ochraceus, A. ostianus, A. pallidofulvus, A. sclerotiorum, and A. westerdijkiae (Circumdati); A. flavus (Flavi); and A. tubingensis, A. welwitschiae, A. niger, A. piperis, and A. uvarum (Nigri). Most of the airborne (73%) and dust borne (54%) isolates were found at post-flood locations, and the highest concentrations measured in indoor air (5720 colony-forming units (CFU)/m³) and dust (2.5 × 10⁵ CFU/g) were up to twenty times higher than in the control locations. A. flavus dominated among airborne isolates (25%) at the unrepaired locations, while 56% of the dust borne Aspergilli were identified as A. tubingensis and A. welwitschiae. The ability of identified isolates to produce mycotoxins aflatoxin B₁ (AFB₁), fumonisin B₂ (FB₂), and ochratoxin A were assessed by LC-MS analysis. All ochratoxin A (OTA)-producing Circumdati belonged to A. westerdijkiae (13.7 ± 15.81 µg/mL); in the section, FlaviA. flavus produced AFB₁ (2.51 ± 5.31 µg/mL), while A. welwitschiae and A. niger (section Nigri) produced FB₂ (6.76 ± 13.51 µg/mL and 11.24 ± 18.30 µg/mL, respectively). Water damage dominantly supported the occurrence of aflatoxigenic A. flavus in indoor environments. Yet unresolved, the causal relationship of exposure to indoor Aspergilli and adverse health effects may support the significance of this research.

Comprehensive Fungal Community Analysis of House Dust Using Next-Generation Sequencing

Fungal community analyses in homes have been attracting attention because fungi are now generally considered to be allergens. Currently, these analyses are generally conducted using the culture method, although fungal communities in households often contain species that are difficult to culture. In contrast, next-generation sequencing (NGS) represents a comprehensive, labor- and time-saving approach that can facilitate species identification. However, the reliability of the NGS method has not been compared to that of the culture method. In this study, in an attempt to demonstrate the reliability of this application, we used the NGS method to target the internal transcribed spacer 1 (ITS1) in the fungal genome, conducted fungal community analyses for 18 house-dust samples and analyzed fungal community structures. The NGS method positively correlated with the culture method regarding the relative abundance of Aspergillus, Penicillium, Cladosporium and yeasts, which represent the major fungal components found in houses. Furthermore, several genera, such as Malassezia, could be sensitively detected. Our results imply that the reliability of the NGS method is comparable to that of the culture method and indicates that easily available databases may require modifications, including the removal of registrations that have not been sufficiently classified at the genus level.

On-site investigation of the concentration and size distribution characteristics of airborne fungi in a university library

It is important to investigate fungal air quality in libraries because they represent a complex indoor environment. The aim of the study was to quantitatively investigate airborne fungal contamination levels based on field measurements in autumn and winter in four selected library rooms (compact stack, lending room, reading room, study room) in a university library building, as well as the effects of several factors on the culturability of airborne fungi. Airborne fungal levels varied by room, with the highest fungal levels in the reading room (634 ± 275 CFU/m³) and the lowest in the lending room (486 ± 177 CFU/m³). Airborne fungal concentrations were significantly different with seasonal variation (p < 0.05) for all rooms except for the reading room. The size distribution analysis showed that the most airborne fungi were 1.1-3.2 μm in size; based on the schematic diagram of the human respiratory system, more than 80% of airborne fungi could be deposited in the lower respiratory tract (0.65-4.7 μm). Indoor/outdoor airborne fungal concentration ratios were below 1.0 for all four rooms during autumn and winter, showing that outdoor fungi are the main source of indoor fungi. Pearson correlations showed that the fungal concentration was significantly positively correlated with both temperature (r = 0.531, p < 0.05) and relative humidity (r = 0.555, p < 0.05). Indoor temperature, indoor relative humidity and number of open windows significantly positively affected airborne fungal concentration in a multiple linear regression model (p < 0.05). This paper provides fundamental data on fungal contamination that can help experts in indoor air quality to develop guidelines for airborne fungi in libraries and create a safe environment for library patrons and staff.

Predicting the concentration of indoor culturable fungi using a kernel-based extreme learning machine (K-ELM)

Indoor fungal is of great significance for human health. The kernel-based extreme learning machine is employed to determine the most important parameters for predicting the concentration of indoor culturable fungi (ICF). For model training and statistical analysis, parameters that contained indoor or outdoor PM₁₀ and PM_2.5, RH, Temperature, CO₂ and ICF were measured in 85 residential buildings of Baoding, China, from November 2016 to March 2017. The variable selection process contains four different cases to identify the optimal input combination. The results indicate that root mean square error of the optimal input combinations can be improved 5.6% from 1 to 2 input variables, while that could be only improved 1.9% from 2 to 3 input variables. However, considering both precision and simplicity, the combination of indoor PM₁₀ and RH provides a more suitable selection for predicting the ICF.

Indoor Microbiome: Quantification of Exposure and Association with Geographical Location, Meteorological Factors, and Land Use in France

The indoor microbial community is a mixture of microorganisms resulting from outdoor ecosystems that seed the built environment. However, the biogeography of the indoor microbial community is still inadequately studied. Dust from more than 3000 dwellings across France was analyzed by qPCR using 17 targets: 10 molds, 3 bacteria groups, and 4 mites. Thus, the first spatial description of the main indoor microbial allergens on the French territory, in relation with biogeographical factors influencing the distribution of microorganisms, was realized in this study. Ten microorganisms out of 17 exhibited increasing abundance profiles across the country: Five microorganisms (Dermatophagoïdes pteronyssinus, Dermatophagoïdes spp., Streptomyces spp., Cladosporium sphaerospermum, Epicoccum nigrum) from northeast to southwest, two (Cryptococcus spp., Alternaria alternata) from northwest to southeast, Mycobacteria from east to west, Aspergillus fumigatus from south to north, and Penicillium chrysogenum from south to northeast. These geographical patterns were partly linked to climate and land cover. Multivariate analysis showed that composition of communities seemed to depend on landscapes, with species related to closed and rather cold and humid landscapes (forests, located in the northeast) and others to more open, hot, and dry landscapes (herbaceous and coastal regions, located in the west). This study highlights the importance of geographical location and outdoor factors that shape communities. In order to study the effect of microorganisms on human health (allergic diseases in particular), it is important to identify biogeographic factors that structure microbial communities on large spatial scales and to quantify the exposure with quantitative tools, such as the multi-qPCR approach.

Logistic regression models for predicting daily airborne Alternaria and Cladosporium concentration levels in Catalonia (NE Spain)

Alternaria and Cladosporium are the most common airborne fungal spores responsible for health problems, as well as for crop pathologies. The study of their behavior in the air is a necessary step for establishing control and prevention measures. The aim of this paper is to develop a logistic regression model for predicting the daily concentrations of airborne Alternaria and Cladosporium fungal spores from meteorological variables. To perform the logistic regression analysis, the concentration levels are binarized using concentration thresholds. The fungal spore data have been obtained at eight aerobiological monitoring stations of the Aerobiological Network of Catalonia (NE Spain). The meteorological data used were the maximum and minimum daily temperatures and daily rainfall provided by the meteorological services. The relationship between the meteorological variables and the fungal spore levels has been modeled by means of logistic regression equations, using data from the period 1995-2012. Values from years 2013-2014 were used for validation. In the case of Alternaria, three equations for predicting the presence and the exceedance of the thresholds 10 and 30 spores/m³ have been established. For Cladosporium, four equations for the thresholds 200, 500, 1000, and 1500 spores/m³ have been established. The temperature and cumulative rainfall in the last 3 days showed a positive correlation with airborne fungal spore levels, while the rain on the same day had a negative correlation. Sensitivity and specificity were calculated to measure the predictive power of the model, showing a reasonable percentage of correct predictions (ranging from 48 to 99%). The simple equations proposed allow us to forecast the levels of fungal spores that will be in the air the next day, using only the maximum and minimum temperatures and rainfall values provided by weather forecasting services.

Microbial exposure to dairy farmers' dwellings and COPD occurrence

Dairy farming is a risk factor for chronic obstructive pulmonary disease (COPD). The aim was to determine predictive markers either in blood samples or in dwelling dust samples by comparing COPD and healthy controls with or without farming activity. Dust was collected and analyzed by real-time quantitative PCR. ELISA and DELFIA® were performed to assay the level of specific IgG and IgE of 10 targeted microorganisms. The dwelling exposure of farmers was higher than in the non-farmers (Especially Eurotium amstelodami and Lichtheimia corymbifera). The IgG response against Wallemia sebi and Saccharopolyspora rectivirgula was more often higher in the farmers than the non-farmers. However, exposure and sensitization to the microorganisms tested cannot explain the occurrence of COPD in the dairy farmers' population. COPD development is probably caused by multiple factors associated with exposure over a period of several years.

Rapid evolutionary responses to insecticide resistance management interventions by the German cockroach (Blattella germanica L.)

The German cockroach (Blattella germanica L.) is a worldwide pest that lives exclusively in human environments. B. germanica threatens human health by producing asthma-triggering allergens, vectoring pathogenic/antibiotic-resistant microbes, and by contributing to unhealthy indoor environments. While insecticides are essential for reducing cockroach populations and improving health outcomes, insecticide resistance has been a consistent barrier to cockroach control since the 1950s. We conducted seminal field studies to compare three insecticide resistance intervention strategies for cockroaches and evaluated resistance evolution across multiple generations. Using pre-treatment resistance assessment to drive decisions, we found that single active ingredient (AI) treatments can successfully eliminate cockroaches if starting resistance levels are low. We further established that rotation treatments intuitively reduce selection pressure, and are effective when insecticides with no/low resistance are used. We also found that mixture products containing thiamethoxam + λ-cyhalothrin AIs were universally ineffective and highly repellent; and finally, evolution of cross-resistance among AIs is a significant, previously unrealized challenge.

Identifying indoor air Penicillium species: a challenge for allergic patients

PURPOSE

Penicillium is the most common mould isolated in housing. Penicillium chrysogenum is the only species tested by prick test or serology for allergic patients. The American Institute of Medicine has accepted Penicillium as an aetiological agent of rhinitis in children and adults and as an asthma agent in children. However, few studies have identified Penicillium in housing to the species level (354 species). Phenotypic identification is difficult. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) should be an alternative. The aim of this study was (1) to identify the Penicillium species present in dwellings in Eastern France and (2) to evaluate the reliability of MALDI-TOF MS for identification, by comparing it to DNA sequencing and phenotypic identification.

METHODOLOGY

Identification to the species level was performed by MALDI-TOF MS on 275 strains isolated from 48 dwellings. These results were compared to beta-tubulin gene sequencing and to the phenotypic aspects.

RESULTS

Thanks to MALDI-TOF, 235/275 strains could be identified (85.5 %). Fourteen species were identified among 23 Penicillium species included in the Filamentous Fungi Library 1.0 (Bruker Daltonics). However, 72.2  % of the strains belonged to five main taxa: P. chrysogenum (27.3 %), Penicillium glabrum (22.9 %), Penicilliumcommune (11.3 %), Penicillium brevicompactum (6.5 %) and Penicillium expansum (4.2 %).

CONCLUSION

Complete coherence between MALDI-TOF MS and sequence-based identification was found for P. chrysogenum, P. expansum, P. glabrum, Penicillium italicum and Penicillium corylophilum. The main drawback was observed for Penicillium crustosum, which included 21 strains (7.6 %) that could not be identified using MALDI-TOF MS.

Aflatoxin production and in vitro toxicity of Aspergilli section Flavi isolated from air samples collected from different environments

Aspergilli section Flavi, originally isolated from air samples collected from inhabited apartments (AP), unoccupied basements (BS), and processing facilities of a grain mill (GM), were analyzed for their potential to produce aflatoxin B₁ (AFB₁) on solid media. The isolates were further characterized with regard to their cytotoxic, genotoxic, and pro-inflammatory properties in vitro. Aspergilli were identified based on partial calmodulin (CaM) gene sequencing; the producing capacities of isolates were analyzed by HPLC/FLD and confirmed by genes in biosynthesis (aflR, norA, omtA). In the grain mill, the Aspergilli section Flavi (up to 1.3 × 10⁶ cfu/m³) dominated by AFB₁-producing Aspergillus flavus (71%, 4.5-5254 ng/ml) which showed a serious health risk for workers. Living environments were not relevant sources of exposure. After 24 h, AFB₁ (1-100 μmol/l) reduced cell viability (MTT test) in both A549 cells and THP-1 macrophage-like cells without reaching IC₅₀. In A549 cells, the extract of the AFB₁-producing A. flavus significantly decreased cell viability but not below 50%. THP-1 macrophage-like cells were more sensitive to both extracts, but IC₅₀ was obtained only for the AFB₁-producing strain (0.37 mg/ml; AFB₁ 2.78 μmol/l). AFB₁ (1 and 10 μmol/l) induced significant DNA damage (tail intensity, alkaline comet assay) in A549 cells in contrast to Aspergilli extracts. AFB₁ elevated IL-6 and IL-8, while Aspergilli extracts increased IL-1β, TNF-α, and IL-17 release in THP-1 macrophages (ELISA). Chronic exposure to AFB₁ and/or other metabolites in airborne A. flavus from occupational environments may stimulate epithelial damage of airways accompanied by lowered macrophage viability.

Survey of 1012 moldy dwellings by culture fungal analysis: Threshold proposal for asthmatic patient management

Different countries have tried to define guidelines to quantify what levels of fungi are considered as inappropriate for housing. This retrospective study analyzes indoor fungi by cultures of airborne samples from 1012 dwellings. Altogether, 908 patients suffering from rhinitis, conjunctivitis, and asthma were compared to 104 controls free of allergies. Portuguese decree law no 118/2013 (PDL118), ANSES (a French environmental and health agency) recommendations, and health regulations of Besançon University Hospital were applied to determine the rates of non-conforming dwellings, which were respectively 55.2%, 5.2%, and 19%. Environmental microbiological results and medical data were compared. The whole number of colonies per cubic meter of air was correlated with asthma (P < 0.001) and rhinitis (P = 0.002). Sixty-seven genera and species were detected in bedrooms. Asthma was correlated to Aspergillus versicolor (P = 0.004) and Cladosporium spp. (P = 0.02). Thresholds of 300 cfu/m³ for A. versicolor or 495 cfu/m³ for Cladosporium spp. are able to discriminate 90% of the asthmatic dwellings. We propose a new protocol to obtain an optimal cost for indoor fungi surveys, excluding surface analyses, and a new guideline to interpret the results based on >1000 cfu/m³ of whole colonies and/or above threshold levels for A. versicolor or Cladosporium spp.

Conservation mycology in Australia and the potential role of citizen science

Fungi are undoubtedly important for ecosystem functioning; however, they have been omitted or given scant attention in most biodiversity policy documents, management plans, and formal conservation schedules throughout the world. This oversight may be due to a general lack of awareness in the scientific community and compounded by a scarcity of mycology-associated curricula at the tertiary level and a lack of mycologists in research institutions. Although molecular techniques advance the systematic cataloging of fungi and facilitate insights into fungal communities, the scarcity of professional mycologists in the environmental sciences hampers conservation efforts. Conversely, citizen science initiatives are making significant contributions to the mycology discipline by increasing awareness and extending the scope of fungal surveys. Future research by professional and amateur mycologists into the distribution of fungi and their function in ecosystems will help identify wider and more effective conservation goals.

Bedroom Allergen Exposure Beyond House Dust Mites

PURPOSE OF REVIEW

The review provides insight into recent findings on bedroom allergen exposures, primarily focusing on pet, pest, and fungal exposures.

RECENT FINDINGS

Large-scale studies and improved exposure assessment technologies, including measurement of airborne allergens and of multiple allergens simultaneously, have extended our understanding of indoor allergen exposures and their impact on allergic disease. Practical, streamlined methods for exposure reduction have shown promise in some settings, and potential protective effects of early-life exposures have been further elucidated through the investigation of specific bacterial taxa. Advances in molecular allergology have yielded novel data on sensitization profiles and cross-reactivity. The role of indoor allergen exposures in allergic disease is complex and remains incompletely understood. Advancing our knowledge of various co-exposures, including the environmental and host microbiome, that interact with allergens in early life will be crucial for the development of efficacious interventions to reduce the substantial economic and social burden of allergic diseases including asthma.

Short-term effect of outdoor mould spore exposure on prescribed allergy medication sales in Central France

BACKGROUND

Outdoor moulds are classically associated with exacerbations of asthma.

OBJECTIVE

The aim of this paper was to examine nasal allergy morbidity by studying the short-term relationship between mould spore exposure and daily sales of reimbursable anti-allergic treatment in central France.

METHODS

The relationship between daily changes in mould concentrations and daily sales obtained from the national healthcare database was analysed with generalized additive models, taking into account confounding factors such as air pollution, weather conditions, pollen counts, and days of the week.

RESULTS

During the study, the average total yearly number of treated people was around 10 000 over approximately 230 000 surveyed. The relative risk (95% CI confidence interval) of sales of oral antihistamines with topical treatment associated with an interquartile increase in mould concentration was significant for Cladosporium 1.079 [1.019-1.142] and Aspergillus-Penicillium (Asp-Pen) 1.051 [1.021-1.082] in the whole population. When the influence of age and sex was considered, the relationship was significant only in male children aged 0-12 years and those aged between 13 and 49 years for Cladosporium: 1.256 [1.081-1.460] and 1.151 [1.063-1.245], respectively. The relationship was also significant for Asp-Pen: 1.038 [1.003-1.075] for those aged between 13 and 49 years and 1.056 [1.007-1.108] for adults over 50 years of age.

CONCLUSION

The association between prescribed daily sales of oral antihistamines with topical treatment sales is associated with temporal changes to Cladosporium and Aspergillus-Penicillium in the whole population. When the influence of age and sex was considered, these two moulds contributed to prescribed medication sales only in the male general population.

Exploring the potential relationship between indoor air quality and the concentration of airborne culturable fungi: a combined experimental and neural network modeling study

Indoor airborne culturable fungi exposure has been closely linked to occupants' health. However, conventional measurement of indoor airborne fungal concentration is complicated and usually requires around one week for fungi incubation in laboratory. To provide an ultra-fast solution, here, for the first time, a knowledge-based machine learning model is developed with the inputs of indoor air quality data for estimating the concentration of indoor airborne culturable fungi. To construct a database for statistical analysis and model training, 249 data groups of air quality indicators (concentration of indoor airborne culturable fungi, indoor/outdoor PM_2.5 and PM₁₀ concentrations, indoor temperature, indoor relative humidity, and indoor CO₂ concentration) were measured from 85 residential buildings of Baoding (China) during the period of 2016.11.15-2017.03.15. Our results show that artificial neural network (ANN) with one hidden layer has good prediction performances, compared to a support vector machine (SVM). With the tolerance of ± 30%, the prediction accuracy of the ANN model with ten hidden nodes can at highest reach 83.33% in the testing set. Most importantly, we here provide a quick method for estimating the concentration of indoor airborne fungi that can be applied to real-time evaluation.

Air- and Dust-Borne Fungi in Indoor and Outdoor Home of Allergic Patients in a Dust-Storm-Affected Area

Despite the recent increases in fungi-induced allergic diseases, there is no report yet in the region of the Persian Gulf on concentration levels of fungi in relationship with health state. Therefore, our aim was to measure fungi prevalence as well as to evaluate the relationships between air- and dust-borne fungal genera and allergic diseases. A matched case-control study was carried out including 45 allergic cases and 45 age- and gender-matched controls for each individual. Indoor and outdoor dust and indoor air samples were collected from participant homes during May to October 2015. A Quick Take 30 Pump and sterile wet swab were used to determine fungal types and their amounts in the air (CFU/m³) and dust (CFU/100 cm²) samples, respectively. A significant reverse association was found between indoor dust-borne Alternaria and asthma (Odds ratio (OR) = 0.14, 95% CI = 0.02-0.86). Contrarily, increased levels of indoor air-borne Aspegillus fumigatus (OR = 2.00, 95% CI = 0.37-10.55) and Alternaria (OR = 3.00, 95% CI = 0.34-25.83) were correlated with asthma development. Also, correlation analysis showed a significant relation between indoor air-borne Penicillium levels and reactivity to skin prick test in asthmatic patients (p = 0.04). Our findings support the notion that fungal exposures can either cause or prevent the development of allergic diseases. Accordingly, appropriate measures should be taken for a better management of fungi-induced allergic diseases.

SBS symptoms in relation to dampness and ventilation in inspected single-family houses in Sweden

Purpose

To investigate the relationships between symptoms compatible with the sick building syndrome (SBS) in adults and building dampness and ventilation in single-family houses.

Methods

Within the Swedish BETSI study, a national sample of single-family houses were inspected by professional building experts, and adults living in the houses answered a questionnaire on SBS. Relationships between building factors and SBS were analysed using logistic regression.

Results

Of the respondents, 23% reported having had weekly SBS symptoms during the last three months. A large proportion of houses exhibited building or construction problems. In total, 40% of houses had dampness problems in the foundation, and this was related to a higher prevalence of both mucous and dermal symptoms, and any SBS symptoms. Furthermore, high air humidity was related to more symptoms, with the relationship with absolute humidity being stronger than that with relative humidity or moisture load. Symptoms were also more prevalent in houses with a high U value, reflecting a poor thermal insulation. Compared to natural ventilation, living in a house with mechanical supply and exhaust ventilation was related to a lower prevalence of general symptoms and any SBS symptoms, but there were only weak associations between measured air exchange rate and symptoms.

Conclusions

A large proportion of single-family houses have dampness problems in the foundation, and pollutants may enter the living space of the house and affect the health of the occupants. Furthermore, absolute air humidity should be measured more often in indoor air studies.

Household indoor air quality and its associations with childhood asthma in Shanghai, China: On-site inspected methods and preliminary results

Few studies were conducted for associations of home environment with childhood health by on-site inspection in China. During 2013-2014, we conducted a case-control study with home inspection among 454 children (186 asthma children and 268 non-asthma children) in Shanghai, China. In this paper, we detailedly described the inspected methods and analyzed the preliminarily collected data. Except in winter, most residences meet the national standard for indoor temperature and relative humidity. Most living rooms had ≤1000ppm CO₂, whereas over half of the child's bedrooms had slightly >1000ppm CO₂ during night. Most residences had notably lower than 2500cfu/m³ airborne culturable fungi and ≤100μg/m³ formaldehyde. More than 70% of the child's bedrooms had ≤75μg/m³ PM_2.5 and ≤150μg/m³ PM₁₀. Indoor and outdoor concentrations of particulate matters had strong linear correlations (r=0.891-0.922; p-value <0.001). Most differences between cases and controls were not significant with respect to CO₂, culturable fungi, formaldehyde, and particulate matters. Before and after adjusted for potential confounders, indoor averaged concentration of CO₂ and particulate matters generally had negative associations with childhood history of doctor-diagnosed asthma in spring, summer, and autumn. Only in winter, indoor CO₂ concentration was significantly associated with the increased odds of childhood asthma. Our results indicated that air quality among most residences in Shanghai could meet the national standard for indoor air quality in warm seasons; but household air quality and ventilation status in winter should be greatly improved. We suspected that those "unexpected" negative associations could exist due to changes in lifestyle behaviors regarding indoor air quality after the child being diagnosed asthma by a doctor.

Assessment of pets (cats and dogs) in homes using electrostatic dust collectors and QPCR: new tools to evaluate exposure and risk of allergies

Contradictory results are found in the literature concerning fungi, bacteria, and pet exposure and the risk of developing asthma. All these allergens have been thoroughly studied separately in cohort studies, and a variety of sampling and analytical methods are used. It is already possible to characterize fungi, mites, and bacteria by QPCR. The aim of our study is to evaluate QPCR systems to quantify the presence of cats and dogs in homes. Twenty-four houses were sampled with an Electrostatic Dust Collector which was analyzed by QPCR. Questionnaires on the presence of pets in homes were completed. The results from QPCR were correlated for real presence of cats and dogs, and highlighted indirect exposure. This study provides a useful screening tool that will be used in future large cohort studies, such as the ELFE cohort study.

Indoor pollutant exposure among children with and without asthma in Porto, Portugal, during the cold season

Considering the time spent in enclosed spaces, indoor air pollutants are of major interest because of its possible impact on health. However, to date, few studies have analysed the air concentrations of a large set of indoor pollutants of respiratory health relevance in dwellings, particularly in Portugal. This study aimed to measure the concentrations of air pollutants that are present in residential buildings and to investigate whether some clustering pattern of indoor air pollutants exists in the dwellings of children with (case group) and without asthma (control group). Measurements were taken in 30 and 38 dwellings of asthmatic and non-asthmatic schoolchildren, respectively, located in the city of Porto, Portugal, during the cold season (October 2012-April 2013), to assess the concentrations of 12 volatile organic compounds (VOC), aldehydes, PM_2.5, PM₁₀, bacteria and fungi. Toluene, d-limonene, formaldehyde, PM_2.5, bacteria and fungi are widely present in dwellings, sometimes in relatively high concentrations in reference to WHO guideline values. Moreover, concentrations of CO₂ exceeding 1000 ppm were often encountered, indicating that 70 % of all dwellings had poor ventilation (<4 L/s person). While exposures to common dwelling indoor pollutants are similar for schoolchildren with and without asthma, except for d-limonene levels, the identification and control of VOC and PM sources is important and prudent, especially for vulnerable individuals.

The Indoor Fungus Cladosporium halotolerans Survives Humidity Dynamics Markedly Better than Aspergillus niger and Penicillium rubens despite Less Growth at Lowered Steady-State Water Activity

Indoor fungi cause damage in houses and are a potential threat to human health. Indoor fungal growth requires water, for which the terms water activity (aw) and relative humidity (RH) are used. The ability of the fungi Aspergillus niger, Cladosporium halotolerans, and Penicillium rubens at different developmental stages to survive changes in aw dynamics was studied. Fungi grown on media with high aw were transferred to a controlled environment with low RH and incubated for 1 week. Growth of all developmental stages was halted during incubation at RHs below 75%, while growth continued at 84% RH. Swollen conidia, germlings, and microcolonies of A. niger and P. rubens could not reinitiate growth when retransferred from an RH below 75% to a medium with high aw All developmental stages of C. halotolerans showed growth after retransfer from 75% RH. Dormant conidia survived retransfer to medium with high aw in all cases. In addition, retransfer from 84% RH to medium with high aw resulted in burst hyphal tips for Aspergillus and Penicillium Cell damage of hyphae of these fungi after incubation at 75% RH was already visible after 2 h, as observed by staining with the fluorescent dye TOTO-1. Thus, C. halotolerans is more resistant to aw dynamics than A. niger and P. rubens, despite its limited growth compared to that of these fungi at a lowered steady-state aw The survival strategy of this phylloplane fungus in response to the dynamics of aw is discussed in relation to its morphology as studied by cryo-scanning electron microscopy (cryo-SEM).

IMPORTANCE

Indoor fungi cause structural and cosmetic damage in houses and are a potential threat to human health. Growth depends on water, which is available only at certain periods of the day (e.g., during cooking or showering). Knowing why fungi can or cannot survive indoors is important for finding novel ways of prevention. Until now, the ability of fungi to grow on media with little available water at steady state (unchanging conditions) has been important for evaluating whether a fungus can grow indoors. In the present study, we found that the fungus Cladosporium halotolerans, a common indoor fungus, is more resistant to changes in available water than the fungi Aspergillus niger and Penicillium rubens, despite the fact that the latter fungi can grow on media with low water availability. We concluded that the ability of fungi to deal with changes in humidity is at least as important as the ability to grow on low-water media.

The characteristics of indoor and outdoor fungi and their relation with allergic respiratory diseases in the southern region of Turkey

Indoor and outdoor fungal exposure has been shown to be associated with the development of allergic respiratory diseases. The aim of the study was to investigate the types and concentrations of airborne fungi inside and outside homes and evaluate the association between fungal levels and allergic diseases in the southern region of Turkey. A total of 61 children admitted with respiratory complaints to the pediatric allergy clinic between September 2007 and November 2008 were included in this study. The air samples were obtained using the Air IDEAL volumetric air sampler longitudinally for 1 year. A comprehensive questionnaire was used for medical history and housing conditions. Skin prick test was performed to determine fungal sensitivity and spirometric indices were employed. The predominant indoor fungal species were Cladosporium (69.3 %), Penicillium (18.9 %), Aspergillus (6.5 %), and Alternaria (3.1 %). A strong correlation between indoor and outdoor fungal levels was detected for the Cladosporium species (p < 0.001, r = 0.72) throughout the year. Living in a detached home (p = 0.036) and the presence of cockroaches (p = 0.005) were associated with total indoor fungal levels. The presence of cockroaches (aOR 3.5; 95 % CI 0.95-13.10, p = 0.059) was also associated with fungal sensitization at the edge of significance. The statistical cutoff values of indoor and outdoor Cladosporium levels to predict symptomatic asthma were found to be >176 CFU/m(3) (p = 0.003, AUC 0.696; sensitivity 65.5 %; specificity 68.7 %) and >327 CFU/m(3) (p = 0.038; AUC 0.713; sensitivity 66.6 %; specificity 76.9 %), respectively. Children with respiratory symptoms are exposed to a considerable level of fungi inside and outside their homes. The prevention of fungal exposure may provide valuable intervention for respiratory diseases.

Procedures to Assist Health Care Providers to Determine When Home Assessments for Potential Mold Exposure Are Warranted

Drawing evidence from epidemiology and exposure assessment studies and recommendations from expert practice, we describe a process to guide health care providers helping their patients who present with symptoms that might be associated with living in damp housing. We present the procedures in the form of a guided 2-part interview. The first part has 5 questions that triage the patient toward a more detailed questionnaire that reflects features of housing conditions known to be reliably associated with exposures to mold and dampness contaminants. We chose the questions based on the conditions associated with moisture problems in homes across the United States and Canada. The goal is to facilitate the clinician's effort to help patients reduce exposure to environmental triggers that elicit symptoms to better manage their disease.