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Tuuminen T. The Roles of Autoimmunity and Biotoxicosis in Sick Building Syndrome as a "Starting Point" for Irreversible Dampness and Mold Hypersensitivity Syndrome. Antibodies (Basel) 2020; 9:E26. [PMID: 32580407 DOI: 10.3390/antib9020026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/13/2020] [Accepted: 06/19/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The terminology of "sick building syndrome" (SBS), meaning that a person may feel sick in a certain building, but when leaving the building, the symptoms will reverse, is imprecise. Many different environmental hazards may cause the feeling of sickness, such as high indoor air velocity, elevated noise, low or high humidity, vapors or dust. The Aim: To describe SBS in connection with exposure to indoor air dampness microbiota (DM). Methods: A search through Medline/Pubmed. Results and Conclusions: Chronic course of SBS may be avoided. By contrast, persistent or cumulative exposure to DM may make SBS potentially life-threatening and lead to irreversible dampness and mold hypersensitivity syndrome (DMHS). The corner feature of DMHS is acquired by dysregulation of the immune system in the direction of hypersensitivities (types I-IV) and simultaneous deprivation of immunity that manifests as increased susceptibility to infections. DMHS is a systemic low-grade inflammation and a biotoxicosis. There is already some evidence that DMHS may be linked to autoimmunity. Autoantibodies towards, e.g., myelin basic protein, myelin-associated glycoprotein, ganglioside GM1, smooth muscle cells and antinuclear autoantibodies were reported in mold-related illness. DMHS is also a mitochondropathy and endocrinopathy. The association of autoimmunity with DMHS should be confirmed through cohort studies preferably using chip-based technology.
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Tuuminen T, Lohi J. Immunological and toxicological effects of bad indoor air to cause dampness and Mold Hypersensitivity Syndrome. AIMS Allergy and Immunology 2018. [DOI: 10.3934/allergy.2018.4.190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wiesmüller GA, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewzyk R, Thomas P, Valtanen K, Hurrass J. Kurzfassung der AWMF-Leitlinie medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenräumen. Allergo J 2017. [DOI: 10.1007/s15007-017-1382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wiesmüller GA, Heinzow B, Aurbach U, Bergmann KC, Bufe A, Buzina W, Cornely OA, Engelhart S, Fischer G, Gabrio T, Heinz W, Herr CEW, Kleine-Tebbe J, Klimek L, Köberle M, Lichtnecker H, Lob-Corzilius T, Merget R, Mülleneisen N, Nowak D, Rabe U, Raulf M, Seidl HP, Steiß JO, Szewszyk R, Thomas P, Valtanen K, Hurraß J. Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure: S2K Guideline of the German Society of Hygiene, Environmental Medicine and Preventive Medicine (GHUP) in collaboration with the German Association of Allergists (AeDA), the German Society of Dermatology (DDG), the German Society for Allergology and Clinical Immunology (DGAKI), the German Society for Occupational and Environmental Medicine (DGAUM), the German Society for Hospital Hygiene (DGKH), the German Society for Pneumology and Respiratory Medicine (DGP), the German Mycological Society (DMykG), the Society for Pediatric Allergology and Environmental Medicine (GPA), the German Federal Association of Pediatric Pneumology (BAPP), and the Austrian Society for Medical Mycology (ÖGMM). Allergo J Int 2017; 26:168-193. [PMID: 28804700 PMCID: PMC5533814 DOI: 10.1007/s40629-017-0013-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This article is an abridged version of the AWMF mould guideline "Medical clinical diagnostics of indoor mould exposure" presented in April 2016 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with the above-mentioned scientific medical societies, German and Austrian societies, medical associations and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. Apart from allergic bronchopulmonary aspergillosis (ABPA) and mould-caused mycoses, only sufficient evidence for an association between moisture/mould damage and the following health effects has been established: allergic respiratory disease, asthma (manifestation, progression and exacerbation), allergic rhinitis, hypersensitivity pneumonitis (extrinsic allergic alveolitis), and increased likelihood of respiratory infections/bronchitis. In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitizing prevalence of 3-10% in the general population across Europe. Limited or suspected evidence for an association exist with respect to mucous membrane irritation and atopic eczema (manifestation, progression and exacerbation). Inadequate or insufficient evidence for an association exist for chronic obstructive pulmonary disease, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis and cancer. The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 (Aspergillus fumigatus, A. flavus) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, above all the substrate. In the case of indoor moisture/mould damage, everyone can be affected by odour effects and/or mood disorders. However, this is not a health hazard. Predisposing factors for odour effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly with regard to an infection risk are persons on immunosuppression according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) at the Robert Koch- Institute (RKI) and persons with cystic fibrosis (mucoviscidosis); with regard to an allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma should be protected. The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections the reader is referred to the AWMF guideline "Diagnosis and Therapy of Invasive Aspergillus Infections". With regard to mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medicine standpoint it is important that indoor mould infestation in relevant dimension cannot be tolerated for precautionary reasons. With regard to evaluating the extent of damage and selecting a remedial procedure, the reader is referred to the revised version of the mould guideline issued by the German Federal Environment Agency (Umweltbundesamt, UBA).
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Affiliation(s)
- Gerhard A. Wiesmüller
- Institute for Occupational Medicine and Social Medicine, University Hospital, Medical Faculty, RWTH Aachen University, Aachen, Germany
- Department of Infection Control and Environmental Hygiene, Cologne Health Authority, Neumarkt 15–21, 50667 Cologne, Germany
| | - Birger Heinzow
- Formerly: Regional Social Security Authorities (LAsD) for Schleswig-Holstein, Kiel, Germany
| | - Ute Aurbach
- Department of Microbiology and Mycology, Dr. Wisplinghoff Laboratory, Cologne, Germany
| | | | - Albrecht Bufe
- Experimental Pneumology, Ruhr University, Bochum, Germany
| | - Walter Buzina
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Oliver A. Cornely
- Department I for Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Guido Fischer
- Baden-Württemberg Regional Health Authorities at the Regional Council Stuttgart, Stuttgart, Germany
| | - Thomas Gabrio
- Formerly: Baden-Württemberg Regional Health Authorities at the Regional Council in Stuttgart, Stuttgart, Germany
| | - Werner Heinz
- Medical Clinic and Outpatient Clinic II with Special Focus on Infectiology, Würzburg University Hospital, Würzburg, Germany
| | - Caroline E. W. Herr
- Bavarian Office for Health and Food Safety, Munich, Germany
- Adj. Prof. “Hygiene and Environmental Medicine”, Ludwig-Maximilian University, Munich, Germany
| | | | - Ludger Klimek
- Wiesbaden Centre for Rhinology and Allergology, Wiesbaden, Germany
| | - Martin Köberle
- Clinic and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Herbert Lichtnecker
- Medical Institute for Environmental and Occupational Medicine MIU GmbH, Erkrath, Germany
| | | | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | | | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Member of the German Centre for Lung Research, Munich University Hospital, Munich, Germany
| | - Uta Rabe
- Centre for Allergology and Asthma, Johanniter Hospital im Fläming Treuenbrietzen GmbH, Treuenbrietzen, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bochum, Germany
| | - Hans Peter Seidl
- Formerly: Chair of Microbiology and Clinic and Outpatient Clinic for Dermatology and Allergology am Biederstein, Technical University of Munich, Munich, Germany
| | - Jens-Oliver Steiß
- Centre for Pediatric and Adolescent Medicine, University Hospital Gießen and Marburg GmbH, Gießen, Germany
- Specialist Practice for Allergology and Pediatric Pneumology, Fulda, Germany
| | - Regine Szewszyk
- FG (specialist field) II 1.4 Microbiological Risks, Federal Environmental Agency, Berlin, Germany
| | - Peter Thomas
- Department and Outpatient Clinic for Dermatology and Allergology, Ludwig-Maximilian University, Munich, Germany
| | - Kerttu Valtanen
- FG (specialist field) II 1.4 Microbiological Risks, Federal Environmental Agency, Berlin, Germany
| | - Julia Hurraß
- Department of Infection Control and Environmental Hygiene, Cologne Health Authority, Neumarkt 15–21, 50667 Cologne, Germany
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Angelon-Gaetz KA, Richardson DB, Marshall SW, Hernandez ML. Exploration of the effects of classroom humidity levels on teachers' respiratory symptoms. Int Arch Occup Environ Health 2016; 89:729-37. [PMID: 26814540 DOI: 10.1007/s00420-016-1111-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/14/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Previous studies indicate that teachers have higher asthma prevalence than other non-industrial worker groups. Schools frequently have trouble maintaining indoor relative humidity (RH) within the optimum range (30-50 %) for reducing allergens and irritants. However, the potential relationship between classroom humidity and teachers' health has not been explored. Thus, we examined the relationship between classroom humidity levels and respiratory symptoms among North Carolina teachers. METHODS Teachers (n = 122) recorded daily symptoms, while data-logging hygrometers recorded classroom RH levels in ten North Carolina schools. We examined effects of indoor humidity on occurrence of symptoms using modified Poisson regression models for correlated binary data. RESULTS The risk of asthma-like symptoms among teachers with classroom RH >50 % for 5 days was 1.27 (95 % Confidence Interval (CI) 0.81, 2.00) times the risk among the referent (teachers with classroom RH 30-50 %). The risk of cold/allergy symptoms among teachers with classroom RH >50 % for 5 days was 1.06 (95 % CI 0.82, 1.37) times the risk among the referent. Low RH (<30 %) for 5 days was associated with increased risk of asthma-like [risk ratio (RR) = 1.26 (95 % CI 0.73, 2.17)] and cold/allergy symptoms [RR = 1.11 (95 % CI 0.90, 1.37)]. CONCLUSIONS Our findings suggest that prolonged exposure to high or low classroom RH was associated with modest (but not statistically significant) increases in the risk of respiratory symptoms among teachers.
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Affiliation(s)
- Kim A Angelon-Gaetz
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
| | - David B Richardson
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Stephen W Marshall
- Epidemiology Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Michelle L Hernandez
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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Wolff H, Mussalo-Rauhamaa H, Raitio H, Elg P, Orpana A, Piilonen A, Haahtela T. Patients referred to an indoor air health clinic: exposure to water-damaged buildings causes an increase of lymphocytes in bronchoalveolar lavage and a decrease of CD19 leucocytes in peripheral blood. Scand J Clin Lab Invest 2009; 69:537-44. [PMID: 19347744 DOI: 10.1080/00365510902770061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Respiratory and other symptoms are often associated with exposure to microbes present in water-damaged buildings. MATERIAL AND METHODS We examined 82 consecutive patients referred to the Indoor Air Clinic, Helsinki University Hospital, due to symptoms suspected of having been caused by long-term exposure to water damage in the home or workplace. Exposure to water damage was assessed by building inspections and microbial analyses as needed. Bronchoalveolar lavage, lung function measurements, skin prick tests to inhalant allergens and radiological examinations were performed in all patients. Leucocyte subsets in peripheral blood were analysed in 35 patients. RESULTS Marked water damage was detected in the homes or workplaces of 47 (59%) patients; the remaining 34 patients formed the control group. The exposed group expressed more symptoms in total than the control group: fatigue, conjunctival symptoms, rhinitis with sinusitis, recurrent bronchitis and asthma were more common in the exposed group, but a significant difference was seen only for headache. In BAL (bronchoalveolar lavage) samples, lymphocytes represented 25% of the total cell population in non-smoking-exposed patients compared with 12% in control patients (p=0.004). In peripheral blood, CD19 leucocytes were significantly decreased in the exposed group (7.5% versus 12.3%; p<0.01). CONCLUSIONS Confirmed exposure to water damage was associated with an increase in symptoms. Exposure to water damage caused a significant change in the cellular composition in BAL fluid (lymphocytosis) and blood (decrease of CD19 cells). The depletion of CD19 leucocytes in peripheral blood may indicate an active immune response in the lungs.
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Affiliation(s)
- Henrik Wolff
- Finnish Institute of Occupational Health, Biological Mechanisms and Prevention of Work-Related Diseases/Immunopathology, Helsinki, Finland.
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Sahakian N, Park JH, Cox-Ganser J. Respiratory morbidity and medical visits associated with dampness and air-conditioning in offices and homes. Indoor Air 2009; 19:58-67. [PMID: 19076249 DOI: 10.1111/j.1600-0668.2008.00561.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED We used data from 4345 adult US residents who were part of a 2004 national random mail survey to investigate associations between dampness and air-conditioning (AC) in homes and offices, and health outcomes, sick leave due to respiratory symptoms and medical visits during the past 12 months. We identified from this group 1396 office workers employed in professional, executive, administrative, managerial or administrative support occupations. Office workers reporting home dampness had an elevated prevalence of nasal symptoms [prevalence ratio (PR) = 1.4, P = 0.01] and constitutional symptoms (PR = 1.3, P = 0.01) in the previous year. Office workers reporting workplace dampness had an elevated prevalence of sick leave attributed to respiratory symptoms (PR = 1.3, P = 0.04) in the previous year. Office workers with home AC were more likely to have visited a medical specialist in the previous year (PR = 1.3, P = 0.02). We did not find any statistically significant associations between workplace AC and any of the health outcomes. We estimated an annual cost of US$1.4 billion for excess respiratory-related sick leave among office workers with workplace dampness. Our study strengthens the evidence of a relationship between dampness and health effects, and highlights the resulting economic impact. PRACTICAL IMPLICATIONS This study adds to the literature on respiratory morbidity associated with home and office exposures to mold and dampness. Public health response to lessen these exposures will improve the health and well-being of residents and workers as well as diminish the economic burden of lost work time and medical costs.
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Affiliation(s)
- N Sahakian
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, Morgantown, WV 26505, USA.
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Thaon I, Reboux G, Moulonguet S, Dalphin J. Les pneumopathies d’hypersensibilité en milieu professionnel. ARCH MAL PROF ENVIRO 2007. [DOI: 10.1016/s1775-8785(07)78223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lignell U, Meklin T, Putus T, Rintala H, Vepsäläinen A, Kalliokoski P, Nevalainen A. Effects of moisture damage and renovation on microbial conditions and pupils' health in two schools--a longitudinal analysis of five years. ACTA ACUST UNITED AC 2007; 9:225-33. [PMID: 17344947 DOI: 10.1039/b615459j] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Airborne microbes and pupils' symptoms were monitored in a moisture-damaged (index) school and a reference school for five consecutive years. These surveys were carried out in two separate years before the renovation of the index school, during the renovation, and one and two years after the renovation. Microbial concentrations were higher in the index school than those in the reference school before and during renovation, but afterwards, the levels decreased to the level of the reference school. The effect of remediation was seen as an altered mycobiota in the index school. Year-to-year variation of microbial concentrations, probably due to climatic factors, caused a peak in both schools but their difference remained. Several symptoms were more prevalent in the moisture-damaged school than in the reference school, but the differences disappeared during the renovations. These results emphasize the importance of using a reference building in assessing the microbial conditions of a moisture damaged building. Furthermore, microbial concentrations reflected well the technical condition of the construction, but the reported symptoms of the occupants did not strictly follow the timely fluctuation in microbial conditions.
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Affiliation(s)
- Ulla Lignell
- National Public Health Institute, Department of Environmental Health, P.O. Box 95, FI-70701 Kuopio, Finland.
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Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) is a granulomatous disease of the lungs due to immune reactions following chronic inhalation of organic dusts or chemicals especially encountered in the occupational environment. The main purpose of this review is to report current concepts regarding aetiologies, epidemiology, diagnosis, treatment as well as legal aspects of HP. STATE OF THE ART The following aspects will be focused: (1) increase in new etiological circumstances, especially occupational and news antigens, (2) for diagnosis, the major contribution of chest high resolution CT scan which often shows characteristic images but also recent developments in simple diagnostic criteria that may be used for an epidemiological approach, (3) importance of bronchial obstruction and even emphysema as a long term sequelae, finally (4) the possibility of continuing occupational activities in certain circumstances where preventive measures can be used. PERSPECTIVES The increasing knowledge of etiological agents and circumstances as well as the development of secondary and especially primary preventive measures should lead to reduce the frequency of this disease and of its medico-social consequences.
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Affiliation(s)
- I Thaon
- Service des Maladies Professionnelles, CHU de Besançon, France
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Bartlett KH, Kennedy SM, Brauer M, van Netten C, Dill B. Evaluation and determinants of airborne bacterial concentrations in school classrooms. J Occup Environ Hyg 2004; 1:639-47. [PMID: 15631055 DOI: 10.1080/15459620490497744] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A survey of 39 elementary schools was undertaken to determine indoor air concentrations of bioaerosols within a coastal, temperate climatic zone in British Columbia, Canada. This article reports the results for airborne bacteria. Determinants of exposure were grouped into environmental (outdoor temperature, relative humidity, season, weather), ventilation and comfort parameter (indoor relative humidity, temperature, indoor CO2 concentration, indoor fungal concentration), and occupancy (number of occupants, activity levels, occupancy patterns) variables. Regression modeling was used to evaluate the association between these factors and measured concentrations of indoor mesophilic bacteria. Naturally ventilated rooms (47% of the total rooms surveyed) had higher bacterial counts than mechanically ventilated rooms (geometric mean 325 vs. 166 CFU/m3, respectively, p < 0.001). In univariate analyses, bacterial counts were negatively correlated with supply and exhaust flow rates, air exchange rates, and the percentage of the day that occupants spent quietly sitting at their desks. Analysis of bacterial groups indicated various sources of the bacterial aerosol, with micrococci and staphylococci closely associated with occupancy variables, Bacillus with site and occupancy, and coryneform bacteria with site variables only. Approximately 60% of the variance in the outcome measurement of total bacteria was accountedfor by indoor CO2, lower air exchange rate, the age of the building, signs of current or old moisture stains, room volume, indoor relative humidity, and occupant activity level in a multiple linear regression model, with ventilation factors accounting for 40% of the variance.
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Affiliation(s)
- Karen H Bartlett
- School of Occupational and Environmental Hygiene, University of British Columbia, Vancouver, British Columbia, Canada.
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Affiliation(s)
- De-Wei Li
- P & K Microbiology Services, Inc., 1936 Olney Ave Cherry Hill, New Jersey 08003, USA
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Mendell MJ, Naco GM, Wilcox TG, Sieber WK. Environmental risk factors and work-related lower respiratory symptoms in 80 office buildings: an exploratory analysis of NIOSH data. Am J Ind Med 2003; 43:630-41. [PMID: 12768613 DOI: 10.1002/ajim.10211] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We evaluated relationships between lower respiratory symptoms and risk factors for microbiological contamination in office buildings. METHODS The National Institute for Occupational Safety and Health collected data from 80 office buildings during standardized indoor environmental health hazard evaluations. Present analyses included lower respiratory symptom-based outcome definitions and risk factors for potential microbiologic contamination. Multivariate logistic regression models for selected outcomes identified key risk factors. RESULTS Adjusted odds ratios (95% confidence intervals) for "at least three of four work-related lower respiratory symptoms" were, for debris in ventilation air intake, 2.0 (1.0-3.9), and for poor drainage in air-conditioning drip pans, 2.6 (1.3-5.2). Adjusted associations with risk factors were consistently stronger for outcomes requiring both multiple symptoms and improvement away from work, and somewhat stronger among diagnosed asthmatics. CONCLUSIONS Moisture and debris in ventilation systems, possibly by supporting microbiologic growth, may increase adverse respiratory effects, particularly among asthmatics. Data from more representative buildings are needed to confirm these findings.
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Affiliation(s)
- Mark J Mendell
- Indoor Environment Department, Environmental Energy Technologies Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA.
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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.
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Affiliation(s)
- D M Kuhn
- Division of Infectious Diseases, Department of Medicine, University Hospitals of Cleveland, and Case Western Reserve University, Cleveland, Ohio 44106, USA
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