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Mouldy homes and bleeding lungs
  1. ARCHIVIST

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    The importance of dampness in the home in relation to applications for rehousing is often debated. An intriguing piece of medical detective work in Cleveland, Ohio, USA (Ruth A Etzel and colleagues, Archives of Pediatrics and Adolescent Medicine1998;152:757–62) has demonstrated an apparently rare but startling effect of home dampness on infants.

    Over two years (1993–94) 10 infants (all black, nine boys) were admitted to a children’s hospital with acute pulmonary haemorrhage and haemosiderosis; there had been just three such cases in the previous 10 years. The presenting features were acute haemoptysis with lethargy, sudden cessation of crying, pallor, limpness, and respiratory failure. All of the babies were severely ill and needed intensive care, nine were intubated, and one died. Five had to be readmitted because of another episode up to six months after discharge. The diagnosis was confirmed in all cases by lung biopsy or bronchial lavage. All of the babies lived in one area of the city and there was a common history of water damage to the home from leaking roofs, plumbing leaks, or flooding. Some of the infants had evidence of haemolysis and this, together with the epidemiological features, led investigators to consider the possibility of a haemolytic toxin producing fungus. They investigated specifically for Stachybotrys atra, a fungus known to grow in damp conditions and to produce a toxin that causes bleeding and haemolysis in animals.

    They examined the homes of nine of the 10 infants and 28 of 30 age and locality matched controls. Mean colony counts for all fungi in air were more than 40 times greater in the patients’ homes than in those of controls. Counts of S atra were 10 times higher in the air, and 3000 times higher on surfaces, in patients’ homes compared with controls’. The patients were also more likely to have been exposed to tobacco smoke in the home. Surveys have shown S atrain up to 3% of North American homes. In this outbreak the babies with acute pulmonary haemorrhage were much more likely than control babies to have been exposed to high concentrations of S atra. The association has not been proved to be one of cause and effect but the evidence seems highly suggestive.

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