Pulmonary Hemorrhage and Hemosiderosis in Infants
Pediatric Pulmonary Pediatric Critical Care Environmental Hygiene
Introduction Over the past several years, there have been a
number of young infants (most under 6 months old), in the eastern
neighborhood of Cleveland, who have been coughing up blood due to
bleeding in their lungs. Some infants have died and more infants
continue to get ill. This bleeding, a disorder called Pulmonary
Hemorrhage appears to be caused by something in their home environments,
most likely toxins produced by an unusual fungus called Stachybotrys
chartarum or similar fungi. Bleeding in the lungs. What Are The Symptoms? Severe bleeding can cause coughing up blood or
nose bleeds. This is particularly concerning in infants under 6 months
old. Chronic, low grade bleeding can cause chronic cough and congestion
with anemia. Aside from infants bleeding, there are still many symptoms
of contamination from
Stachybotrys
chartarum
or other similar fungi. What Causes The Bleeding? Most likely, toxins made by an unusual fungus or mold Stachybotrys. When infants breathe in the toxins, the blood vessels in their lungs may become fragile. The weak vessels may be bothered by cigarette smoke or stresses from other illnesses and start to bleed. You cannot see the toxins in the air rather they are carried in the microscopic fungal spores. [ Please note: to find out more info on symptoms of contamination from Stachybotrys chartarum or similar fungi and its effects, please visit: Mold/Fungi] How Do I Know If The Fungus Or Mold Is In My House? This fungus or mold grows only on wood or paper that have gotten very wet for more than a few days or so. (It does NOT grow on plastic, vinyl, concrete products, or ceramic tiles). If the wood/paper gets wet and is not cleaned up and dried, the fungus may grow and spread. The fungus is black and slimy when wet. It is NOT found in the green mold on bread or the black mold on the shower tiles (but the shower tiles should be kept clean too). If you have had plumbing leaks, roof leaks, flooding in the basement (even if you don't use the basement), or sewer backup in the past year, look for mold or a musty odor. [Please note: For more info on how this dangerous mold grows and spread in your home, please visit: Mold/Fungi , Toxic Mold Inspector , or Certified Mold Contractor. Common Areas for This Mold Growth: Water soaked wood, ceiling tiles, wall paneling, unpainted plaster board surfaces, cotton items, cardboard boxes, and stacks of newspapers. If these areas have been very wet, usually for longer than one week, check for mold. After the area dries, the fungus will not continue to grow, but the black dust caused by the fungus can be sucked up by the furnace blower and spread throughout the house. Be sure and check your basement for the black mold. If you do not have access to the basement, ask your landlord for assistance. Note: not all black mold is Stachybotrys, but moldy homes are not healthy homes. Heating Systems: If you have mold in your basement, check to see if there is any way that your forced air furnace can send the mold dust up to the living spaces. Is there ductwork connecting the cold air returns to your furnace or does your furnace pull air from the basement? The latter is the case if you can see the furnace filter face on (rather than just the edge).
Over the past seven years in the Cleveland, Ohio area there have been 45 cases of pulmonary hemorrhage (PH) in young infants. Sixteen of the infants have died. Thirty-two of the infants have been African American. Most of these cases have occurred within ten contiguous zip codes area in the eastern portion of the metropolitan area. In November/December, 1994, the Centers for Disease Control and Prevention (CDC) lead a case-control investigation on the first ten cases. This study found an epidemiological association of PH in these infants with water-damaged homes containing the toxic fungi, predominantly Stachybotrys. Several lines of evidence suggest that the most likely causal agents are fungal toxins from a fungus called Stachybotrys atra. This somewhat unusual fungus was found in high quantity in the home environments of the affected infants but also to a lesser degree in some of the comparison homes. Stachybotrys requires water soaked cellulose to grow, and was found in homes where there had been water damage from flooding, plumbing leaks or roof leaks involving wood or paper products (e.g. insulation, gypsum board, ceiling tile). The spores of this fungus contain very potent mycotoxins which appear to be particularly toxic to the rapidly growing lungs of young infants. The linkage of Stachybotrys to PH in infants is on the basis of epidemiological data and has not been conclusively demonstrated. Other factors such as environmental tobacco smoke appear to be important triggers in precipitating overt pulmonary hemorrhage. More cases continue to occur, a few infants having had only very subtle initial symptoms such as nose bleeds and chest congestion. Concern that there may be a larger number of undetected young infants with this disorder, led to the examination of all infant coroner cases over a three year period, 1993-1995. This revealed seven "SIDS" (sudden infant death syndrome) cases with evidence of preexisting major pulmonary bleeding. All but one of these infants had lived in the ten zip code cluster area. This disorder is likely to extend beyond Cleveland since an informal national survey of all pediatric pulmonary centers and continued reporting has identified over 100 similar cases of pulmonary hemorrhage in infants across the country over the last seven years. While Stachybotrys chartarum (atra) occurs widely in North America, it is probably rather uncommon to find it in homes. It requires water soaked cellulose (wood, paper, and cotton products) to grow. While wet it looks black and slimy perhaps with the edges white, and when dry it looks less shiny. It is not the only or the most common black mold to be found in these conditions. If your clean-up is not simple, i.e. your water damage and mold growth is extensive and/or involves structural materials, contact your city or county health department for assistance in assessing the problem. They can put you in contact with environmental laboratories capable of identifying Stachybotrys and with abatement contractors familiar with the precautions and other specifics important for extensive inspection. If you have a large area of mold growth (greater than two square feet or so), seek professional assistance in mold remediation. You can get quite ill yourself if you inhale a large quantity of the fungal dust or get it on your skin. [Please note: for information on mold testing and mold removal, please visit these very helpful websites.] Mold Removal and Remediation. |
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