1. Mold Awareness Training
Mold
What are the health effects
of mold exposure?
April 27, 2008.
Suite 1000, 8484 Georgia Ave.
Silver Spring, MD
Main Phone:
Main Fax:
Don Ellenberger
DOE & EPA Training Director
Phone:
Fax:

2. Mold Awareness Training
Who is affected?
v Virtually anyone exposed to
airborne mold can react to
the toxigenic properties of
mold spores.
v Asthmatics and others with
allergy to mold will react at
lower exposure levels.

3. Mold Awareness Training
Who is affected?
v Heavily exposed individuals run the risk of serious
illnesses, beyond the toxic and allergic reactions.
v Infants and susceptible
individuals (e.g., persons
with compromised immune
systems, living with HIV,
cystic fibrosis, and the aged)
will likely react at lower
concentrations and require
special attention.
Photo by George Newman, CPWR (November, 2005). Pediatrics ward University Hospital (Tulane University, NOLA).

4. Mold Awareness Training
Where are we?
A lot of time indoors
Where do we spend our time?
Most mold-related allergy diseases and reactions are prompted by outdoor exposure; however, four prominent outdoor molds are found indoors when windows and doors are left open: Penicillium, Aspergillus, Cladosporium, and Alternaria.

5. Mold Awareness Training
1. Infections
Pathways
v Respiratory
v Oral
v Contact
v Penetration
Eating/dining/food prep in the home. Multiple pathway opportunities for infectious, allergic, and toxic exposure for the family that occupies this room.
Vectors (via insect bite) is a fifth infectious disease pathway. This room’s air is being “scrubbed”.
Respiratory = breathing
Oral = eating
Contact = touching
Penetration = open cut/wound and the like.
Inhalation -- Most of the heath problems associated with exposure to mold are caused by inhalation
Ingestion -- Eating foods contaminated with mold such as grains, nuts, fruits, vegetables, and other foods
Skin contact -- Direct contact with contaminated building materials such as wood, paper, fabric, drywall, wallpaper, insulation, carpets, upholstery, and other porous or organic material

6. Opportunistic Infections
Mold Awareness Training
Opportunistic Infections
People with weakened immune systems (immune compromised or immune suppressed) may be more vulnerable to infections caused by molds. Aspergillus fumigatus has been known to infect the lungs of immune compromised individuals. When the spores are inhaled the mold begins to grow in the lungs.
Infections caused by mold-produced toxins may develop into diseases.

7. Opportunistic Infections
Mold Awareness Training
Opportunistic Infections
Athlete’s Foot
Molds can cause skin diseases such as athlete’s foot, fingernail/ toenail fungus and other infections such as yeast infection. Case reports and epidemiologic studies show clear association between dampness and disease.
Infections can rapidly becomes diseases.

8. Mold Awareness Training
Infectious Diseases
Athlete’s Foot under a microscope
Just one type of fungal infection. Shower, pool areas, locker rooms, etc.

9. Mold Awareness Training
2. Allergic Diseases
Asthma, Hay Fever, and more
aspergillus under
a microscope
v Allergic rhinitis (hay fever)
v Allergic asthma
v Allergic bronchopulmonary
aspergillosis -- ABPA
v Extrinsic allergic alveolitis -- HP
(hypersensitivity pneumonitis)
HP = (also extrinsic allergic alveolitis) Farmers lung; generally requires high concentrations; flu-like 4-6
hours after; can lead to fibrosis. Examples of hypersensitivity pneumonitis include: pigeon
breeder's disease from exposure to protein particles in pigeon droppings, sauna takers' disease
from exposure to mold growing in wet containers, mushroom workers' disease from exposure to
moldy compost, and bagassosis from exposure to moldy sugar cane.
Hypersensitivity pneumonitis (HP) = Rare, but serious, immune-related condition resembling bacterial
pneumonia; may develop after either acute or chronic exposure (via inhalation) to molds; usually
related to occupational exposure; can also be caused by bacteria. Chronic (long–term)
hypersensitivity pneumonitis causes lung scarring (fibrosis). Symptoms of chronic hypersensitivity
pneumonitis include of shortness of breath and cough.
ABPA =Allergic bronchopulmonary aspergillosis
*Rhinitis: sneezing, itchy eyes, congestion, fatigue, dermatitis
*Asthma: 10-15% of children now have asthma; strong association with household dampness; once
developed, other triggers can cause reaction. * denotes most common.
>Inhaling or touching mold or mold spores may produce allergic reactions in sensitive
individuals.
>Allergic responses include hay-fever type symptoms, such as sneezing, runny nose, red/
burning eyes, or skin rashes (dermatitis).
>Symptoms of exposure may be immediate, delayed or increase in severity over time of
exposure.
>Mold spores and fragments can cause allergic reactions regardless of whether the mold is
alive or dead.

10. Mold Awareness Training
Allergic Diseases
Allergic Bronchopulmonary
Aspergillosis – ABPA
Aspergillus in the attic
Patient with aspergillus-related pneumonia
Patient with aspergillus-related tumor in mouth
Aspergillus fumigatus
Aspergillus favus
Mold CFUs in Petri dishes – culture dishes.
Lung fibrosis and
tumor from ABPA

11. U.S. Allergy Disease Prevalence
Mold Awareness Training
U.S. Allergy Disease Prevalence
v 1of 5 Americans
suffer from allergic
disease
v Indoor allergens
responsible for
significant share
v Environmental
control reduces
disease severity
HP = Farmers lung; generally requires high concentrations; flu-like 4-6 hours after
Allergic Dermatitis = Rash that occurs when the skin is exposed to certain allergens. ______________________________________________
ABPA = Allergic bronchopulmonary aspergillosis is a hypersensitivity response to the Aspergillus fumigatus, the spores of which are ubiquitous in soil and are commonly found in the sputum of healthy individuals. Repeated acute episodes left untreated can result in progressive pulmonary fibrosis that is often seen in the upper zones and can give rise to a similar radiological appearance to that produced by tuberculosis. Symptoms include wheezing, coughing, fever, malaise, recurrent pneumonia (not affected by antibiotics) expectoration of mucoid plugs containing the fungal hyphae, and unexplained worsening of asthma or cystic fibrosis.
_______________________________________________
People with ASTHMA have very sensitive airways that can react to various irritants, making breathing difficult. The number of people with asthma has increased by 59 percent since 1970 to a total of over 9.6 million people. Asthma in children under 15 has increased 41 percent in the same period. The number of deaths from asthma is up by 68 percent since 1979, a total of almost 4400 deaths per year. It is believed that 21 percent of new asthma cases are brought on by occupational exposures to airborne toxins.
____________________________________
Irritant Effects -- Mold exposure can cause irritation to the eyes, skin, nose, throat, and lungs sometimes creating a burning sensation in these areas. Fungi produce Microbial Volatile Organic Compounds {mVOC} during degradation of substrates that cause the “moldy” odor associated with fungal contamination. These compounds can be irritating to mucous membranes, cause headaches, nasal irritation, dizziness, fatigue, and nausea. Eyes, Skin, Nose, Throat, and Lungs are most likely to be the object of irritant effects.
Source: NHLBI, 1991

12. Mold Awareness Training
Allergen Exposure
Dust Mites Molds
Animal Dander Pollen
Allergenic Chemicals
Other Exposures
Viruses
Air Pollution
Tobacco Smoke
Genetic
Predisposition
or Susceptibility
Immunologic
Sensitization
Allergic Disease
Mild
Moderate
Severe
(Death)
Source: Pope AM, et al., eds., 1993

13. Mold Awareness Training
3. Fungal Toxins
Important Mycotoxins
Aspergillus favus ……….. Aflatoxin B, Cyclopiazonic acid Aspergillus parasiticus …. Aflatoxin B Aspergillus terreus …….. Citreoviridin Aspergillus versicolor ….. Sterigmatocysin, 5 Ethoxysterigmatocstin Fusarium ………………….. Trichothecene, Zearalenone Fusarium moniliforme …...Fumonisins Penicillium ………………...Citrinin, Patulin Penicillium veridicatum ….Penicillic Acid Stachybotrys chartarum …Trichothecene, Trichodermol, (black mold) Trichodermol
Published Mold and their Mycotoxin(s) lists vary in spelling and to some degree, in names of the mycotoxins. Exposure to mold-related toxins may lead to infections which may develop into a disease. Many mycotoxins are highly carcinogenic. There many more toxins than listed here. The term "toxic mold" is not accurate. While certain molds are toxigenic, meaning they can produce toxins (specifically mycotoxins), the molds themselves are not toxic, or poisonous. Hazards presented by molds that may produce mycotoxins should be considered the same as other common molds which can grow in your house. There is always a little mold everywhere - in the air and on many surfaces. There are very few reports that toxigenic molds found inside homes can cause unique or rare health conditions such as pulmonary hemorrhage or memory loss. These case reports are rare, and a causal link between the presence of the toxigenic mold and these conditions has not been proven.
Ochratoxin is primarily produced by species of Penicillium & Aspergillus. Ochratoxin damages the kidneys & liver. It is a suspected carcinogen & may be responsible for impairment of the immune system.

14. Mold Awareness Training
Fungal Toxins
Stachybotrys chartarum
Black Mold
T-2 toxin is a Trichothecene produced by species of Fusarium & Stachybotrys. This is one of the more deadly toxins. If ingested in sufficient quantity, T-2 toxin can severely damage the entire digestive tract & cause rapid death due to internal hemorrhage. It affects human immune and inflammatory systems. It weakens the immune system resulting in viruses, infections and bacteria will have greater chance of making people sick. Possible associate with infants and acute pulmonary hemorrhage. Molds are very common in buildings and homes and will grow anywhere indoors where there is moisture. The most common indoor molds are Cladosporium, Penicillium, Aspergillus, and Alternaria. We do not have precise information about how often Stachybotrys chartarum is found in buildings and homes. While it is less common than other mold species, it is not rare. It can grow on material with a high cellulose and low nitrogen content, such as fiberboard, gypsum board, paper, dust, and lint. Commonly called “Black Mold”. (It is greenish-black). The pictures on this find it on the backing of carpeting/flooring and on the ceiling.
Mycotoxins can produce a number of toxic effects in humans. Exposures to Stachybotrys and A. versicolor: central nervous system complaints, headache, nose, throat, irritation, eye irritation, rash, sinus congestion, nose bleeds, and chronic fatigue. There is some suggestion that immune function and neurological effects may be permanent.
Fusarium mold can cause disease in many of the foods we eat – as the food is being grown. Fumonisin is a toxin associated with Fusarium species. Fumonisin is commonly found in corn & corn-based products. Fumonisin causes “crazy horse disease”, a liquefaction of the brain. Chronic low-level exposure in humans has been associated with esophageal cancer.
Vomitoxin, a trichothecene mycotoxin, is produced by several
species of Fusarium. Vomitoxin has been associated with outbreaks of
acute gastrointestinal illness in humans.

15. Mold Awareness Training
Suite 1000, 8484 Georgia Ave.
Silver Spring, MD
Main Phone:
Main Fax:
Don Ellenberger
DOE & EPA Training Director
Phone:
Fax: