What is Fusarium?

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Fusarium species are ubiquitous and may be found in the soil, air and on plants. Fusarium species can cause mycotoxicosis in humans following ingestion of food that has been colonized by the fungal organism. In humans, Fusarium species can also cause disease that is localized, focally invasive or disseminated. The pathogen generally affects immunocompromised individuals with infection of immunocompetent persons being rarely reported. Localized infection includes septic arthritis, endophthalmitis, osteomyelitis, cystitis and brain abscess. In these situations relatively good response may be expected following appropriate surgery and oral antifungal therapy. Disseminated infection occurs when two or more noncontiguous sites are involved. Over eighty cases have been reported, many of which had a hematologic malignancy including neutropenia. The species most commonly involved include Fusarium solani, Fusarium oxysporum, and Fusarium moniliforme (also termed F. verticillioides). The diagnosis of Fusarium infection may be made on histopathology, gram stain, mycology, blood culture, or serology. Portals of entry of disseminated infection include the respiratory tract, the gastrointestinal tract, and cutaneous sites.

The skin can be an important and an early clue to diagnosis since cutaneous lesions may be observed at an early stage of the disease and in about seventy-five cases of disseminated Fusarium infection. Typical skin lesions may be painful red or violaceous nodules, the center of which often becomes ulcerated and covered by a black eschar. The multiple necrotizing lesions are often observed on the trunk and the extremities. Onychomycosis most commonly due to F. oxysporum or F. solani has been reported. The onychomycosis may be of several types: distal and lateral subungual (DLSO), white superficial (WSO), and proximal subungual (PSO). In proximal subungual onychomycosis there may be associated leukonychia and/or periungual inflammation. Patients with Fusarium onychomycosis have been cured following therapy with itraconazole, terbinafine, ciclopirox olamine lacquer, or topical antifungal agent. In other instances nail avulsion plus antifungal therapy has been successful. In patients with hematologic malignancy or bone marrow transplant, who may experience prolonged or severe neutropenia during the course of therapy, the skin and nails should be carefully examined and consideration given to treating potential infection sites that may serve as portals for systemic dissemination. When disseminated Fusarium infection is present therapy with antifungal agents has generally been disappointing with the chances of a successful resolution being enhanced if the neutropenia can be corrected in a timely manner.

How Mold Effects Us

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After pollens, molds are the leading cause of outdoor airborne allergies, which can recur year-round. Some of the most common symptoms of those sensitive to molds include nasal stuffiness, eye irritation, wheezing, cold and flu-like symptoms, rashes, conjunctivitis, inability to concentrate, and fatigue. Mold exposure has also been associated with asthma onset. Symptoms usually disappear when the mold is removed. However, under certain conditions, exposure to mold can cause serious health problems. Some people with chronic illnesses, such as obstructive lung disease, for example, may develop mold infections in their lungs. Also, some people exposed to large amounts of mold at work, such as farmers working with moldy hay, may develop even more severe reactions, including fever and shortness of breath. Some molds are toxic, producing chemicals called “mycotoxins,” which in large doses may affect human health, usually by causing allergy-like symptoms such as watery eyes or eye irritation, runny nose and sneezing or nasal congestion, wheezing and difficulty breathing, aggravation of asthma, coughing, itching, or rashes.

Other health problems that have been linked to mold exposure involve the odors produced by mold “volatiles” during the degradation of substrates. These have been discovered to irritate mucous membranes, and they have been associated with a number of symptoms from headaches and nausea to fatigue in individuals exposed to them. For those suffering from multiple chemical sensitivities, the simple presence of these microbial volatile organic compounds (MVOCs) can trigger a reaction just as strong and serious as exposure to chemical VOCs. Fungi or microorganisms related to them may cause other health problems similar to allergy. Some kinds of Aspergillus especially may cause several different illnesses, including both infections and allergy. These fungi may lodge in the airways or a distant part of the lung and grow until they form a compact sphere known as a “fungus ball.” In people with lung damage or serious underlying illnesses, Aspergillus may grasp the opportunity to invade and actually infect the lungs or the whole body.

In some individuals, exposure to these fungi can also lead to asthma or to an illness known as “allergic bronchopulmonary aspergillosis.” This latter condition, which occurs occasionally in people with asthma, is characterized by wheezing, low-grade fever, and coughing up of brown-flecked masses or mucous plugs. Skin testing, blood tests, x-rays, and examination of the sputum for fungi can help establish the diagnosis. Corticosteroid drugs are usually effective in treating this reaction; immunotherapy (allergy shots) is not helpful. The occurrence of allergic aspergillosis suggests that other fungi might cause similar respiratory conditions. Inhalation of spores from fungus-like bacteria, called “actinomycetes,” and from mold can cause a lung disease called “hypersensitivity pneumonitis.” This condition is often associated with specific occupations. For example, farmer’s lung disease results from inhaling spores growing in moldy hay and grains in silos. Occasionally, “hypersensitivity pneumonitis” develops in people who live or work where an air conditioning or a humidifying unit that is contaminated with these spores emits them.

The symptoms of “hypersensitivity pneumonitis” may resemble those of a bacterial or viral infection such as the flu. Bouts of chills, fever, weakness, muscle pains, cough, and shortness of breath develop 4 to 8 hours after exposure to the offending organism. The symptoms gradually disappear when the source of exposure is removed and the area properly ventilated. If it is not removed, workers having to be in those contaminated areas must wear a protective mask with a filter capable of removing spores or change jobs. If “hypersensitivity pneumonitis” is allowed to progress, it can lead to serious heart and lung problems. Also, air with a high concentration of fungal spores of a number of different types of molds may contain toxins that, when breathed over a long period of time, may result in a kind of poisoning. Stachybotrys atra, a mold that is commonly found on wet cellulose products (for example, drywall) and is causing growing concern among physicians, is one of these molds. In one recent study, it was linked to lung bleeding in infants. This mold has also been linked to sudden infant death syndrome and to central nervous system symptoms such as personality changes, sleep disorders, and memory loss.

Sick Building Syndrome

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Sick Building Syndrome (SBS) is a term commonly used for non-specific symptoms that are temporally related to occupancy of a particular building. When building-related symptoms are characteristic of a specific clinical entity, they are called Building Related Illness (BRI). These illnesses are varied, and include Legionnaires’ disease, building related hypersensitivity pneumonitis, building-related asthma, and others.

SBS symptoms include mucous membrane irritation (cough, scratchy throat, stuffy sinuses, and itchy eyes), headache, fatigue, difficulty concentrating, and other non-specific symptoms. The causes of SBS vary with the building and its occupants. SBS was once called “Tight Building Syndrome” and was considered to be a result of excess tightening of buildings in response to energy use concerns. However, many buildings with an excess of symptoms among the occupants are well ventilated. Still, increase in ventilation rates is often the “cure” for the problem.

Some people consider that SBS is caused not by the physical environment, but, rather, by psychosocial factors. Gender, lack of control, poor management, too much work, too little work, perceived housekeeping quality, and many other social factors have been blamed for the symptoms. In some cases, psychosocial factors may be the major cause of complaints. However, clearly, in some cases, environmental factors are at fault. For example, paper dust, and photocopier use have both been related to increases in complaints in a dose-dependent way. An excess of volatile organic compounds have been blamed for SBS symptoms. However, one study attributed this effect to the perception of odors at VOC concentrations far below those that would be likely to have an effect. These authors discuss the possibility that reactive chemistry might produce irritants that might be responsible for some symptoms.

Mold contamination has clearly been related to cases of BRI. However, its relationship to SBS is less clear. A Swedish study documented that dampness in residential buildings was associated with SBS symptoms with symptoms increasing with the number of dampness indicators present. Whether or not mold growth was responsible for these symptoms remains unknown. An extremely interesting study exposed people to measured doses of airborne fungal spores from growth on building materials. In this study, symptoms were similar among the two fungi studied AND for the placebo tests, indicating no specific effect of the spores. Mycotoxins have not been measured in quantities sufficient to cause the normal SBS symptoms, and the data regarding the role of mycotoxins in indoor air remain equivocal.

Most Common Mold Symptoms

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Mold allergies are easily treatable when properly diagnosed, so it is important for individuals who suspect their symptoms may be related to mold to consult with an allergy specialist or a physician to determine an appropriate course of treatment. Taking steps such as repairing water leaks and installing dehumidifiers in the home can also help to hinder mold growth and relieve mold allergy symptoms. Understanding what causes mold allergies and taking preventative measures to avoid exposure are essential in managing symptoms.

Itching Eyes

Itching eyes are a common allergic symptom that can develop following exposure to mold spores, pet dander and seasonal pollens. Individuals who experience itching eyes during wet or humid weather or when moisture levels are high inside the home may be suffering from mold allergy symptoms.

Stuffy Nose & Post Nasal Drip

Nasal congestion is a common mold allergy symptom that is often triggered after periods of wet weather or when an individual is exposed to mold spores in the home. When nasal stuffiness occurs, it is often accompanied by postnasal drip, a condition in which nasal secretions run down the back of the throat. Additional symptoms of postnasal drip include bad breath and coughing.

Itching Throat

Individuals with mold allergies may also experience an itching sensation in the throat. Itching throat symptoms are typically caused by postnasal drip, but can also be a symptom of a serious allergic reaction that can lead to throat swelling if left untreated. It is important for sufferers to seek medical attention if itching throat symptoms are present to ensure prompt treatment.

Sinus Headaches

Mold spores can cause the sinuses to become congested, which in turn can trigger sinus headaches in individuals with mold allergies. Sinus headaches cause pain and pressure in the forehead and sinus cavities. In certain cases, sinus pressure can also cause tooth and ear pain. Sinus headaches tend to worsen when lying down.

Exacerbated Asthma Symptoms

Individuals with mold allergies who also suffer from asthma may experience exacerbated asthma symptoms when exposed to mold. Asthma symptoms include chest tightness, wheezing and coughing. Anyone experiencing a severe asthma attack following possible mold exposure should seek immediate medical attention.

Long & Short Term Effects of Mold

The type and severity of health effects that result from mold exposure is widely variable among different locations, from person to person and over time. Although difficult to predict, exposure to molds growing indoors is most often associated with the following allergy symptoms:

Nasal and sinus congestion
Cough/sore throat
Chest tightness
Dyspnea (breathing difficulty)
Asthma (or exacerbation of it)
Epistaxis (nosebleed)
Upper respiratory tract infections
Headache
Skin and eye irritation

Long-term exposure to indoor molds is certainly unhealthy to anyone, but some groups will develop more severe symptoms sooner than others, including:

Infants and children
Elderly people
Individuals with respiratory conditions, allergies and/or asthma

Some indoor molds are capable of producing extremely potent toxins (mycotoxins) that are lipid-soluble and readily absorbed by the intestinal lining, airways, and skin. These agents, usually contained in the fungal spores, have toxic effects ranging from short-term irritation to immunosuppression and cancer.

More severe symptoms that could result from continuous human exposure to indoor mycotoxigenic molds include:

Cancer (aflatoxin best characterized as potential human carcinogen)
Hypersensitivity pneumonitis/pulmonary fibrosis
Pulmonary injury/hemosiderosis (bleeding)
Neurotoxicity
Hematologic and immunologic disorders
Hepatic, endocrine and/or renal toxicities
Pregnancy, gastrointestinal and/or cardiac conditions

It is important to notice that the clinical relevance of mycotoxins under realistic airborne exposure levels is not fully established. Further, some or much of the supporting evidence for these other health effects is based on case studies rather than controlled studies, studies that have not yet been reproduced or involve symptoms that are subjective.