CHRONIC TOXIC ENCEPHALOPATHIES APPARENTLY RELATED TO EXPOSURE TO TOXICOGENIC FUNGI
AUTHORS: Pierre L. Auger, MD, Pierrot Pépin IH, J. David Miller PhD., Manfreid Gareis D.V.M., PhD., Julien Doyon PhD., Rémi Bouchard MD, Marie-France Pinard PhD., Claude Mainville Ing.
PRESENTER: Pierre L. Auger, M.D.
Clinique De Santé Au Travail et De Santé Environnementale, Montreal, Quebec Canada
1.) Goals and objectives: Description of four cases of toxic encephalopathies possibly caused by a prolonged exposure to toxin producing filamentous fungi in the workplace. We will also demonstrate that complete fungal evaluation with species identification and complementary cytotoxicity testing can be useful to identify possible causes of health effects of mold exposure.
2.) Outline of talk/abstract: Fungal toxins have irritant, immunosuppressive, neurotoxicological and carcinogenetic effects (Henry 1993). Recent report have suggested neurotoxic effects (Croft 1986, Johanning 1996). We report four cases who were diagnosed type 2b solvent type syndrome concurrent with a sensitive neuropathy in one occupant and novel asthma in a second.
First building is a harbour station built over a crawl space with the presence of Aspergillus Fumigatus, A. Versicolor, Penicillium aurantiogriseum. In this building a 42-year old director along with his 32-year old secretary have commenced to suffer from neuropsychological and systemic symptoms and novel asthma in the secretary. Improvement is noticed after 3 – 4 months after removal from exposure. Irreversible sequelae are described 15 months later: slight attention deficit in the director and asthma in the secretary.
Second building is a medical office in which severe flooding occurred during the Winter. In Spring, an environmental evaluation yielded the presence of Penicillium crustosum, P, brevicompactum, Fusarium incarnatum. Important neuropsychological deficits more or less similar in both are found. Improvement is noted upon removal from exposure. The pediatrician died of renal failure because of light chains disease. The female was left with irreversible brain damage.
3.) Conclusion of what is to be learned: The four workers presented with findings similar to solvent encephalopathies (Lindsberg 1995). In an occupational setting, an acute CNS disease with tremor was related to exposure to high levels of Aspergillus (Gordon 1993). The presence of toxicogenic molds in an environment suggests that when two or more occupants of dwelling suffer from neuropsychological symptoms, a detailed exposure analysis should be done with a neuropsychological evaluation on these same occupants.
4.) References:
Croft WA, Jarvis BJ, Yatawara CS. 1986 Airborne outbreak of trichothecene toxicosis Atmosph. Environm. 20: 549-558
Gordon KE, Masotiti RE, Waddell WR 1993 Tremorgenic encephalopthy: a role of mycotoxins in the production of CNS disease in human? Can. J. Neurol. Science 20: 237-37
Henry KM, Cole EC, 1993. A review of mycotoxicosis in indoor air J. Tooxicol Environm. Health 38: 183-93
Johanning E., Biagini R., Hull D. Morey P, Jarvis B. Landsbergis P 1996 Health and Immunology Study Following Exposure to Toxicogenic (Stachybotrys chartarum) in a water-damaged office Int. Arch. Occup. Environm. Health 68: 207-218
Lundberg I, Hogstedt C, Liden C, Nise CJ 1995. Organic Solvents and Related Compounds In Rosenstock I, Cullen MR editors Textbook of Clinical Occupational and Environmental Medicine Philadelphia Saunders WB 31: 766-84.