Mold toxicity

Background

• Molds are multicellular fungi that decompose organic matter
• Common household molds:
  • Penicillium
  • Cladosporium
  • Aspergillus
  • Alternaria

Mechanism of Toxicity

• Allergy
  • More commonly outdoor molds cause allergy but they can be found indoors in cases of excessive water damage
• Infection
  • Only a few fungi can infect immunocompetent people: Coccidioides, Blastomyces, Histoplasma, Cryptococcus
  • Immunocompromised people are at significant risk even from Candida and Aspergillus
• Toxicity
  • Glucans, a component of the cell wall, can produce Organic Dust Toxic Syndrome when inhaled

Clinical Features

Mold Allergy

• IgE antibodies against molds can lead to asthma or allergic rhinitis
• Hypersensitivity pneumonitis is a rare immune response to high concentrations of fungal proteins

Organic Dust Toxic Syndrome

• flu-like illness between 4-8 hours after heavy exposure to mold
• Symptoms are self-limited and resolve in 24 hours

Sick Building Syndrome

• Vague constellation of neurologic, dermatologic, gastrointestinal, and respiratory complaints attributed to a building's environment

Evaluation

• Generally, no specific workup in the ED
  • May workup specific symptoms, if deemed appropriate

Outpatient

Consider:

• RAST (Radioallergosorbent) testing can detect IgE mediated allergy
• Air samples and "bulk, wipe, and wall" samples can detect presence of molds

Management

• No Specific drugs or antidotes
• Decontamination and avoidance of environment

Disposition

• Outpatient management