Khalili Barzin, Montanaro Marc T, Bardana Emil J
Oregon Health Sciences University, Portland, Oregon 97239, USA.
Ann Allergy Asthma Immunol. 2005 Sep;95(3):239-46. doi: 10.1016/s1081-1206(10)61220-3.
Three well-accepted mechanisms of mold-induced disease exist: allergy, infection, and oral toxicosis. Epidemiologic studies suggest a fourth category described as a transient aeroirritation effect. Toxic mold syndrome or inhalational toxicity continues to cause public concern despite a lack of scientific evidence that supports its existence.
To conduct a retrospective review of 50 cases of purported mold-induced toxic effects and identify unrecognized conditions that could explain presenting symptoms; to characterize a subgroup with a symptom complex suggestive of an aeroirritation-mediated mechanism and compare this group to other diagnostic categories, such as sick building syndrome and idiopathic chemical intolerance; and to discuss the evolution of toxic mold syndrome from a clinical perspective.
Eighty-two consecutive medical evaluations were analyzed of which 50 met inclusion criteria. These cases were critically reviewed and underwent data extraction of 23 variables, including demographic data, patient symptoms, laboratory, imaging, and pulmonary function test results, and an evaluation of medical diagnoses supported by medical record review, examination, and/or test results.
Upper respiratory tract, lower respiratory tract, systemic, and neurocognitive symptoms were reported in 80%, 94%, 74%, and 84% of patients, respectively. Thirty patients had evidence of non-mold-related conditions that explained their presenting complaints. Two patients had evidence of allergy to mold allergens, whereas 1 patient exhibited mold-induced psychosis best described as toxic agoraphobia. Seventeen patients displayed a symptom complex that could be postulated to be caused by a transient mold-induced aeroirritation.
The clinical presentation of patients with perceived mold-induced toxic effects is characterized by a disparate constellation of symptoms. Close scrutiny revealed a number of preexisting diagnoses that could plausibly explain presenting symptoms. The pathogenesis of aeroirritation implies completely transient symptoms linked to exposures at the incriminated site. Toxic mold syndrome represents the furtive evolution of aeroirritation from a transient to permanent symptom complex in patients with a psychogenic predisposition. In this respect, the core symptoms of toxic mold syndrome and their gradual transition to chronic symptoms related to nonspecific environmental fragrances and irritants appear to mimic what has been observed with other pseudodiagnostic categories, such as sick building syndrome and idiopathic chemical intolerance.
公认的霉菌诱发疾病的机制有三种：过敏、感染和经口中毒。流行病学研究提示存在第四种类型，即短暂的空气刺激效应。尽管缺乏支持其存在的科学证据，但有毒霉菌综合征或吸入性毒性仍继续引起公众关注。
对50例所谓的霉菌诱发毒性效应病例进行回顾性分析，确定可能解释现有症状但未被识别的病症；对一组具有提示空气刺激介导机制症状复合体的患者进行特征描述，并将该组与其他诊断类别（如病态建筑综合征和特发性化学不耐受）进行比较；从临床角度讨论有毒霉菌综合征的演变。
对连续82例医学评估进行分析，其中50例符合纳入标准。对这些病例进行严格审查，并提取23个变量的数据，包括人口统计学数据、患者症状、实验室检查、影像学检查和肺功能测试结果，并通过病历审查、体格检查和/或检查结果对医学诊断进行评估。
分别有80%、94%、74%和84%的患者报告有上呼吸道、下呼吸道、全身和神经认知症状。30例患者有与霉菌无关的病症证据，可解释其现有主诉。2例患者有对霉菌过敏原过敏的证据，而1例患者表现出霉菌诱发的精神病，最恰当的描述为中毒性广场恐惧症。17例患者表现出一种症状复合体，可推测是由短暂的霉菌诱发空气刺激引起的。
感觉有霉菌诱发毒性效应的患者的临床表现具有一系列不同的症状。仔细审查发现了许多可能合理解释现有症状的既往诊断。空气刺激的发病机制意味着与暴露于可疑场所相关的完全短暂的症状。有毒霉菌综合征代表了在有心理易患倾向的患者中，空气刺激从短暂症状复合体向永久症状复合体的隐秘演变。在这方面，有毒霉菌综合征的核心症状及其逐渐转变为与非特异性环境香料和刺激物相关的慢性症状，似乎与其他假性诊断类别（如病态建筑综合征和特发性化学不耐受）中观察到的情况相似。
