Terr Abba I
UCSF Medical Center, San Francisco, California 94108, USA.
Med Mycol. 2009;47 Suppl 1:S217-22. doi: 10.1080/13693780802510216. Epub 2009 Mar 2.
Moulds are responsible for diseases in humans through the three pathogenetic mechanisms of infection, allergy, and toxicity. Fungal infection is especially a risk factor for immunodeficient patients, but it occurs in immunocompetent patients as well. Fungal allergy is manifested as bronchial asthma, hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, or allergic fungal sinusitis. Mycotoxicosis is almost exclusively the result of ingestion of mould-contaminated foodstuffs. In each case there is specificity for the etiologic mould. There is controversy regarding the ability of indoor airborne mould spores to cause human disease through non-specific toxicity via the inhalation route. Pulmonary mycotoxicosis is an established, although rare, occupational disease of farmers who inhale enormous quantities of mycotoxins, endotoxins, and other toxic chemicals from contaminated silage. Other conditions attributed to indoor airborne mycotoxin are unproven. These include infantile pulmonary hemosiderosis, epistaxis, 'toxic encephalopathy', immune dysregulation and a variety of subjective complaints without objective signs of pathology such as fatigue, headache, dyspnea, gastrointestinal distress, neuromuscular and skeletal complaints, etc. Non-specific irritation from moulds via the inhalation route is also a controversial subject that remains unproven. Published studies alleging an epidemiologic causal relationship are unconvincing.
霉菌通过感染、过敏和毒性这三种致病机制导致人类疾病。真菌感染尤其对免疫缺陷患者构成风险因素，但在免疫功能正常的患者中也会发生。真菌过敏表现为支气管哮喘、过敏性肺炎、变应性支气管肺曲霉病或变应性真菌性鼻窦炎。霉菌毒素中毒几乎完全是摄入受霉菌污染的食品所致。在每种情况下，致病霉菌都具有特异性。关于室内空气中的霉菌孢子通过吸入途径导致人类疾病的非特异性毒性能力，存在争议。肺部霉菌毒素中毒是一种既定的职业病，尽管很少见，主要发生在吸入大量来自受污染青贮饲料的霉菌毒素、内毒素和其他有毒化学物质的农民身上。其他归因于室内空气中霉菌毒素的病症未经证实。这些病症包括婴儿肺含铁血黄素沉着症、鼻出血、“中毒性脑病”、免疫失调以及各种无病理学客观体征的主观症状，如疲劳、头痛、呼吸困难、胃肠道不适、神经肌肉和骨骼不适等。霉菌通过吸入途径引起的非特异性刺激也是一个有争议的话题，尚未得到证实。声称存在流行病学因果关系的已发表研究并不令人信服。
