Hodgson M J, Morey P, Leung W Y, Morrow L, Miller D, Jarvis B B, Robbins H, Halsey J F, Storey E
Division of Occupational and Environmental Medicine, University of Connecticut Health Center, Farmington 06032-6210, USA.
J Occup Environ Med. 1998 Mar;40(3):241-9. doi: 10.1097/00043764-199803000-00006.
The authors present an outbreak of disease associated with exposure to Stachybotrys chartarum and Aspergillus species. A courthouse and two associated office buildings had generated discomfort among employees for two years since initial occupancy. Multiple interventions had been unsuccessful An initial evaluation of 14 individuals identified three with potential asthma and three with symptoms consistent with interstitial lung disease. A clinical screening protocol to identify individuals who should be removed from work identified three likely and seven possible cases of building-related asthma. Detailed environmental and engineering assessments of the building identified major problems in mechanical system design, building construction, and operational strategies leading to excess moisture and elevated relative humidities. Moisture-damaged interior surfaces in both buildings were contaminated with S. chartarum, A. versicolor, and Penicillium species. Aspergillus species, especially A. versicolor, at concentrations of 10(1) to 10(4)/m3 dominated the indoor air under normal operating conditions. Bulk samples also revealed large quantities of Stachybotrys. A questionnaire survey of the three case and two control buildings documented between three- and 15-fold increases in symptoms. A nested case-control study suggested emphysematous-like disease in individuals meeting questionnaire definitions for cases. Replication of analysis strategies used in similar previous investigations suggested an association between worsening symptoms and decreased diffusing capacity of the lung. Performance on neuropsychological measures was similar for both cases and controls, although workers with symptoms reported increased levels of current but not past psychiatric symptomatology. Chemical analyses demonstrated the presence of satratoxins G and H. Cytotoxic laboratory analyses demonstrated the presence of agents with biological effectiveness in bulk materials. No association was seen between IgE or IgG antibodies and the presence of disease. This outbreak represents a likely human response to inhaled fungal toxins in indoor environments. Moisture indoors represents a public health issue currently inadequately addressed by building, health, or housing codes.
作者报告了一起与接触枝孢霉和曲霉菌种有关的疾病暴发事件。一座法院大楼及两座相关办公楼自投入使用两年以来，一直让员工感到不适。多次干预均未成功。对14名个体进行的初步评估发现，3人有潜在哮喘，3人有与间质性肺病相符的症状。一项用于确定应离岗人员的临床筛查方案识别出3例可能的和7例疑似与建筑物相关的哮喘病例。对该建筑物进行的详细环境和工程评估发现，机械系统设计、建筑施工及运营策略存在重大问题，导致湿气过多和相对湿度升高。两座建筑物内受潮损坏的内表面均被枝孢霉、杂色曲霉和青霉菌种污染。在正常运行条件下，曲霉菌种，尤其是杂色曲霉，浓度为10(1)至10(4)/立方米，在室内空气中占主导地位。大量样本还显示存在大量枝孢霉。对3座病例大楼和2座对照大楼进行的问卷调查显示，症状增加了3至15倍。一项巢式病例对照研究表明，符合问卷定义的病例个体存在类肺气肿样疾病。重复此前类似调查中使用的分析策略表明，症状加重与肺弥散能力下降之间存在关联。病例组和对照组在神经心理学测量方面的表现相似，不过有症状的工人报告当前精神症状有所增加，但既往精神症状未增加。化学分析表明存在G型和H型葡萄穗霉毒素。细胞毒性实验室分析表明，散装材料中存在具有生物活性的物质。未发现IgE或IgG抗体与疾病存在之间存在关联。此次疾病暴发可能是人体对室内环境中吸入的真菌毒素的反应。室内潮湿是一个目前建筑、健康或住房法规未充分解决的公共卫生问题。
