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Mold Toxins and Human Illness: Patients Need Mold-Free Buildings and Mold-Free Food. Homes, Schools, Government Structures and Businesses Cannot Cause Mold Sickness and Remain Sick Buildings

2 Practical Up to Date and Clear Mold Books with Solutions by Dr. Schaller

  1. Mold Illness and Mold Remediation Made Simple
  2. When Traditional Medicine Fails, Your Guide to Mold Toxins
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Fungi and selected mycotoxins from pre- and postfermented corn silage.

Gonz‡lez Pereyra ML, Alonso VA, Sager R, Morlaco MB, Magnoli CE, Astoreca AL, Rosa CA, Chiacchiera SM, Dalcero AM, Cavaglieri LR.

Departamento de Microbiolog’a e Inmunolog’a, Universidad Nacional de R’o Cuarto, R’o Cuarto, C—rdoba, Argentina.

Aim: To determine fungal genera, Aspergillus and Fusarium species and aflatoxin B(1) (AFB(1)), zearalenone (ZEA), deoxynivalenol (DON), fumonisin B(1) (FB(1)) contamination from pre- and postfermented corn silage produced in the most important region of Argentina where silage practice is developed. Methods and Results: Sampling of corn silos was performed manually through silos in transects at three levels: upper, middle and low sections. AFB(1) and FB(1) were quantified by high-performance liquid chromatography, zearalenone by enzyme-linked immunosorbent assay and DON by gas chromatography. Over 90% of the samples showed counts higher than 1 x 10(4) CFU g(-1). Aspergillus flavus and Fusarium verticillioides were the prevalent species. Some tested samples were contaminated with AFB(1), ZEA, DON and FB(1). Conclusions: This study demonstrates the presence of fungi and AFB(1), ZEA, DON and FB(1) contamination in corn silage in Argentina. Significance and Impact of the Study: This manuscript makes a contribution to the knowledge of mycotoxins in Argentinean silage in particular because the environmental conditions in this country differ from those of most reports. The comparison of pre- and postfermentation silage is also outstanding. Therefore, information on fungi and mycotoxins present in silage - an increasingly popular commodity - is useful to estimate potential risk for animal and human health.

PMID: 18005347 [PubMed - as supplied by publisher]

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Ochratoxin A production in relation to ecophysiological factors by Aspergillus section Nigri strains isolated from different substrates in Argentina.

Astoreca A, Magnoli C, Barberis C, Chiacchiera SM, Combina M, Dalcero A.

Departamento de Microbiolog’a e Inmunolog’a, Facultad de Ciencias Exactas, F’sico-Qu’micas y Naturales, Universidad Nacional de R’o Cuarto, R’o Cuarto, C—rdoba, Argentina. aastoreca@exa.unrc.edu.ar

Contamination of foodstuff with mycotoxins such as ochratoxins is a major matter of concern for human and animal health. In Aspergillus species, ochratoxin synthesis depends on several environmental factors. The aims of this work were to evaluate the effect of water activity (0.995-0.85), temperature (15, 25 and 30 degrees C), incubation time (7, 14 and 21 days) and their interactions on OTA production on peanut, maize kernels, dried grapes and coffee beans meal extract agar medium by eight strains of Aspergillus section Nigri isolated from human food in Argentina. The optimum temperature for OTA production was 25 or 30 degrees C depending on the strains assayed, in most cases the highest OTA levels were achieved after 7 days of incubation, whereas this situation occurred at 15 degrees C after 14 days of incubation for only one strain. The maximum OTA level was obtained at earlier growth states when incubation temperature increased. In general, OTA concentration increased as water activity (a(W)) increased with no significant production at 0.85-0.91 a(W) under all temperature levels tested. Production occurred over a range of temperatures (15-30 degrees C) with optimum production at 30 degrees C depending on a(W) assayed. The knowledge of Aspergillus section Nigri ecophysiology is critical in the development and prediction of the risk models of raw material and final product contamination by these species under fluctuating and interacting environmental parameters.

Publication Types:
PMID: 17920659 [PubMed - in process]

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Using rare diseases as models for biobehavioral research: allergic bronchopulmonary aspergillosis.

Greenberger PA, Yucha CB, Janson S, Huss K.

Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA. p-greenberger@northwestern.edu

Biobehavioral science explores links between biological, psychosocial, and behavioral factors and health. Maintaining positive health outcomes over time and across a variety of populations and settings requires understanding interactions among biological, behavioral, and social risk factors as well as other variables that influence behavior. Some barriers to biobehavioral research are related to performing biobehavioral research along the natural history of an illness, limitations in existing methodologies to assess the biological impact of behavior, the unknowns relating to impact of behavior on biology, and lack of valid and reliable biobehavioral methods to assess outcomes. A rare disease, such as allergic bronchopulmonary aspergillosis (ABPA) can be used as a model of biobehavioral research. ABPA complicates asthma and cystic fibrosis. It is a hypersensitivity reaction to Aspergillus fumigatus in most cases. ABPA can be classified into five stages: acute, remission, exacerbation, steroid-dependent asthma, and fibrotic or end stage. Because of its rarity, there can be delays in diagnosis. Treatment has used oral corticosteroids and antifungal agents in addition to management of asthma or cystic fibrosis. The National Institute of Nursing Research held an invitational 2-day working group meeting on July 15-16, 2004 with biobehavioral, biological, and immunologic science experts to examine current knowledge of biobehavioral research and to provide recommendations for additional research. The focus was on biobehavioral methods of measurement and analysis with interdisciplinary/biobehavioral approaches. This article is an outcome of this meeting.

Publication Types:
PMID: 17883921 [PubMed - indexed for MEDLINE]

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Biodiversity of complexes of mycotoxigenic fungal species associated with Fusarium ear rot of maize and Aspergillus rot of grape.

Logrieco A, Moretti A, Perrone G, Mul G.

Institute of Sciences of Food Production, National Research Council, ISPA, Via G. Amendola 122/O, 70126 Bari, Italy.

Fusarium ear rot of maize and Aspergillus rot of grape are two examples of important plant diseases caused by complexes of species of mycotoxigenic fungi. These complexes of species tend to be closely related, produce different classes of mycotoxins, and can induce disease under different environmental conditions. The infection of maize and grape with multiple fungal species and the resulting production of large classes of mycotoxins is an example of mutual aggressiveness of microorganisms toward host species as well as to humans and animals that eat feed or food derived from the infected and contaminated plants. Infection of crop plant with a complex of microbial species certainly represents a greater threat to a crop plant and to human and animal health than infection of the plant with a single fungal species.

PMID: 17765992 [PubMed - in process]

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Recombination, balancing selection and adaptive evolution in the aflatoxin gene cluster of Aspergillus parasiticus.

Carbone I, Jakobek JL, Ramirez-Prado JH, Horn BW.

Center for Integrated Fungal Research, Department of Plant Pathology, North Carolina State University, Raleigh, NC 27695, USA. ignazio_carbone@ncsu.edu

Aflatoxins are toxic and carcinogenic polyketides produced by several Aspergillus species that are known to contaminate agricultural commodities, posing a serious threat to animal and human health. Aflatoxin (AF) biosynthesis is almost fully characterized and involves the coordinated expression of approximately 25 genes clustered in a 70-kb DNA region. Aspergillus parasiticus is an economically important and common agent of AF contamination. Naturally occurring nonaflatoxigenic strains of A. parasiticus are rarely found and generally produce O-methylsterigmatocystin (OMST), the immediate precursor of AF. To elucidate the evolutionary forces acting to retain AF and OMST pathway extrolites (chemotypes), we sequenced 21 intergenic regions spanning the entire cluster in 24 A. parasiticus isolates chosen to represent the genetic diversity within a single Georgia field population. Linkage disequilibrium analyses revealed five distinct recombination blocks in the A. parasiticus cluster. Phylogenetic network analyses showed a history of recombination between chemotype-specific haplotypes, as well as evidence of contemporary recombination. We performed coalescent simulations of variation in recombination blocks and found an approximately twofold deeper coalescence for cluster genealogies compared to noncluster genealogies, our internal standard of neutral evolution. Significantly deeper cluster genealogies are indicative of balancing selection in the AF cluster of A. parasiticus and are further corroborated by the existence of trans-species polymorphisms and common haplotypes in the cluster for several closely related species. Estimates of Ka/Ks for representative cluster genes provide evidence of selection for OMST and AF chemotypes, and indicate a possible role of chemotypes in ecological adaptation and speciation.

Publication Types:
PMID: 17725568 [PubMed - in process]

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Factors determining accumulation of mycotoxin producers in cereal grain during harvesting.

Lugauskas A, Raila A, Zvicevicius E, Railiene M, Novosinskas H.

Laboratory of Biodeterioration Research, Institute of Botany, Vilnius, Lithuania. lugauskas@botanika.lt

During the meteorologically contrasting period of 2003-2005, the contamination of winter wheat, malt barley and fodder barley grain with micromycetes during grain harvesting and preparation for storage was investigated. Micromycetes of over 70 species ascribed to 16 genera were isolated and identified, the density of their populations in grain was determined. Micromycetes with a population density of >50% were attributed to dominant species. Short biological characteristic, ecological peculiarities of the dominating micromycetes are provided; factors determining intensity of their development and abilities to synthesise and excrete toxic metabolites are indicated. The importance of grain drying for stabilisation of its contamination with micromycete propagules is highlighted. It is noted that in grain dried in shaft dryer using air at 90 degrees C the number of cfu (colony forming units) was reduced from 2.2 to 8.2 times. When active ventilation is applied, conditions favourable for the development of micromycetes remain longest in the upper layers of the mound. The airflow passing through the layer of damp grain inhibits the development of micromycetes, but an increase of comparative air flow for more than 500 m3x(txh)(-1) did not reduce the abundance of micromycete cfu. After drying Alternaria alternata, Fusarium avenaceum, F. culmorum, Penicillum verrucosum dominated in wheat grain; Aspergillus flavus, Bipolaris sorokiniana, Fusarium chlamydosporum, F. culmorum, F. tricinctum in malts barley grain; Fusarium avenaceum, F. culmorum, F. tricinctum, Alternaria alternata in fodder barley grain. It has been determined that all micromycetes recorded on grain after drying are potential producers of toxic metabolites, i.e. are hazardous to human health.

PMID: 17655196 [PubMed - indexed for MEDLINE]

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AIDS-related opportunistic mycoses seen in a tertiary care hospital in North India.

Wadhwa A, Kaur R, Agarwal SK, Jain S, Bhalla P.

Department of Microbiology, Maulana Azad Medical College, New Delhi, India. dranupriyawadhwa@gmail.com

Sixty symptomatic confirmed human immunodeficiency virus (HIV)-positive adult patients, of both sexes, suspected of having a fungal infection were taken as a study population, and the clinicomycological profile was correlated with the immunological status of the patients with particular reference to CD4 counts. Relevant samples were collected and subjected to direct microscopy, fungal culture and serology. CD4 counts were determined by flow cytometry. Patients belonged to the age group of 17-65 years, with a male : female ratio of 4.8 : 1. Heterosexuality was the commonest mode of transmission. Candidiasis was the most common diagnosis (41.7 %), followed by cryptococcosis (10.0 %), and pneumocystinosis and aspergillosis (8.3 % each). Two cases of histoplasmosis were also diagnosed. A low mean CD4 count of <200 cells microl(-1) was seen with most fungal infections. A total of 73 % of patients belonged to World Health Organization (WHO) stage 4, while 23.33 % belonged to stage 3. Thirty one patients (51.67 %) belonged to Centers for Disease Control and Prevention (CDC) stage C3. Various fungal infections correlated well with the mean CD4 counts. It was difficult to correlate statistically WHO and CDC staging because of the small sample size. However, it was possible to assess to a limited extent the possibility of using clinical diagnosis to predict the status of progression of HIV infection in a resource-poor outpatient setting.

Publication Types:
PMID: 17644719 [PubMed - indexed for MEDLINE]

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[Nematophagous fungi of Toxocara canis eggs in a public park of La Plata, Argentina]

[Article in Spanish]

Gortari C, Cazau C, Hours R.

CIC-PBA and CINDEFI (CONICET-UNLP) Facultad de Ciencias Exactas, UNLP, La Plata, Argentina.

Fungi have showed a great potential for the biological control of nematodes. However, they have not been evaluated for the control of animal and/or human parasites transmitted by egg contaminated soils. Environmental contamination with Toxocara spp. eggs is a public health problem. Accidental swallowing of Toxocara canis eggs (a nematode of dogs) usually results on a zoonotic infection (toxocarosis). The objectives of this research were: 1) To test the presence of antagonistic fungi against T. canis in the soil in public places of La Plata city, Argentina, infected with eggs of this parasite, 2) To determine the possible association between biotic and abiotic factors of the soil with the presence of fungal parasites of egg nematodes. Soil samples were tested for: textural type, organic matter (%), pH, presence of egg-parasite fungi, of larvae and of nematode eggs, in particular of Toxocara spp. The studied area showed the following characteristics: pH: 6.6-8.0, organic matter: 1.2-70%, with a predominantly loam texture. The following antagonistic fungal genera were identified: Acremonium, Aspergillus, Chrysosporium, Fusarium, Humicola, Mortierella, Paecilomyces and Penicillium. A prevalence of 70% was detected for nematode eggs, of 33% for Toxocara spp. eggs and of 90% for larvae. No association between the presence of egg-parasite fungi and the considered factors was found. More studies are necessary to know the natural antagonism factors to T. canis eggs for its in situ biological control.

Publication Types:
PMID: 17592887 [PubMed - indexed for MEDLINE]

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Harmful fungi in both agriculture and medicine.

De Lucca AJ.

Southern Regional Research Center, USDA, ARS, New Orleans, LA 70124, USA. adelucca@srrc.ars.usda.gov

Most fungi are saprophytic and not pathogenic to plants, animals and humans. However, a relative few fungal species are phytopathogenic, cause disease (e.g., infections, allergies) in man, and produce toxins that affect plants, animals and humans. Among such fungi are members of the Aspergillus and Fusarium genera as well as other genera (e.g., Alternaria, Mucor) comprising the emerging pathogen group in humans. These fungi present a common threat to both agricultural production and the health of healthy and immunocompromised individuals. Taken together, these relative few fungi can cause huge economic losses to agriculture, loss of food for consumption, and serious, often fatal diseases in humans and animals. Plants may be a source of antifungal compounds since they have had to develop compounds to resist infections by fungi present in their environment.

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PMID: 17592884 [PubMed - indexed for MEDLINE]

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[Exposure to aflatoxin B1 in experimental animals and its public health significance]

[Article in Spanish]

Guzm‡n de Pe–a D.

Laboratorio de Micotoxinas, Departamento de Biotecnolog’a y Bioqu’mica, Campus Guanajuato, Centro de Investigaci—n y de Estudios Avanzados del IPN, Irapuato, Guanajuato, MŽxico. dguzman@ira.cinvestav.mx

The presence of AFB1 in human beings was detected in Mexico in 1996 both as a mutation of the gene p53 in hepatocellular carcinomas in Monterrey, Mexico, and as the adduct AFB1-lysine in serum from patients in Matamoros, Mexico in 2003. Aflatoxin B1 has been classified as a carcinogenic agent to humans by the International Agency for Research on Cancer. The compound is a natural contaminant produced by Aspergillus flavus and/or A. parasiticus when these fungi grow on different food products. At the molecular level, this review covers the carcinogenic, mutagenic and toxic properties of these mycotoxins and their risk to humans. It also gives insight into the causal relationship between aflatoxins and hepatocellular carcinoma. Information is provided about AFB1-formamidopyrimidine, which is a determinant of the carcinogenic and mutagenic capabilities. The results suggest that the Mexican population ingests food containing low amounts of AFB1. Analyses is presented of AFB1 toxicity, which is a consequence of the carcinogenic activity in liver cells.

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PMID: 17589777 [PubMed - indexed for MEDLINE]

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[Detection of some zoonotic agents in the domestic pigeon (Columba livia) in the city of Chill‡n, Chile]

[Article in Spanish]

Gonz‡lez-Acu–a D, Silva G F, Moreno S L, Cerda L F, Donoso E S, Cabello C J, L—pez M J.

Facultad de Medicina Veterinaria, Universidad de Concepci—n, Chill‡n, Chile. danigonz@udec.cl

INTRODUCTION: There is an increase in the population of doves (Columba livia) as well as their contact with healthy and immunocompromised hosts. OBJECTIVES: detection of some zoonotic agents of the domestic pigeon (Columba livia) in Chill‡n city, Chile. MATERIALS AND METHODS: From October 2002 to September 2003, 100 domestic pigeons were captured. Blood, organs and intestine contents were sampled from each pigeon. The samples were cultivated in different kinds of agar according to the searched microorganism. Fungi were typified by morphological studies after staining with 2% methylene blue. For the detection of Chlamydophila psittaci a commercial Elisa kit (IDEXX) was used. RESULTS: Pigeons were registered positive for: chlamydiosis (11%), staphylococcus (8%), salmonellosis (4%) and aspergillosis (1%). No pigeon had evidence of cryptococcosis and listeriosis. CONCLUSIONS: these results confirm that domestic pigeon could act as vector of zoonotic agents of public health importance.

Publication Types:
PMID: 17554438 [PubMed - indexed for MEDLINE]

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[Evidence-based infection control]

[Article in Japanese]

Yano K.

Publication Types:
PMID: 17515119 [PubMed - indexed for MEDLINE]

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Nosocomial fungal infections: epidemiology, diagnosis, and treatment.

Perlroth J, Choi B, Spellberg B.

Division of Infectious Diseases, Harbor-University of California Los Angeles (UCLA) Medical Center, California 90502, USA.

Invasive fungal infections are increasingly common in the nosocomial setting. Furthermore, because risk factors for these infections continue to increase in frequency, it is likely that nosocomial fungal infections will continue to increase in frequency in the coming decades. The predominant nosocomial fungal pathogens include Candida spp., Aspergillus spp., Mucorales, Fusarium spp., and other molds, including Scedosporium spp. These infections are difficult to diagnose and cause high morbidity and mortality despite antifungal therapy. Early initiation of effective antifungal therapy and reversal of underlying host defects remain the cornerstones of treatment for nosocomial fungal infections. In recent years, new antifungal agents have become available, resulting in a change in standard of care for many of these infections. Nevertheless, the mortality of nosocomial fungal infections remains high, and new therapeutic and preventative strategies are needed.

Publication Types:
PMID: 17510856 [PubMed - indexed for MEDLINE]

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Role of micafungin in the antifungal armamentarium.

Ikeda F, Tanaka S, Ohki H, Matsumoto S, Maki K, Katashima M, Barrett D, Aoki Y.

Development Division, Astellas Pharma Inc. 3-17-1 Hasune, Tokyo 174-8612, Japan.

Serious infections caused by opportunistic molds remain a major problem for public health. Immune deficiency following organ transplantation and aggressive cancer treatment has greatly increased the incidence of systemic mycoses, and invasive aspergillosis in patients with AIDS is associated with significant morbidity and mortality. Amphotericin B is the first-line therapy for systemic infection because of its broad-spectrum and fungicidal activity. However, considerable side effects limit its clinical utility. The echinocandins are large lipopeptide molecules that inhibit the synthesis of 1,3-beta-D-glucan, a key component of the fungal cell wall. Three echinocandins have reached the market, and some others are in early clinical development. Caspofungin was the first echinocandin to be licensed for clinical use in most countries. Micafungin is licensed for clinical use in Japan, China, Taiwan, Jordan, Korea, Hong-Kong and the US, and anidulafungin is currently licensed in the US. The novel class of echinocandins represents a milestone in antifungal drug research that has further expanded our therapeutic options. Studies to date have shown that micafungin exhibits extremely potent antifungal activity against clinically important fungi, including Aspergillus and azole-resistant strains of Candida. In animal studies, micafungin is as efficacious as amphotericin B with respect to improvement of survival rate. Micafungin is also characterized by a linear pharmacokinetic profile and substantially fewer toxic effects. Micafungin is a poor substrate for the cytochrome P450 enzymes, and compared to azoles, fewer drug interactions are described. No dose adjustments of the drug are required in the presence of mycophenolate mofetil, cyclosporin, tacrolimus, prednisolone, or sirolimus. Strategies using this new echinocandin agent will benefit a large number of patients with severe immune dysfunction.

Publication Types:
PMID: 17504145 [PubMed - indexed for MEDLINE]

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Eurotiomycetes: Eurotiomycetidae and Chaetothyriomycetidae.

Geiser DM, Gueidan C, Miadlikowska J, Lutzoni F, Kauff F, Hofstetter V, Fraker E, Schoch CL, Tibell L, Untereiner WA, Aptroot A.

Department of Plant Pathology, Pennsylvania State University, University Park 16802, USA. dgeiser@psu.edu

The class Eurotiomycetes (Ascomycota, Pezizomycotina) is a monophyletic group comprising two major clades of very different ascomycetous fungi: (i) the subclass Eurotiomycetidae, a clade that contains most of the fungi previously recognized as Plectomycetes because of their mostly enclosed ascomata and prototunicate asci; and (ii) the subclass Chaetothyriomycetidae, a group of fungi that produce ascomata with an opening reminiscent of those produced by Dothideomycetes or Sordariomycetes. In this paper we use phylogenetic analyses based on data available from the Assembling the Fungal Tree of Life project (AFTOL), in addition to sequences in GenBank, to outline this important group of fungi. The Eurotiomycetidae include producers of toxic and useful secondary metabolites, fermentation agents used to make food products and enzymes, xerophiles and psychrophiles, and the important genetics model Aspergillus nidulans. The Chaetothyriomycetidae include the common black yeast fungi, some of which are pathogens of humans and animals, as well as some primarily lichenized groups newly found to be phylogenetically associated with this group. The recently proposed order Mycocaliciales shows a sister relationship with Eurotiomycetes. The great majority of human pathogenic Pezizomycotina are Eurotiomycetes, particularly in Eurotiales, Onygenales and Chaetothyriales. Due to their broad importance in basic research, industry and public health, several genome projects have focused on species in Onygenales and Eurotiales.

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PMID: 17486980 [PubMed - indexed for MEDLINE]

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Mass spectrometry-based strategy for direct detection and quantification of some mycotoxins produced by Stachybotrys and Aspergillus spp. in indoor environments.

Bloom E, Bal K, Nyman E, Must A, Larsson L.

Dept of Laboratory Medicine, Division of Medical Microbiology, Lund University, Sšlvegatan 23, Lund, Sweden.

Dampness in buildings has been linked to adverse health effects, but the specific causative agents are unknown. Mycotoxins are secondary metabolites produced by molds and toxic to higher vertebrates. In this study, mass spectrometry was used to demonstrate the presence of mycotoxins predominantly produced by Aspergillus spp. and Stachybotrys spp. in buildings with either ongoing dampness or a history of water damage. Verrucarol and trichodermol, hydrolysis products of macrocyclic trichothecenes (including satratoxins), and trichodermin, predominately produced by Stachybotrys chartarum, were analyzed by gas chromatography-tandem mass spectrometry, whereas sterigmatocystin (mainly produced by Aspergillus versicolor), satratoxin G, and satratoxin H were analyzed by high-performance liquid chromatography-tandem mass spectrometry. These mycotoxin analytes were demonstrated in 45 of 62 building material samples studied, in three of eight settled dust samples, and in five of eight cultures of airborne dust samples. This is the first report on the use of tandem mass spectrometry for demonstrating mycotoxins in dust settled on surfaces above floor level in damp buildings. The direct detection of the highly toxic sterigmatocystin and macrocyclic trichothecene mycotoxins in indoor environments is important due to their potential health impacts.

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PMID: 17483261 [PubMed - indexed for MEDLINE]

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An outbreak of Aspergillus meningitis following spinal anaesthesia for caesarean section in Sri Lanka: a post-tsunami effect?

Gunaratne PS, Wijeyaratne CN, Chandrasiri P, Sivakumaran S, Sellahewa K, Perera P, Fernando R, Wanigasinghe J, Jayasinghe S, Ranawala R, Riffsy MT, Seneviratne HR.

National Hospital of Sri Lanka. pagunara@hotmail.com

An outbreak of Aspergillus fumigatus meningitis occurred in 5 women following spinal anaesthesia, performed between 21 June and 17 July 2005 for caesarean section, in Colombo, Sri Lanka. The patients' median age was 27 years. Different teams in 2 maternity hospitals gave spinal anaesthesia. Mean incubation period was 11.2 days. Fever, headache and nuchal rigidity were common presentations. Remittent fever continued despite broad-spectrum intravenous antibiotics. Papilloedema, lateral rectus palsy, cerebral infarction and haemorrhage developed later. Three patients died. Cerebrospinal fluid pleocytosis with low glucose yielded negative PCR for fungi. Fungal cultures subsequently grew Aspergillus fumigatus. A post-mortem of the first patient confirmed Aspergillus meningitis, followed by treatment with amphotericin B and voriconazole, that saved the lives of others. Visual and hearing impairment in one and complete recovery in the other were observed a year after treatment. Examination of unused plastic syringes, needles, cannulae, and ampoules of anaesthetic agents confirmed that 43 syringes from three different manufactures were contaminated with Aspergillus fumigatus. The stores for drugs and devices of the Ministry of Health were examined and found to be full of tsunami donations, while regular procurements of the Ministry were kept in a poorly maintained humid warehouse. Inadequate space for tsunami donations was identified as the most plausible explanation for sub-optimal storage. Withdrawal and incineration of all unused syringes controlled the outbreak. The survival of those aggressively treated for Aspergillus meningitis suggests in hindsight that the availability of diagnostic tests and specific treatment, and early recognition of the outbreak could have saved the lives of victims who died. Early life-threatening side-effects and permanent long term sequelae of antifungal medication stress the need to be cautious with empirical treatment in immuno-competent low-risk individuals.

PMID: 17461323 [PubMed - indexed for MEDLINE]

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Diagnostics of fungal infections in the Nordic countries: we still need to improve!

Arendrup MC, Chryssanthou E, Gaustad P, Koskela M, Sandven P, Fernandez V.

Unit of Mycology and Parasitology, Statens Serum Institute, Copenhagen, Denmark. mad@ssi.dk

A Nordic External Quality Assessment programme in medical mycology was established in 2005. In order to monitor not 'best practice' but the level of routine diagnostics, specimens were designed to resemble clinical samples and laboratories were asked to handle the samples like routine samples. Five simulated clinical samples were distributed to 59 participating Nordic laboratories of clinical microbiology. The specimens contained the following microorganisms: 1) Candida glabrata and C. albicans in a ratio of 1:20; 2) Cryptococcus neoformans; 3) Aspergillus fumigatus, C. albicans and Enterobacter cloacae; 4) C. tropicalis, Klebsiella pneumonia and Enterococcus faecium; 5) None. 66% of the laboratories failed to detect the C. glabrata isolate in sample no. 1. 34% of the laboratories reporting susceptibility results incorrectly reported the Cryptococcus neoformans isolate as fluconazole susceptible. 24% of the laboratories failed to detect Aspergillus fumigatus in specimen no. 3 despite the accompanying clinical information notifying that it was a BAL sample from a neutropenic patient in an ICU. In conclusion, this distribution of simulated clinical samples illustrates that the traditional quality assessment programmes may give a false sense of satisfactory performance, that mycological diagnosis is difficult, and that there is a need of further improvement and attention.

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PMID: 17454898 [PubMed - indexed for MEDLINE]

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Optimization of the cutoff value for the Aspergillus double-sandwich enzyme immunoassay.

Maertens JA, Klont R, Masson C, Theunissen K, Meersseman W, Lagrou K, Heinen C, CrŽpin B, Van Eldere J, Tabouret M, Donnelly JP, Verweij PE.

Department of Hematology, Universitaire Ziekenhuizen, Catholic University Leuven, Leuven, Belgium. johan.maertens@uz.kuleuven.ac.be

BACKGROUND: Many health care centers worldwide use the Platelia Aspergillus enzyme immunoassay (PA-EIA; Bio-Rad Laboratories) for diagnosis of invasive aspergillosis (IA). A cutoff optical density (OD) index of 1.5 was originally recommended by the manufacturer, but in practice, most institutions use lower cutoff values. Moreover, a cutoff OD index of 0.5 was recently approved in the United States. In the present study, we set out to optimize the cutoff level by performing a retrospective analysis of PA-EIA values for samples that had been obtained prospectively from adult patients at risk for IA at 2 European health care centers. METHODS: In total, 239 treatment episodes were included of which there were 19 episodes of proven IA and 19 episodes of probable IA. Per-episode and per-test analyses and receiver operating characteristic curves were used to determine the optimal cutoff value. RESULTS: In the per-episode analysis, lowering the cutoff OD index for positivity from 1.5 to 0.5 increased the overall sensitivity by 21% (from 76.3% to 97.4%) but decreased the overall specificity by 7% (from 97.5% to 90.5%). Requiring 2 consecutive samples with an OD index > or = 0.5 resulted in the highest test accuracy, with an improved positive predictive value. At a cutoff OD index of 0.5, the antigen test result was positive during the week before conventional diagnosis in 65% of cases and during the week of diagnosis in 79.5% of cases. CONCLUSIONS: A cutoff OD index of 0.5--identical to the approved cutoff in the United States--improves the overall performance of the PA-EIA for adult hematology patients.

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PMID: 17443470 [PubMed - indexed for MEDLINE]

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Ethylene inhibits aflatoxin biosynthesis in Aspergillus parasiticus grown on peanuts.

Gunterus A, Roze LV, Beaudry R, Linz JE.

Department of Food Science and Human Nutrition, Michigan State University, E. Lansing, MI 48824, USA.

The filamentous fungi Aspergillus parasiticus and Aspergillus flavus synthesize aflatoxins when they grow on a variety of susceptible food and feed crops. These mycotoxins are among the most carcinogenic naturally occurring compounds known and they pose significant health risks to humans and animals. We previously demonstrated that ethylene and CO2 act alone and together to reduce aflatoxin synthesis by A. parasiticus grown on laboratory media. To demonstrate the potential efficacy of treatment of stored seeds and grains with these gases, we tested ethylene and CO2 for ability to inhibit aflatoxin accumulation on Georgia Green peanuts stored for up to 5 days. We demonstrated an inverse relationship between A. parasiticus spore inoculum size and the level of toxin accumulation. We showed that ethylene inhibits aflatoxin synthesis in a dose-dependent manner on peanuts; CO2 also inhibits aflatoxin synthesis over a narrow dose range. Treatments had no discernable effect on mold growth. These observations support further exploration of this technology to reduce aflatoxin contamination of susceptible crops in the field and during storage.

Publication Types:
PMID: 17418318 [PubMed - indexed for MEDLINE]

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[Hazardous food-borne fungi and present and future approaches to the mycotoxin regulations in Japan]

[Article in Japanese]

Takatori K, Aihara M, Sugita-Konishi Y.

takatori@nihs.go.jp

In recent years, various food-related accidents and health scares have dissipated trust in the food industry. Health hazards resulting from food contaminated with fungi is increasing. Food contamination by fungi causes many problems, especially in Japan, which relies on foreign countries for about 60% of its food: the contamination of imported food by fungi and mycotoxins constitutes a serious problem. As the quantity of imported food increases and changes in food distribution have occurred, so too has the number and type of fungi causing food-related damages; osmophilic and thermotolerant fungi, in addition to the mainstream fungi of genera Cladosporium, Pecinillium, and Aspergillus, have become a problem. Although European countries and the U.S. have recently conducted risk assessments for mycotoxins, Japan has not attained an international level in the determination of baseline values. However, in addition to risk management for Aflatoxin M1, Ochratoxin, T-2 toxin/HT-2 toxin, and Fumonisin, determination of baseline values for mycotoxins is beginning in Japan. In this review, we summarize hazardous food-borne fungi, and present and future approaches to the mycotoxin regulations in Japan.

Publication Types:
PMID: 17405518 [PubMed - indexed for MEDLINE]


Onychomycosis in eastern Nepal.

Agarwalla A, Agrawal S, Khanal B.

Department of Dermatology, Marwari Maternity Hospital, Adhgaon, Guwahati, Assam, India.

Onychomycosis, a fungal infection of the nail is responsible for up to 50.0% of all nail diseases. Though, dermatophytes are most frequently implicated as the causative agents in onychomycosis, yeast and molds are increasingly recognized as causative pathogens. This study was aimed to know the clinical and mycological pattern of onychomycosis in eastern Nepal. Eighty-two clinically diagnosed patients of onychomycosis attending the Dermatology Outpatient department of a tertiary hospital over a period of one year were enrolled in this study. Clipping from the severely affected nail and skin scrapping from active border of the skin lesions if associated were collected from each patient and subjected to microscopy and culture for identification of fungi. The commonest affected age group was 21-40 years. The male: female ratio was 2.7:1. Fifty-one patients had isolated fingernail involvement, while involvement of toenails was seen in 15 patients. Distolateral subungual onychomycosis (67%) was the commonest clinical type followed in decreasing order by superficial white onychomycosis (14.6%), proximal subungual onychomycosis (9.8%), candidal onychomycosis (7.4%) and total dystrophic onychomycosis (1.2%). Trichophyton mentagrophytes (28.8%) was the most common pathogen isolated followed by Trichophyton rubrum (21.2%), Trichophyton tonsurans (11.5%), Candida albicans (11.5%), Trichospron beigelii, (9.6%), Epidermophyton floccosum (7.7%), Trichophyton violaceum (5.8%), and Aspergillus flavus (3.9%). Distolateral subungual onychomycosis was the most common clinical presentation and T. mentagrophytes and T. rubruni were the most frequently isolated fungi for onychomycosis in eastern Nepal.

Publication Types:
PMID: 17357634 [PubMed - indexed for MEDLINE]

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[Fungus microbiota in air conditioners in intensive care units in Teresina, Piau’]

[Article in Portuguese]

Mobin M, do Amparo Salmito M.

Laborat—ria de Microbiologia e Imunologia, Faculdade de Saœde, Cincias Humanas e Tecnol—gicas do Piau’, Teresina, PI, Brazil. mitramobin@novafapi.com.br

With the aim of identifying the fungus microbiota in air conditioners in intensive care units (ICUs) within public and private hospitals in Teresina, Piau’, solid material was collected from ten different ICUs. Thirty-three species of Moniliaceae and Dematiaceae were isolated, which was the first report of these in Piau’. High frequencies of Aspergillus niger Van Tieghem (60%), Aspergillus fumigatus Fres (50%), Trichoderma koningii Oudem (50%) and Aspergillus flavus Link: Fr. (40%) were recorded. The air conditioner cleanliness validity had expired in all the ICUs, and the quantity of colony-forming units exceeded the levels permitted by Law 176/00 from the Ministry of Health. It is important to provide individual protection equipment for professionals, adopt hospital infection control measures, raise the awareness of the presence of fungus infection, improve air circulation around the environment, periodically clean the air conditioners, and make health professionals alert to the importance of these fungi in the hospital environment.

Publication Types:
PMID: 17308702 [PubMed - indexed for MEDLINE]

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Trends in the epidemiology of invasive fungal infections.

Warnock DW.

Division of Foodborne, Bacterial and Mycotic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

Invasive fungal infections have increased in importance, largely because of the increasing size of the population at risk. Candida species remain the fourth most important cause of hospital-acquired bloodstream infections. Infections with Candida species other than C. albicans appear to have become more common, but significant geographic variation has been reported. Invasive aspergillosis and other mould infections are a leading cause of infection-related death in hematopoietic stem cell transplant recipients. Although Aspergillus fumigatus remains the most frequent cause of infection, A. terreus has emerged as an important pathogen, at least among certain populations. Despite marked reductions in the rates of AIDS-associated fungal infections, such as cryptococcosis, in the United States and other developed countries, the burden of these diseases in developing countries is large and increasing. Enhanced surveillance and reporting will be critical to improve our understanding of the importance of invasive fungal infections, to enable prioritization of research and prevention efforts, and to evaluate prevention strategies.

Publication Types:
PMID: 17287717 [PubMed - indexed for MEDLINE]

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Environmental dimensionality controls the interaction of phagocytes with the pathogenic fungi Aspergillus fumigatus and Candida albicans.

Behnsen J, Narang P, Hasenberg M, Gunzer F, Bilitewski U, Klippel N, Rohde M, Brock M, Brakhage AA, Gunzer M.

Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology, Hans Knšll Institute, Jena, Germany.

The fungal pathogens Aspergillus fumigatus and Candida albicans are major health threats for immune-compromised patients. Normally, macrophages and neutrophil granulocytes phagocytose inhaled Aspergillus conidia in the two-dimensional (2-D) environment of the alveolar lumen or Candida growing in tissue microabscesses, which are composed of a three-dimensional (3-D) extracellular matrix. However, neither the cellular dynamics, the per-cell efficiency, the outcome of this interaction, nor the environmental impact on this process are known. Live imaging shows that the interaction of phagocytes with Aspergillus or Candida in 2-D liquid cultures or 3-D collagen environments is a dynamic process that includes phagocytosis, dragging, or the mere touching of fungal elements. Neutrophils and alveolar macrophages efficiently phagocytosed or dragged Aspergillus conidia in 2-D, while in 3-D their function was severely impaired. The reverse was found for phagocytosis of Candida. The phagocytosis rate was very low in 2-D, while in 3-D most neutrophils internalized multiple yeasts. In competitive assays, neutrophils primarily incorporated Aspergillus conidia in 2-D and Candida yeasts in 3-D despite frequent touching of the other pathogen. Thus, phagocytes show activity best in the environment where a pathogen is naturally encountered. This could explain why "delocalized" Aspergillus infections such as hematogeneous spread are almost uncontrollable diseases, even in immunocompetent individuals.

Publication Types:
PMID: 17274685 [PubMed - indexed for MEDLINE]

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A new competitive fluorescence assay for the detection of patulin toxin.

de ChampdorŽ M, Bazzicalupo P, De Napoli L, Montesarchio D, Di Fabio G, Cocozza I, Parracino A, Rossi M, D'Auria S.

Institutes of Protein Biochemistry and of Genetics & Biophysics, CNR, and Department of Organic Chemistry, University of Naples, Naples, Italy.

Patulin is a toxic secondary metabolite of a number of fungal species belonging to the genera Penicillum and Aspergillus. It has been mainly isolated from apples and apple products contaminated with the common storage-rot fungus of apples, Penicillum expansum, but it has also been extracted from rotten fruits, moldy feeds, and stored cheese. Human exposure to patulin can lead to serious health problems, and according to a long-term investigation in rats, the World Health Organization has set a tolerable weekly intake of 7 ppb body weight. The content of patulin in foods has been restricted to 50 ppb in many countries. Conventional analytical detection methods involve chromatographic analyses, such as HPLC, GC, and, more recently, techniques such as LC/MS and GC/MS. However, extensive protocols of sample cleanup are required prior to the analysis, and to accomplish it, expensive analytical instrumentation is necessary. An immunochemical analytical method, based on highly specific antigen-antibody interactions, would be desirable, offering several advantages compared to conventional techniques, i.e., low cost per sample, high selectivity, high sensitivity, and high throughput. In this paper, the synthesis of two new derivatives of patulin is described, along with their conjugation to the bovine serum albumin for the production of polyclonal antibodies. Finally, a fluorescence competitive immunoassay was developed for the on-line detection of patulin.

Publication Types:
PMID: 17222046 [PubMed - indexed for MEDLINE]

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Isolation of Aspergillus in critically ill patients: a potential marker of poor outcome.

Khasawneh F, Mohamad T, Moughrabieh MK, Lai Z, Ager J, Soubani AO.

Wayne State University/Detroit Medical Center, Detroit, MI 48201, USA.

OBJECTIVE: Recent reports have suggested a rising incidence of pulmonary aspergillosis in intensive care unit (ICU) patients. The aim of this study was to determine the clinical significance of isolating Aspergillus from respiratory samples of critically ill patients. DESIGN: Retrospective review of medical records. SETTING: Tertiary medical center that has a large cancer center. PATIENTS: All patients admitted to the ICU between January 1998 and August 2004, in whom Aspergillus was isolated from respiratory samples or lung tissue. INTERVENTION: None. RESULTS: The charts of 104 patients were reviewed. Aspergillus was isolated for a mean of 6.6 days after ICU admission. Thirty-three percent of patients had hematological malignancy, 10% had absolute neutropenia, 14% had bone marrow transplant, 11% had HIV infection, and 22% had chronic obstructive pulmonary disease. Upon admission to ICU, 79%, 43%, and 19% were on antibiotics, corticosteroids, or immunosuppressive therapy, respectively. Ninety percent of patients required mechanical ventilation. The mean Acute Physiologic and Chronic Health Evaluation II score on ICU admission was 20.6, with predicted mortality of 35.5%. However, the actual ICU mortality rate for the cohort was 50%. Twenty-eight percent of patients were diagnosed with probable or definite invasive pulmonary aspergillosis, and 72% had Aspergillus colonization. On univariate analysis, the significant clinical differences between the 2 groups were the presence of neutropenia (P < .05), immunosuppressants (P < .05), antibiotics (P < .05), or bone marrow transplant (P < .05). The differences in Acute Physiologic and Chronic Health Evaluation II score, the need for mechanical ventilation, ICU length of stay, and ICU mortality were not statistically significant. On multivariate analysis, the following factors were independently associated with invasive diseases, bone marrow transplantation (P < .01), hematological malignancy (P = .02), and broad-spectrum antibiotics (P = .02). CONCLUSION: Isolation of Aspergillus in critically ill patients is a poor prognostic marker and is associated with high mortality irrespective of invasion or colonization. Those who are neutropenic, on immunosuppressive therapy, on broad-spectrum antibiotics, or had bone marrow transplantation are more likely to have invasive pulmonary aspergillosis.

PMID: 17175418 [PubMed - indexed for MEDLINE]

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In vivo confocal microscopy in fungal keratitis.

Brasnu E, Bourcier T, Dupas B, Degorge S, Rodallec T, Laroche L, Borderie V, Baudouin C.

Department of Ophthalmology III, Quinze-Vingts National Center of Ophthalmology, Paris, France.

BACKGROUND: Fungal keratitis is a major blinding eye disease found throughout the world, particularly in developing countries. Given the recent increase in Fusarium keratitis infections in contact lens wearers owing to contact lens solutions, a warning was recently issued by the Food and Drug Administration, making it a public health concern in developed countries. OBJECTIVE: To show the advantages of in vivo confocal microscopy imaging using the Heidelberg Retina Tomograph II-Rostock Cornea Module (HRTII-RCM) in the early diagnosis of fungal keratitis. METHODS: HRTII-RCM confocal microscopy was performed on five patients presenting with fungal keratitis and on three donor corneas contaminated with Fusarium solani, Aspergillus fumigatus and Candida albicans. RESULTS: Direct microscopic evaluation of corneal smears and culture revealed the presence of F solani in four cases and C albicans in one case. HRTII-RCM examination of the infected patients and contaminated donor corneas revealed numerous high-contrast elements resembling Fusarium, Aspergillus hyphae or Candida pseudofilaments in the anterior stroma. CONCLUSION: HRTII-RCM in vivo confocal microscopy is a new, non-invasive and rapid technique for the early diagnosis of fungal keratitis, showing high-resolution images resembling fungal structures in the early phase of the disease.

PMID: 17151059 [PubMed - indexed for MEDLINE]

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[Micosis among five highly underprivileged Mexican communities]

[Article in Spanish]

MŽndez-Tovar LJ, Anides-Fonseca A, V‡zquez-Hern‡ndez A, Galindo-Gonz‡lez M, D’az-Madrid M, Berd—n-Castro A, Manzano-Gayosso P, Mill‡n-Chiu B, Hern‡ndez-Hern‡ndez F, L—pez-Mart’nez R.

Unidad de Investigaci—n MŽdica en Dermatolog’a y Micolog’a "Dr. Ernesto Macotela", UMAE Hospital de Especialidades "Dr. Bernardo Sepœlveda", Centro MŽdico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico D. F., MŽxico. ljmt@servidor.unam.mx

BACKGROUND: In many small rural communities in Mexico, medical care is deficient, empirical or absent. OBJECTIVE: In order to improve health coverage in rural areas, the Mexican Institute of Social Security organizes Medical and Surgical Meetings of various specialties including Dermatology and Mycology (MSDM). These include visits to rural hospitals by dermatologists and a mycologist to care for underprivileged communities. In addition to taking samples, they establish the clinical diagnosis and indicate medical and/or surgical treatment, with follow-up visits when needed. MATERIAL AND METHODS: In 2004 and 2005, five MSDM in Chiapas (two), Puebla (one), Michoac‡n (one) and Oaxaca (one) were organized. Mycoses were within the first four skin pathologies detected. RESULTS: Direct examination with potassium hydroxide led to the diagnosis of mycosis and other skin diseases such as scabies, pediculosis or hair disorders. The sample cultures showed, in addition to common fungi as dermatophytes (Trichophyton rubrum, 19 cases), other uncommon fungal agents such as Trichosporon spp, Chrysosporium spp, Cryptococcus, Geotrichum spp and Aspergillus spp. Most of the candidiasis cases were caused by Candida parapsilosis (nine cases) followed by C. albicans (three cases).

Publication Types:
PMID: 17128817 [PubMed - indexed for MEDLINE]

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Degradation mechanisms of benzo[a]pyrene and its accumulated metabolites by biodegradation combined with chemical oxidation.

Zang S, Li P, Li W, Zhang D, Hamilton A.

Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang 110016, China.

A high degradation extent of benzo[a]pyrene (BaP) should not be considered as the sole desirable criterion for the bioremediation of BaP-contaminated soils because some of its accumulated metabolites still have severe health risks to human. Two main metabolites of BaP, benzo[a]pyrene-1,6-quinone (BP1,6-quinone) and 3-hydroxybenzo[a]pyrene (3-OHBP) were identified by high performance liquid chromatography (HPLC) with standards. This study was the first time that degradation of both BaP and the two metabolites was carried out by chemical oxidation and biodegradation. Three main phases during the whole degradation process were proposed. Hydrogen peroxide-zinc (H(2)O(2)-Zn), the fungus - Aspergillus niger and the bacteria - Zoogloea sp. played an important role in the different phases. The degradation parameters of the system were also optimized, and the results showed that the effect of degradation was the best when fungus-bacteria combined with H(2)O(2)-Zn, the concentration range of BaP in the cultures was 30-120mg/l, the initial pH of the cultures was 6.0. However, as co-metabolites, phenanthrene significant inhibited the degradation of BaP. This combined degradation system compared with the conventional method of degradation by domestic fungus only, enhanced the degradation extent of BaP by more than 20% on the 12d. The highest accumulation of BP1,6-quinone and 3-OHBP were reduced by nearly 10% in the degradation experiments, which further proved that the combined degradation system was more effective as far as joint toxicity of BaP and its metabolites are concerned.

Publication Types:
PMID: 17126885 [PubMed - indexed for MEDLINE]

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Evaluation of certain food additives.

Joint FAO/WHO Expert Committee on Food Additives.

This report represents the conclusions of a Joint FAO/WHO Expert Committee convened to evaluate the safety of various food additives, with a view to recommending acceptable daily intakes (ADIs) and to prepare specifications for the identity and purity of food additives. The first part of the report contains a general discussion of the principles governing the toxicological evaluation of food additives (including flavouring agents), assessments of intake, and the establishment and revision of specifications for food additives. A summary follows of the Committee's evaluations of toxicological and intake data on various specific food additives (Beeswax, Candelilla wax, Calcium L-5-Methyltetrahydrofolic acid (L-5-MTHF), Phospholipase A1 from Fusarium venenatum expressed in Aspergillus oryzae, Pullulan, Quillaia extract Type 1, Quillaia extract Type 2) and seven groups of flavouring agents. Annexed to the report are tables summarizing the Committee's recommendations for ADIs of the food additives, recommendations on the flavouring agents considered, changes in the status of specifications, and further information requested or desired.

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PMID: 17069402 [PubMed - indexed for MEDLINE]

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Chemical components, palatability, antioxidant activity and antimutagenicity of oncom miso using a mixture of fermented soybeans and okara with Neurospora intermedia.

Matsuo M.

Faculty of Home Science, Gifu Women's University, 80 Taromaru, Gifu 501-2592, Japan. makko3_ishimatsu@yahoo.co.jp

The enzyme activities of Aspergillus oryzae on koji (malted rice) and Neurospora intermedia on S-oncom and O-oncom (fermented soybeans and okara with N. intermedia, respectively) were compared. The major enzymes of N. intermedia were different from those of A. oryzae, and the enzyme activities of O-oncom were extremely higher than those of S-oncom. S5-Miso, S10-miso and S9O1-miso replacing 50% or 100% of steamed soybeans with S-oncom or a 9 : 1 mixture of S-oncom and O-oncom, respectively, were prepared to supplement the enzyme action of koji. The chemical components of those miso were almost the same as those of soybean-miso (C-miso). The miso soups prepared with S5-miso, S10-miso and S9O1-miso were all considered to be more palatable and pleasant-tasting than the soup prepared with C-miso, and their flavor was preferred in the same degree as that of T5-miso using 50% tempeh, the soybeans fermented with Rhizopus oligosporus. Scavenging activities of DPPH and O2- and antimutagenicity of the 70% ethanol extract from those miso were higher than those of hot-water extract, and the activities of S9O1-miso were the highest. The isoflavone-aglycons and brownish color of S9O1-miso were higher than those of C-miso. The higher contents of isoflavone-aglycons and melanoidines of S9O1-miso might contribute to their higher antioxidant activity and antimutagenicity. From these results, S9O1-miso has potential as a healthier alternative to C-miso in terms of taste and health benefits.

Publication Types:
PMID: 16967767 [PubMed - indexed for MEDLINE]

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Aspergillus fumigatus challenge increases cytokine levels in nasal lavage fluid.

Stark H, Roponen M, Purokivi M, Randell J, Tukiainen H, Hirvonen MR.

Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland. harri.stark@kuh.fi

Several studies have shown an association between exposure in moisture-damaged buildings and adverse health effects. There are several indicator microbes of moisture damage, but Aspergillus fumigatus is one of the best-documented molds provoking health problems in different occupational conditions. We assessed whether inhalation of a commercial A. fumigatus solution would affect cytokine levels (tumor necrosis factor [TNF]-alpha, interleukin [IL]-1beta, IL-4, IL-6, interferon [IFN]-gamma) in nasal lavage fluid (NAL) compared with that evoked by placebo challenge. Twenty-seven subjects were studied: 13 had occupational exposure in a moisture-damaged building, 4 were atopic, and 10 were considered as controls. In all the subjects, the IL-1beta levels were increased significantly both at 6 (p = 0.013) and 24 h (p = .005) after the A. fumigatus challenge compared to placebo. In subjects with previous occupational exposure in a moisture-damaged building, IL-4 concentrations were increased significantly both at 6 (p =.046) and 24 h (p =.008) after the A. fumigatus challenge compared with placebo. Furthermore, in the control group, TNF-alpha levels were significantly increased at 6 h after the A. fumigatus challenge compared to placebo (p = .028). Thus, these data show a link between markers of inflammation in NAL and experimental A. fumigatus challenge.

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PMID: 16966303 [PubMed - indexed for MEDLINE]

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Airborne mold and endotoxin concentrations in New Orleans, Louisiana, after flooding, October through November 2005.

Solomon GM, Hjelmroos-Koski M, Rotkin-Ellman M, Hammond SK.

Natural Resources Defense Council, San Francisco, California, USA. gsolomon@nrdc.org

BACKGROUND: The hurricanes and flooding in New Orleans, Louisiana, in October and November 2005 resulted in damp conditions favorable to the dispersion of bioaerosols such as mold spores and endotoxin. OBJECTIVE: Our objective in this study was to assess potential human exposure to bioaerosols in New Orleans after the flooding of the city. METHODS: A team of investigators performed continuous airborne sampling for mold spores and endotoxin outdoors in flooded and nonflooded areas, and inside homes that had undergone various levels of remediation, for periods of 5-24 hr during the 2 months after the flooding. RESULTS: The estimated 24-hr mold concentrations ranged from 21,000 to 102,000 spores/m3 in outdoor air and from 11,000 to 645,000 spores/m3 in indoor air. The mean outdoor spore concentration in flooded areas was roughly double the concentration in nonflooded areas (66,167 vs. 33,179 spores/m3 ; p < 0.05) . The highest concentrations were inside homes. The most common mold species were from the genera of Cladosporium and Aspergillus/Penicillium ; Stachybotrys was detected in some indoor samples. The airborne endotoxin concentrations ranged from 0.6 to 8.3 EU (endotoxin units) /m3 but did not vary with flooded status or between indoor and outdoor environments. CONCLUSIONS: The high concentration of mold measured indoors and outdoors in the New Orleans area is likely to be a significant respiratory hazard that should be monitored over time. Workers and returning residents should use appropriate personal protective equipment and exposure mitigation techniques to prevent respiratory morbidity and long-term health effects.

Publication Types:
PMID: 16966092 [PubMed - indexed for MEDLINE]

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Ochratoxins: a global perspective.

Bayman P, Baker JL.

Depto. de Biolog’a, Universidad de Puerto Rico-R’o Piedras, PO Box 23360, San Juan, PR, 00931, USA. pbayman@upracd.upr.clu.edu

Ochratoxins have been overshadowed by better-known mycotoxins, but they are gaining importance. Here we consider ochratoxins in the context of aflatoxins, which are better understood than ochratoxins on many levels. We review recent work on taxonomic distribution, contamination of commodities, biosynthesis, toxicity and regulatory aspects of ochratoxins. We focus on ochratoxins in coffee, since coffee is becoming a key commodity in ochratoxin research and regulation.

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PMID: 16944288 [PubMed - indexed for MEDLINE]

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Non-specificity of nutritional substrate for ochratoxin A production by isolates of Aspergillus ochraceus.

Pardo E, Sanchis V, Ramos AJ, Mar’n S.

Food Technology Department, University of Lleida, Rovira Roure 191, 25198 Lleida, Spain.

Aspergillus ochraceus is an important contaminant of diverse substrates, such as cereals, coffee, grapes and derivates. This fungus produce a nephrotoxic metabolite, ochratoxin A (OTA), whose presence on food and feeds may be an important risk for animal and human health. The aim of this work was to evaluate the significance of the origin of A. ochraceus isolates on their OTA production patterns on different substrates (yeast extract sucrose (YES) broth, irradiated barley grains, irradiated green coffee beans and sterilized grapes) and under different environmental conditions. Results did not show a significant influence of the isolation source on OTA-production profiles by A. ochraceus isolates on several substrates, since the isolates which produced the highest OTA amounts in vitro (YES medium) were also the isolates with the highest OTA yields on the other substrates. Abiotic factors assayed (water activity, temperature and substrate) affected significantly OTA productions by A. ochraceus. Maximum OTA amounts were detected at 25 degrees C and 0.98 a(w) on all substrates tested. The highest OTA accumulations found on the different substrates were: green coffee beans (> 2 mg g(-1)), barley grains (approximately 1 mg g(-1)), YES medium (13.9 microg ml(-1)) and grape (approximately 3 ng g(-1)).

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PMID: 16943024 [PubMed - indexed for MEDLINE]

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The fungal profile of cotton lint from diverse sources and implications for occupational health.

Lane SR, Sewell RD.

Welsh School of Pharmacy-Pharmacology, Cardiff University, Wales. lanesr@cf.ac.uk

There is mounting evidence that inhalation of fungal spores and their fragments and toxins may cause respiratory illness, particularly in indoor environments and industrial settings. However, analysis of these organisms on cotton has not been carried out in detail and, hence, further examination may prove important in identifying sources of these organisms and assessing the risks posed to cotton workers. This study identified fungi from cotton lint samples originating in 12 world regions and revealed six different fungal genera, with the following rank order of sample isolation incidence: Aspergillus > Cladosporium > Fusarium > Rhizopus > Penicillium > Alternaria. Aspergillus was the most common genus and Aspergillus niger in particular was the pecies most frequently identified. Improved understanding of the variety of organisms that contaminate cotton may help to reduce prevalence of organic dust-related lung diseases.

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PMID: 16941777 [PubMed - indexed for MEDLINE]

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Specific fungal exposures, allergic sensitization, and rhinitis in infants.

Osborne M, Reponen T, Adhikari A, Cho SH, Grinshpun SA, Levin L, Bernstein DI, LeMasters G.

Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA.

Indoor air quality has become increasingly important as we live in a society where the majority of our time is spent indoors. Specific attention has been drawn to airborne fungal spores as a factor affecting indoor air quality. This study targeted shortcomings of other studies by utilizing long-term air sampling and total fungal spore enumeration to determine associations between health outcomes and fungal spore concentrations. Infants (n = 144) were clinically evaluated and had skin prick tests (SPT) for 17 allergens. Airborne fungal spores were collected using a Button Personal Inhalable Sampler (SKC Inc.) for 48 h at a flow rate of 4 l/min. Sampling was conducted in the spring (March-May) or fall (August-October) in 2003-2004. Fungal spores were analyzed using microscopy-based total counting and identified to the genus/group level. Total spore and individual genus concentrations were analyzed for associations with rhinitis and positive SPT results. Overall, concentrations varied widely, between <2 and 2294 spores/m(3). While no relationship was observed between SPT(+) and total fungal counts, several significant associations were found when analysis was conducted on the various fungal genera and health outcomes. Positive associations were obtained between: Basidiospores and rhinitis (p < 0.01), Penicillium/Aspergillus and SPT(+) to any allergen (p < 0.01), and Alternaria and SPT(+) to any allergen (p < 0.01). Inverse associations were found between: Cladosporium and SPT(+) to any allergen (p < 0.05), and Cladosporium and SPT(+) to aeroallergens (p < 0.05). This study indicates that health outcome may vary by fungal genera; some fungal types may have sensitizing effects while others may have a beneficial role.

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PMID: 16925691 [PubMed - indexed for MEDLINE]

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[Micotoxins in public health]

[Article in Spanish]

Duarte-Vogel S, Villamil-JimŽnez LC.

Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional de Colombia. smduartev@unal.edu.co

Mycotoxins have become a worldwide problem due to their high incidence and levels of occurrence in human food and animal feed. The conditions for colonising substrates by mycotoxigenic fungus and later contamination by mycotoxins play an important role in surveillance and control strategies. The main mycotoxigenic funguses are the Aspergillus spp., Penicillium spp. and Fusarium spp genera, the main mycotoxins of interest for human health being aflatoxins, trichothecenes, ochratoxin A, fumonisins and zearalenone. These mycotoxins' toxic action mechanisms constitute a risk for both human and animal health, causing diseases in both populations. The situation in Colombia is complex due to the lack of research having been carried out; the few studies made to date have demonstrated the high levels of contamination of food and feed in the country. This paper discusses mycotoxins' potential risk to public health, the difficulties involved in diagnosis and legislation and suggests policy implications for food safety.

Publication Types:
PMID: 16925127 [PubMed - indexed for MEDLINE]

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Endobronchial fungal disease: an under-recognized entity.

Karnak D, Avery RK, Gildea TR, Sahoo D, Mehta AC.

Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey, and Department of Chest Medicine, KEM Hospital, Mumbai, India.

Most fungi enter the human body via inhalation; however, endobronchial fungal infection (EBFI) seems to be a rare manifestation compared to pulmonary or systemic disease. This presentation seems to be related to environmental factors as well as to the host status. With the increasing popularity of flexible bronchoscopy, it is being recognized with a higher frequency. Bronchoscopic findings in EBFI vary from mild mucosal inflammation to central airway obstruction. We searched English literature related to the topic and found 228 total cases of EBFI: Aspergillus species (121), Coccidioides immitis (38), Zygomycetes (31), Candida species (14) Cryptococcus neoformans (13), and Histoplasma capsulatum (11). We have also included a single case of endobronchial Pseudallescheria boydii infection in a lung transplant recipient that has not been reported previously. Most patients were immunocompromised, exhibited systemic manifestations of the primary infection, and responded to appropriate therapy. EBFI should be included in the differential diagnosis of any form of airway lesions in immunocompromised patients, especially among residents from the endemic areas. Copyright (c) 2007 S. Karger AG, Basel.

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PMID: 16864987 [PubMed - indexed for MEDLINE]

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The effect of storage time and agroecological zone on mould incidence and aflatoxin contamination of maize from traders in Uganda.

Kaaya AN, Kyamuhangire W.

Department of Food Science and Technology, Makerere University, P.O. Box 7062, Kampala, Uganda. ankaya@agric.mak.ac.ug

A study to determine mould incidence and aflatoxin contamination of maize kernels was carried out among dealers (traders) in the three agroecological zones of Uganda. The maize kernels were categorized into those stored for two to six months or for more than six months to one year. Results indicate that the mean moisture content of the kernels was within the recommended safe storage levels of < or =15% but was significantly lower in the Highland maize kernels followed by the Mid-Altitude (dry) kernels while the Mid-Altitude (moist) kernels had the highest levels. Across the agroecological zones, Aspergillus, Fusarium, Penicillium and Rhizopus were the most predominant fungal genera identified and, among their species, A. niger had the highest incidence, followed by A. flavus, F. verticillioides, A. wentii, A. penicillioides and Rhizopus stolonifer. There were more aflatoxin positive samples from the Mid-Altitude (moist) zone (88%) followed by those samples from the Mid-Altitude (dry) zone (78%) while samples from the Highland zone (69%) were least contaminated. Aflatoxin levels increased with storage time such that maize samples from the Mid-Altitude (dry and moist) stored for more than six months had mean levels greater than the 20 ppb FDA/WHO regulatory limits. Aflatoxin B1 was the most predominant type and was found to contaminate maize kernels from all the three agroecological zones. These results indicate that maize consumers in Uganda are exposed to the danger of aflatoxin poisoning. Thus, there is the need for policy makers to establish and enforce maize quality standards and regulations related to moulds and aflatoxins across the agroecological zones to minimize health hazards related to consumption of contaminated kernels.

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PMID: 16822572 [PubMed - indexed for MEDLINE]

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Potential compromise of hospital hygiene by clinical waste carts.

Blenkharn JI.

18 South Road, Ealing, London W5 4RY, UK. blenkharn@ianblenkharn.com

Bulk waste storage carts are common in hospitals and undoubtedly assist in the day-to-day management of clinical wastes. They are used for the transport and interim storage of primary clinical waste containers and are often located close to or within hospital buildings to receive such wastes from clinical departments. Examination of a random selection of bulk clinical waste carts at nine acute hospitals across Greater London revealed external soiling in all of 23 carts. Eight of 13 carts were also soiled on the inner surfaces, with evidence of bloodstains and free fluids in the base of five carts. Staphylococcus aureus and enterococci were recovered in low numbers from the lids (N=7) and wheels (N=10) of carts and Escherichia coli, Enterobacter spp. and Pseudomonas aeruginosa were recovered from the wheels of a further five carts. Two carts were heavily contaminated with Aspergillus spp. Pathogens originating from clinical wastes may be transferred from contaminated bulk waste carts to the wider hospital environment. It may be advisable to keep bulk carts outside clinical areas, and preferably outside all hospital buildings. This becomes particularly important in circumstances where carts supplied by contractors are not dedicated to a single hospital or National Health Service trust.

Publication Types:
PMID: 16759738 [PubMed - indexed for MEDLINE]

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Preliminary data on the presence of mycotoxins (ochratoxin A, citrinin and aflatoxin B1) in black table olives "Greek style" of Moroccan origin.

El Adlouni C, Tozlovanu M, Naman F, Faid M, Pfohl-Leszkowicz A.

UniversitŽ Chouaib Doukkali, FacultŽ des Sciences, Lab Biologie & Biotechnologie VŽgŽtales, El Jadida, Morocco. chakib_eladlouni@yahoo.fr

Many mould strains, in particular Aspergillus and/or Penicillium, are able to develop on olive and produce ochratoxin A (OTA) and/or citrinin (CIT) and/or aflatoxin B (AFB) after harvest, during drying and storage of olives. The development of fungi on olives is responsible for the reduction of nutritional quality of olive because they can disturb the synthesis of the fatty acids. OTA, CIT and AFB are particularly dangerous for health, inducing cancer of urinary tracts or liver carcinoma. In this study, ten olive samples bought at retailer and at supermarket in Morocco were analyzed for their OTA, CIT and AFB contents. These three mycotoxins were extracted simultaneously by a method based on solvent partition validated in-house, then separated by HPLC coupled to a fluorescence detector. All olive samples contain OTA ranging from LOQ to 1.02 microg/kg. Respectively, 50 and 25% from retailer and supermarket samples were contaminated by more than 0.65 microg/kg. In addition, 80% of olive samples contained CIT above LOD, and 100% of olive tested contained AFB above 0.5 microg/kg. As simultaneous presence of these toxins increases toxic risks, it is thus essential to have a good control of the conservation of olives after harvest.

Publication Types:
PMID: 16688704 [PubMed - indexed for MEDLINE]

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Monitoring the mycotoxins in food and their biomarkers in the Czech Republic.

Malir F, Ostry V, Grosse Y, Roubal T, Skarkova J, Ruprich J.

Department of Xenobiochemistry, Institute of Public Health Hradec Kralove, National Reference Laboratory for Biomarkers of Mycotoxins and Mycotoxins in Food, The Czech Republic. xeno@zulahk.cz

Testing of the presence of toxigenic microfungi and mycotoxins in foodstuffs in the food chain is an important part of the food safety strategy in The Czech Republic. At the national level, control of their presence in the entire food chain is assured by Public Health Protection Agencies, by the Veterinary Administration and by the Czech Agriculture and Food Inspection Authority. This article summarizes surveillance activities of Public Health Protection Agencies and mycotoxins findings in dietary raw materials and foodstuffs from the 1990s to 2004 in the Czech Republic. At present, the health risk from the mycotoxins exposure from foodstuffs is assessed to be relatively low in the Czech Republic, especially as far as the foodstuffs of the Czech origin are concerned. It may result in late toxic effects (e. g., carcinogenic risk) following a single or repeated ingestion of low mycotoxins doses from foodstuffs. Nevertheless, the overall situation may change due to the globalization of the food market. In order to minimize the risk associated with mycotoxins and eliminate their impact on Czech public health, continuous monitoring of the presence of toxigenic moulds, mycotoxins, and their biomarkers is necessary, in conjunction with strict respect to European Union legislation.

PMID: 16676375 [PubMed - indexed for MEDLINE]

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Impact of gutkha chewing & smoking on microbial environment of oral cavity: a case study on slum dwellers of selected areas in Visakhapatnam.

Avasn Maruthit Y, Rao RS, Palivela H, Thakre S.

Department of Environmental Studies, College of Engineering, GITAM, Rishi konda, Visakhapaynam, Andhra Pradesh. a_yallamraju@yahoo.com

Oral diseases are still a neglected epidemic. During the recent years, in India, both in urban and rual, consumption of tobacco in the form of direct chewing of gutkha is alarmingly increasing especially in the young adults as which is major reason for subsistence of oral cancer. In the present investigation an attempt was made to find out the relationship between gutkha chewing including smoking and oral micro flora in some slum dwellers of Visakhapatnam. The subjects were randomly selected and their health data was collected by distributing questionnaire to control and effected subjects. The oral saliva samples were collected from both gutkha chewers, smokers and from control groups by using saline swabs and inoculated on suitable nutrient media. The results revealed that decrease in salivation and mucous formation in gutkha chewers, which further resulted in reduction in number of oral micro flora. Aspergillus species appeared only in gutkha chewers and smokers. Gutkha chewing and smoking thus, may lead to an increase in the oral pathogens by reducing the normal symbiotic microbial flora.

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PMID: 16649624 [PubMed - indexed for MEDLINE]

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Ochratoxin A in human blood in Abidjan, C™te d'Ivoire.

Sangare-Tigori B, Moukha S, Kouadio JH, Dano DS, Betbeder AM, Achour A, Creppy EE.

Department of Toxicology, University of Bordeaux 2, 146, rue LŽo-Saignat, 33076 Bordeaux, France.

Ochratoxin A (OTA) produced by Aspergillus and Penicillium genera contaminates a diversity of foods including cereals; cereals-derived foods; dry fruits; beans; cocoa; coffee; beer; wine; and foodstuffs of animal origin mainly poultry, eggs, pork and milk, including human breast milk. OTA is nephrotoxic to all animal species studied so far and most likely to humans, who show the longest half-life for elimination of this toxin among all species examined. Among other toxic effects, OTA is teratogenic, immunotoxic, genotoxic, mutagenic and carcinogenic, all of which lead to life-threatening pathologies through several molecular pathways. In C™te d'Ivoire, preliminary surveys conducted by us have proven from 1998 to 2004 the reality of ochratoxin A-contamination of foodstuffs. To assess OTA in human blood, the immunoaffinity columns were used along with HPLC for separation and fluorimetric quantification of blood samples collected in Abidjan from two categories of people: apparently healthy donors (n=63) and nephropathy patients undergoing dialysis (n=39). Among healthy donors, 34.9% show OTA concentrations ranging from 0.01 - 5.81 microg/l with a mean value of 0.83 microg/l, whereas, among nephropathy patients undergoing dialysis 20.5% are OTA positive in a range of 0.167-2.42 microg/l and a mean value of 1.05. Although the sex ratio is 0.82 (46 females for 56 males) ochratoxin A contamination is equally distributed in both sexes. Nephropathy patients undergoing dialysis appear, however, less frequently contaminated than healthy donors (20.5 versus 34.9%) and show higher OTA concentrations (higher mean value, p=0.01). Ochratoxin A concentrations found in human blood reflect concentrations previously detected in cereals and peanuts according to the eating habits and diets of people in C™te d'Ivoire. But, the prevalence of ochratoxin A in blood of nephropathy people undergoing dialysis appears lower than expected from the frequency of OTA contamination in cereals and peanuts. Pearson chi(2)-test indicates that among OTA-positive individuals renal dialysis and age are important modalities for consideration.

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PMID: 16626769 [PubMed - indexed for MEDLINE]

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Ochratoxin a: its cancer risk and potential for exposure.

Clark HA, Snedeker SM.

Program on Breast Cancer and Environmental Risk Factors (BCERF), Sprecher Institute for Comparative Cancer Research, College of Veterinary Medicine, Cornell University, Ithaca, New York 14853-6401, USA. hac4@cornell.edu

Ochratoxin A (OA) is a naturally occurring mycotoxin known to contaminate a variety of foods and beverages. The cancer risk posed by OA was reviewed as relevant to human exposure, regulatory activities, and risk management efforts occurring worldwide, particularly in Europe. OA moves through the food chain and has been found in the tissues and organs of animals, including human blood and breast milk. Results from the National Toxicology Program's rodent bioassays show significantly increased incidence of mammary gland tumors in female rats and kidney tumors in male and female rats given OA orally. Liver tumors in female mice fed OA in the diet have also been observed. In humans, OA exposure has been most often associated with the kidney disease Balkan endemic nephropathy (BEN), symptoms of which include tumors of the kidney and urinary tract. No epidemiological studies have yet adequately evaluated the cancer risk of OA in human populations. Studies have shown OA to be genotoxic as well as immunotoxic, although its mode of action is not fully understood. Organizations and agencies in many countries are currently promulgating standards for OA in foods and beverages. Increased efforts in farm management and food safety are being made to mitigate the risks to public health posed by OA. The U.S. Food and Drug Administration (FDA) is currently evaluating data on OA levels in domestic and imported commodities but has not established official regulations or guidelines for OA in the U.S. food supply.

Publication Types:
PMID: 16621780 [PubMed - indexed for MEDLINE]

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Mycological profile of infectious Keratitis from Delhi.

Saha R, Das S.

Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India. rumpachatterjee@yahoo.co.in

BACKGROUND & OBJECTIVE: Corneal blindness is a major health problem worldwide and infectious keratitis is one of the predominant causes. The incidence of fungal keratitis has increased over the last few years. Though a few studies have been carried out on mycotic keratitis from north and other parts of India, there are none from Delhi. Keeping this in mind, this study was conducted to evaluate the frequency of positive fungal cultures in infectious keratitis and of the various fungal species identified as aetiologic agents in patients attending a tertiary care hospital in East Delhi. METHODS: Corneal scrapings from 346 patients of corneal ulcer with suspected fungal aetiology were subjected to direct examination by 10 per cent KOH mount, Gram stain and culture. The results were examined retrospectively and analyzed. RESULTS: Of the 346 patients of corneal ulcer investigated, in 77 (22.25%) cases fungal aetiology was identified. Males were more commonly affected and were mostly in the age group of 31-40 yr. It was seen that trauma was the most common predisposing factor especially in the agriculturists and the farmers. Aspergillus flavus was the most common fungus isolated in 31.16 per cent cases, followed by A. fumigatus (16.88%) and Fusarium spp. (7.79%). Yeasts were also isolated in 21.62 per cent cases. Both yeasts and mycelial fungi were isolated in 6.5 per cent of cases. INTERPRETATION & CONCLUSION: Because of serious consequences of infectious keratitis, it is important to know the exact aetiology of corneal ulcer to institute appropriate therapy in time. Laboratory confirmation should be undertaken and fungal infection should be ruled out before prescribing corticosteroids and antibacterial antibiotics.

PMID: 16575115 [PubMed - indexed for MEDLINE]

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Genomics of Aspergillus fumigatus.

Ronning CM, Fedorova ND, Bowyer P, Coulson R, Goldman G, Kim HS, Turner G, Wortman JR, Yu J, Anderson MJ, Denning DW, Nierman WC.

The Institute for Genomic Research, 9712 Medical Center Drive, Rockville, MD 20850, USA. cronning@tigr.org

Aspergillus fumigatus is a filamentous fungal saprophyte that is ubiquitous in the environment. It is also a human pathogen and induces allergenic response, negatively impacting health care and associated costs significantly around the world. Much of the basic biology of this organism is only poorly understood, but the recent completion and publication of its genome sequence provides an excellent tool for researchers to gain insight into these processes. In this review we will summarize some of the more salient features revealed by analysis of the genome, including the search for candidate pathogenicity genes and the switch to a pathogenic lifestyle, allergen proteins, DNA repair, secondary metabolite gene clusters that produce compounds both useful and toxic, a theoretical capability of this asexual organism to reproduce sexually, signalling, and transcription. A. fumigatus was compared with the food biotechnology fungus Aspergillus oryzae and sexual fungus Aspergillus nidulans, as well as other fungi, in an attempt to discern key differences between these organisms.

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PMID: 16499415 [PubMed - indexed for MEDLINE]

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Aspergillus flavus genomics: gateway to human and animal health, food safety, and crop resistance to diseases.

Yu J, Cleveland TE, Nierman WC, Bennett JW.

USDA/ARS, Southern Regional Research Center, 1100 Robert E. Lee Boulevard, New Orleans, LA 70124, USA. jiuyu@srrc.ars.usda.gov

Aspergillus flavus is an imperfect filamentous fungus that is an opportunistic pathogen causing invasive and non-invasive aspergillosis in humans, animals, and insects. It also causes allergic reactions in humans. A. flavus infects agricultural crops and stored grains and produces the most toxic and potent carcinogic metabolites such as aflatoxins and other mycotoxins. Breakthroughs in A. flavus genomics may lead to improvement in human health, food safety, and agricultural economy. The availability of A. flavus genomic data marks a new era in research for fungal biology, medical mycology, agricultural ecology, pathogenicity, mycotoxin biosynthesis, and evolution. The availability of whole genome microarrays has equipped scientists with a new powerful tool for studying gene expression under specific conditions. They can be used to identify genes responsible for mycotoxin biosynthesis and for fungal infection in humans, animals and plants. A. flavus genomics is expected to advance the development of therapeutic drugs and to provide information for devising strategies in controlling diseases of humans and other animals. Further, it will provide vital clues for engineering commercial crops resistant to fungal infection by incorporating antifungal genes that may prevent aflatoxin contamination of agricultural harvest.

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PMID: 16499411 [PubMed - indexed for MEDLINE]

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Survey and significance of filamentous fungi from tap water.

Gonalves AB, Paterson RR, Lima N.

Centro de Engenharia Biol—gica, Micoteca da Universidade do Minho, Campus de Gualtar, 4710-057 Braga, Portugal.

Fungi in drinking water are involved in the production of tastes and odours in water. Health problems are possible, originating from mycotoxins, animal pathogens and allergies. This report concerns the surveillance of mesophilic fungi in tap water and assessment of their potential for causing problems. The methods for the determination of the filamentous fungi (ff) were filtering, swabbing and baiting. Tap water, half-strength corn meal, neopeptone-glucose rose Bengal aureomycin (NGRBA) and oomycete selective agars for the enumeration of colony forming units (cfu) were used. Samples were taken consecutively over 16 months. Filtration and NGRBA gave the highest ff counts. A total of 340 taxa were isolated. There appeared to be a negative correlation between bacterial and yeast (b/y) and ff counts. Highest counts were found in winter months for ff and in the warmer months for b/y. Penicillium (40.6%) and Acremonium (38.8%) were the most frequently isolated ff. There was a difference in the pattern of isolation of the key taxa with season: penicillia predominated in early summer and Acremonium in winter. P. expansum was isolated in high numbers in May 2004. This species is associated with the production of the mycotoxin patulin and the odour secondary metabolite geosmin. P. brevicompactum was detected throughout the sampling period and is known to produce the immunosuppressive drug mycophenolic acid. Acremonium is associated with ocentol production which is responsible for bad tastes and flavours. The remaining taxa were Phialophora sp. (4.1%), Cladosporium sp. (3.5%), Rhizopus stolonifer (2.9%), Chaetomium sp. (0.6%), Alternaria sp. (0.3%), Aspergillus sp. (0.3%), mycelia sterilia (2.6%) and unidentified (6.2%). It is emphasised that few Aspergillus and no Fusarium strains were isolated. Rhizopus stolonifer was obtained. However, none of the fungi isolated at mesophilic temperature used could be described as being involved with pathogenicity per se.

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PMID: 16459143 [PubMed - indexed for MEDLINE]

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Mechanical transmission of pathogenic organisms: the role of cockroaches.

Tatfeng YM, Usuanlele MU, Orukpe A, Digban AK, Okodua M, Oviasogie F, Turay AA.

Lahor Public Health and Research Centre, Benin City, Edo State, Nigeria. youtchou@yahoo.com

BACKGROUND & OBJECTIVES: Cockroaches (Diploptera punctata) are basically tropical insects and will do their best to find a home that is both warm and moist. Their involvement in the transmission of tropical diseases is poorly investigated in Africa. METHODS: A study on the bacterial, fungal and parasitic profile of cockroaches trapped in and around houses in Ekpoma was carried out using standard microbiological techniques. RESULTS: Of a total of 234 cockroaches trapped from different sites (toilets, parlours, kitchens and bedrooms) in houses with pit latrines and water system, the bacterial, fungal and parasitic isolates were identical irrespective of the site, these included: E. coli, Klebsiella pneumoniae, Proteus vulgaris, Proteus mirabilis, Citrobacter freundii, Enterobacter cloacae, Salmonella sp, Pseudomonas aeruginosa, Serretia marcescens, S. aureus, S. feacalis, S. epidermidis, Aeromonas sp, Candida sp, Rhizopus sp, Aspergillus sp, Mucor sp, cysts of E. hystolitica, oocysts of C. parvum, C. cayetenensis and Isospora belli, cysts of Balantidium coli, ova of Ascaris lumbricoides, Anchylostoma deodunalae, Enterobius vermicularis, ova Trichuris trichura, larva of Strongyloides stercoralis. Cockroaches trapped in the toilets of houses with pit latrines had a mean bacterial and parasites count of 12.3 x 10(10) org/ml and 98 parasites/ml respectively, while those trapped in the houses with water system had a mean bacterial and parasitic count of 89.5 x 10(7) org/ml and 31 parasites/ml respectively. A bacterial count of 78.9 x 10(7) org/ml was recorded from cockroaches trapped from the kitchens of houses with pit latrines. On the other hand a mean bacterial and parasitic count of 23.7 x 10(6) org/ml and 19 parasites/ml were recorded from kitchens of houses with water system. INTERPRETATION & CONCLUSION: Cockroaches represent an important reservoir for infectious pathogens, therefore, control of cockroaches will substantially minimise the spread of infectious diseases in our environment.

PMID: 16457381 [PubMed - indexed for MEDLINE]

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Erratum in:
  • Pol J Microbiol. 2005;54(4):following table of contents.

Exposure to moulds in flats and the prevalence of allergic diseases--preliminary study.

Gutarowska B, Wiszniewska M, Walusiak J, Piotrowska M, Pa¸czyÄski C, Zakowska Z.

Technical University of L—d, Institute of Fermentation Technology and Microbiology, Poland. gustaw@p.lodz.pl

The presented study concerned mycological analysis of buildings in L—d and evaluation of the role between filamentous fungi contaminated flats and inhabitants health (allergic airway diseases). 49 inhabitants of 20 flats with signs of moulds contamination were examined. Air samples were collected in houses and outdoors. In all inhabitants skin prick tests (SPT) to common allergens and to standardized particular fungal extracts were performed. Moreover, total and serum specific IgE to moulds, rest spirometry were measured in all subjects. Level of moulds contamination in the air of flats was high and in 75% cases exceed accepted limits. The most frequent species isolated from examined rooms were: Penicillium, Cladosporium, Aspergillus, Acremoniu and Alternaria. The most frequent symptoms reported by examined subjects were rhinitis (N = 29, 59.2%), conjunctivitis (N = 29, 59.2%), chronic cough (N = 24, 49%), dyspnea (N = 15, 30.6%) and skin symptoms (N = 24, 49%). Elevated IgE level was found in 12 subjects (24.5%) and in three patients (6.1%) mould specific serum IgE were detected. Nineteen out of all subjects (38.8%) had positive SPT to common allergens (house dust mites, grass and tree pollens). Eight out of these patients (16.3% of the group) were sensitized to moulds (Candida albicans, Alternaria alternata, Botrytis cinerea, Trichophyton mentagrophytes, Helminthosporium halodes, Aspergillus). In all cases sensitisation to moulds was accompanied by allergy to other common allergens. No isolated hypersensitivity to moulds was found. Although the frequency of self-reported symptoms was high, the prevalence of atopy and allergic diseases seems to be similar to that found in general population, but that statement must be confirmed by comparison of the control group.

PMID: 16457375 [PubMed - indexed for MEDLINE]

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Comparison of the aflR gene sequences of strains in Aspergillus section Flavi.

Lee CZ, Liou GY, Yuan GF.

Bioresource Collection and Research Center, Food Industry Research and Development Institute, PO Box 246, Hsinchu 300, Taiwan, ROC.

Aflatoxins are polyketide-derived secondary metabolites produced by Aspergillus parasiticus, Aspergillus flavus, Aspergillus nomius and a few other species. The toxic effects of aflatoxins have adverse consequences for human health and agricultural economics. The aflR gene, a regulatory gene for aflatoxin biosynthesis, encodes a protein containing a zinc-finger DNA-binding motif. Although Aspergillus oryzae and Aspergillus sojae, which are used in fermented foods and in ingredient manufacture, have no record of producing aflatoxin, they have been shown to possess an aflR gene. This study examined 34 strains of Aspergillus section Flavi. The aflR gene of 23 of these strains was successfully amplified and sequenced. No aflR PCR products were found in five A. sojae strains or six strains of A. oryzae. These PCR results suggested that the aflR gene is absent or significantly different in some A. sojae and A. oryzae strains. The sequenced aflR genes from the 23 positive strains had greater than 96.6 % similarity, which was particularly conserved in the zinc-finger DNA-binding domain. The aflR gene of A. sojae has two obvious characteristics: an extra CTCATG sequence fragment and a C to T transition that causes premature termination of AFLR protein synthesis. Differences between A. parasiticus/A. sojae and A. flavus/A. oryzae aflR genes were also identified. Some strains of A. flavus as well as A. flavus var. viridis, A. oryzae var. viridis and A. oryzae var. effuses have an A. oryzae-type aflR gene. For all strains with the A. oryzae-type aflR gene, there was no evidence of aflatoxin production. It is suggested that for safety reasons, the aflR gene could be examined to assess possible aflatoxin production by Aspergillus section Flavi strains.

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PMID: 16385126 [PubMed - indexed for MEDLINE]

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The effects of Aspergillus fumigatus challenge on exhaled and nasal NO levels.

Stark HJ, Randell JT, Hirvonen MR, Purokivi MK, Roponen MH, Tukiainen HO.

Dept of Respiratory Medicine, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland. harri.stark@kuh.fi

Several studies have previously shown that exposure to indoor air microbes from moisture-damaged buildings can cause adverse health effects. Aspergillus fumigatus is one of the best-documented moulds causing health problems to those exposed. In this study, inhalation of a commercial A. fumigatus solution was assessed, to establish if it would have effects on fractional exhaled (FeNO) and nasal (FnNO) nitric oxide levels and on lung function. The results were compared with placebo challenge. A total of 28 subjects were divided into three study groups: group 1 had been exposed to occupational mould; group 2 consisted of atopic subjects; and group 3 was a control group. Some 3 h after A. fumigatus challenge, there was a considerable increase in FeNO, and a significant difference was observed between the A. fumigatus and placebo inhalations. The difference was seen in all study groups. No such differences were found in the levels of FnNO or nitrite in nasal lavage fluid. Subjects reported significantly more frequent respiratory tract symptoms after the A. fumigatus inhalation compared with placebo challenge. In conclusion, it was shown here that inhalation challenge of Aspergillus fumigatus elevated fractional exhaled nitric oxide levels. An increase in fractional exhaled nitric oxide may serve as an indicator of respiratory inflammation of acute mould exposure.

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PMID: 16264051 [PubMed - indexed for MEDLINE]

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Detection of fungi spectrum in industrial and home bakeries and determinated fungal allergy with skin prick test.

Orman A, Fiici SE, Ay A, Ellidokuz H, Sivaci RG, Konuk M.

Department of Pulmonary Diseases, the School of Medicine, Afyon Kocatepe University, Afyon-03200, Turkey. avseorman@aku.edu.tr

Airborne fungal pathogens such as Penicillium, Aspergillus, Cladosporium, Trichophyton, and Alternaria may cause health problems. In this research, the fungal flora at different bakeries and their potential allergenic effects on the workers were investigated. We investigated 148 workers at 17 industrial type bakeries and 62 workers at 17 home type bakeries in Afyon. Our study was performed in two different seasons and climates, between January 2004 and June 2004. Fungal flora was detected by using Petri-dish method. In the winter, Penicillium was the dominant genus, while Cladosporium was the dominant genus during the summer, in both types of bakeries. The allergenic properties of dominant culturable fungi on workers involved in the bakeries were determined with the skin-prick test. It was found that with workers in the industrial type bakeries, the most common skin test positivity was caused by Penicillium. In the other hand, the skin test positivity, performed on workers in the home type bakeries, was equally caused by Penicillium, Trichophyton and Aspergillus.

PMID: 16252836 [PubMed - indexed for MEDLINE]

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Culturable airborne fungi in outdoor environments in Beijing, China.

Fang Z, Ouyang Z, Hu L, Wang X, Zheng H, Lin X.

Key Lab of Systems Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, P.O. Box 2871, Beijing, 100085, ROC.

Airborne fungi are being proposed as a cause of adverse health effects. They may adversely affect human health through allergy, infection, and toxicity. Moreover, they have a great influence on urban air quality in Beijing. In this study, a systematical survey on the culturable airborne fungi was carried out for 1 year in Beijing urban area. Fungal samples were collected for 3 min, three times each day, and continued for three consecutive days of each month with FA-1 sampler from three sampling sites. Results showed that the culturable fungal concentrations ranged from 24 CFU (Colony forming units) /m3 to 13960 CFU/m3, and the mean and median was 1165 CFU/m3 and 710 CFU/m3, respectively. Fungal concentrations in the greener area around the Research Center for Eco-Environmental Sciences (RCEES) and Beijing Botanical Garden (BBG) were significantly higher than in the densely urban and highly trafficked area of Xizhimen (XZM) (***P<0.001), but no significant difference was found between RCEES and BBG (P>0.05). The variation of fungal concentrations in different seasons was significant in RCEES and BBG, where the concentrations were higher in Summer and Autumn, and lower in Spring and Winter. However, there were no significant differences in fungal concentrations between the Spring and the Winter for three sampling sites (P>0.05). Fourteen genera, including 40 species of culturable fungi, were identified in this study. Penicillium, with the most abundant species, which comprised more than 50% of the total isolated fungal species. Cladosporium were the most dominant fungal group, and contributed to more than one third of the total fungal concentration, followed by non-sporing isolates, Alternaria, Pencillium and Asperigillus. The concentration percentage of Cladosporium was significantly higher in RCEES than in XZM (*P<0.05), and the concentration percentages of Penicillium (**P<0.01) and Aspergillus (*P<0.05) were higher in XZM than in RCEES and in BBG. For other groups' concentration percentages, no significant differences were observed among the sampling sites. The distribution pattern of airborne fungi presented log-normal distribution. The highest proportion of culturable fungi was detected in stage 4 (2.0-3.5 microm), and the lowest was in stage 6 (<1.0 microm).

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PMID: 16227072 [PubMed - indexed for MEDLINE]

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Identification and characterization of phospholipase D and its association with drought susceptibilities in peanut (Arachis hypogaea).

Guo BZ, Xu G, Cao YG, Holbrook CC, Lynch RE.

USDA-ARS, Crop Protection and Management Research Unit, Tifton, GA 31793, USA. bguo@tifton.usda.gov

Preharvest aflatoxin contamination has been identified by the peanut industry as a serious issue in food safety and human health because of the carcinogenic toxicity. Drought stress is the most important environmental factor exacerbating Aspergillus infection and aflatoxin contamination in peanut. The development of drought-tolerant peanut cultivars could reduce aflatoxin contamination and would represent a major advance in the peanut industry. In this study, we identified a novel PLD gene in peanut (Arachis hypogaea), encoding a putative phospholipase D (PLD, EC 3.1.4.4). The completed cDNA sequence was obtained by using the consensus-degenerated hybrid oligonucleotide primer strategy. The deduced amino acid sequence shows high identity with known PLDs, and has similar conserved domains. The PLD gene expression under drought stress has been studied using four peanut lines: Tifton 8 and A13 (both drought tolerant) and Georgia Green (moderate) and PI 196754 (drought sensitive). Northern analysis showed that PLD gene expression was induced faster by drought stress in the drought-sensitive lines than the drought tolerance lines. Southern analysis showed that cultivated peanut has multiple copies (3 to 5 copies) of the PLD gene. These results suggest that peanut PLD may be involved in drought sensitivity and tolerance responses. Peanut PLD gene expression may be useful as a tool in germplasm screening for drought tolerance.

Publication Types:
PMID: 16200410 [PubMed - indexed for MEDLINE]

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Aflatoxin levels in maize and maize products during the 2004 food poisoning outbreak in Eastern Province of Kenya.

Muture BN, Ogana G.

National Public Health Laboratory Services, P.O. Box 20750, Nairobi, Kenya.

BACKGROUND: On 10th May, 2004 food samples suspected to have caused acute poisoning in Makueni district were received at the National Public Health Laboratory Services (NPHLS). On analysis, they were found to be highly contaminated with aflatoxin B1. More cases of poisoning were reported in the district and in neighbouring districts of Kitui, Machakos and Thika. As at 20th July, 2004 the Ministry of Health was aware of 317 cases of which 125 resulted in deaths. OBJECTIVE: To assess the magnitude of aflatoxin contamination of maize and maize products in the affected areas. DESIGN: Random environmental sampling of maize and maize products and case/control samples of the same in the affected regions and subsequent determination of aflatoxin levels using immunoaffinity coupled with solution fluorometry. SETTING: National Public Health Laboratory Services, Ministry of Health, Kenya, from May to August, 2004. SUBJECTS: A total of 480 samples comprising 362 random environmental samples, 26 cases and 92 controls were collected and analysed. The foods analysed included maize grains, maize flour and dehulled dry maize, traditionally known as muthokoi. RESULTS: Forty six point four per cent of the environmental samples, 15% of cases and 29.3% of controls were within the maximum permissible limit of 20 microg implying that over 50% (54.4) of the total did not comply and would be regarded as unfit for human consumption. 6.9% of the environmental samples, 57.7% of cases and 21.7 of controls had levels beyond 1000 microg/Kg. The amount of aflatoxin observed in the food samples had a range of 0-58,000 microg/Kg. CONCLUSION: The population in the affected region was exposed to high levels of aflatoxin. There is need to address the issue of pre and post harvest handling of grain and establishing monitoring and surveillance for early detection and intervention.

PMID: 16175776 [PubMed - indexed for MEDLINE]

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Aflatoxicosis: health implications.

Mwanda OW.

Publication Types:
PMID: 16175775 [PubMed - indexed for MEDLINE]

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Acute idiopathic pulmonary haemorrhage in infancy: case report and review of the literature.

Habiba A.

Wanganui Hospital, Wanganui, New Zealand. aahhabiba@netscape.net

This report presents the case of a 4-month-old male infant with recurrent bouts of haemoptysis for which no cause could be detected after extensive investigation. Literature reports of this condition from other geographic locations around the world are reviewed, together with epidemiologic studies attempting to provide a link with certain environmental exposures, toxic and infectious. A diagnostic entity of acute idiopathic pulmonary haemorrhage in infancy has recently been proposed. To my knowledge, this is the first case reported from New Zealand. Although the incidence of such reported cases appears to be rare, they constitute an interesting public health problem, particularly because some of the risk factors appear to overlap with risk factors for sudden infant death. They can therefore trigger an investigation into the home and outdoor environments, and may provide valuable insights into a possible underlying genetic factor and potentially harmful exposures in the modern urban or rural settings.

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PMID: 16150076 [PubMed - indexed for MEDLINE]

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Overview of personal occupational exposure levels to inhalable dust, endotoxin, beta(1-->3)-glucan and fungal extracellular polysaccharides in the waste management chain.

Wouters IM, Spaan S, Douwes J, Doekes G, Heederik D.

Division of Environmental and Occupational Health, Institute for Risk Assessment Sciences (IRAS), Utrecht University, The Netherlands. I.Wouters@iras.uu.nl

INTRODUCTION: In the past decade, we studied occupational bioaerosol exposures in various sites of the waste management chain. In this paper we present an overview of exposure levels of inhalable dust, endotoxin, beta(1-->3)-glucan (known or probable inducers of airways inflammation), and extracellular polysaccharide antigens of Aspergillus and Penicillium species (EPS-Pen/Asp; a common and probably more specific marker of fungal exposure). METHODS: Over 450 personal bioaerosol samples were taken. Mixed regression analyses were performed to estimate exposure determinants, between- and within-worker variance of exposure, and determinants of these variances. Furthermore, we explored whether the type of waste affected the bioaerosol composition of the dust. RESULTS: Endotoxin and glucan exposure levels were relatively low and comparable for waste collection and transferral, green waste composting and use of biomass in power plants. Exposure levels were 5-20 times higher in domestic waste transferral with sorting, and composting of both domestic and domestic and green waste ( approximately 300-1000 EU m(-3) for endotoxin, and 5-10 mug m(-3) for glucan). Observed exposure exceeded Dutch occupational exposure limits at all sites. EPS-Pen/Asp exposure was detected in 20% of waste collectors and 49% of compost workers. Exposure variability within tasks was large (geometric standard deviation > 2), with smaller between-worker than within-worker variance. Type of company and waste largely explained between-worker variance (40-90%), although within companies no major task-related determinants could be established. Markers of exposure correlated moderately to strongly. Relative endotoxin and glucan content in the dust was only weakly associated with handled waste. CONCLUSIONS: Occupational bioaerosol exposure in the waste management chain is lowest for outdoor handling of waste and highest when waste is handled indoors. However, exposure variability is large, with greater within-worker than between-worker variance. Occupational exposure limits for organic dust and endotoxins are frequently exceeded, suggesting workers are at risk of developing adverse health effects.

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PMID: 16141253 [PubMed - indexed for MEDLINE]

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In vitro investigation of individual and combined cytotoxic effects of ochratoxin A and other selected mycotoxins on renal cells.

Heussner AH, Dietrich DR, O'Brien E.

Department of Environmental Toxicology, University of Konstanz, Jakob-Burkhardt-St. 25, P.O. Box X-918, 78457 Konstanz, Germany.

Hundreds of mycotoxins are known to date and many of them are of great interest with regard to human and animal health since they are detected frequently in plant-derived products. Various mycotoxins may occur simultaneously, depending on the environmental and substrate conditions. Considering this coincident production, it is very likely, that humans and animals are always exposed to mixtures rather than to individual compounds. Therefore, future risk assessments should consider mixture toxicity data. This is particularly true for ochratoxin A (OTA), ochratoxin B (OTB), citrinin (CIT) and occasionally for patulin (PAT) as they are all produced by a number of Penicillium and Aspergillus species. Therefore, these four toxins were chosen to study the interactive effects in vitro, using the well-established porcine renal cell line LLC-PK1 and the MTT reduction test as a cytotoxicity endpoint. By application of a step-wise approach to test combination toxicity, using various full factorial as well as a central composite experimental designs, the interactive (synergistic) cytotoxic effects of the these four toxins were assessed. The results obtained in this study confirm a potential for interactive (synergistic) effects of CIT and OTA and possibly other mycotoxins in cells of renal origin.

PMID: 16140496 [PubMed - indexed for MEDLINE]

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Instructions for infection control in outpatient care of patients with cystic fibrosis.

Schewe D, Kappler M, Griese M.

Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital, Ludwig-Maximilians- University, MŸnchen, Germany.

RATIONALE AND GOALS: Infections of the respiratory tract with multiresistant bacteria and other pathogens lead to a poor prognosis in patients with cystic fibrosis. The patient-to-patient transmission of infectious agents during the clinic visit and the transmission via the hands of healthcare workers has gained increased attention in the cystic fibrosis community. For this reason practical and possibly evidence-based instructions for infection control measures are needed that are feasible in every day outpatient management of patients with cystic fibrosis. - METHODS: For generating these instructions, a committee consisting of medical doctors and nursing staff providing care to cystic fibrosis patients, infectious diseases specialists and members of the department of infection control analyzed the patients' route through our cystic fibrosis unit during a routine clinic visit. First, the expert committee defined instructions concerning important infection control measures for each step. Next, each instruction was compared with the published literature and categorized as to its grade of evidence (I, II, 0). Instructions with grades of evidence I and II and instructions without demonstrated evidence (0) but theoretically reasonable and practically feasible, were accepted and outlined in a flow diagram. All other instructions were rejected. - RESULTS: The expert committee defined 45 instructions for infection control measures during an outpatient visit of a cystic fibrosis patient. 43 instructions within the categories "principles", "measures before entering the clinic", "measures in the examination room" and "measures when leaving the clinic" matched the criteria mentioned above and were accepted. 2 instructions were rejected. - CONCLUSIONS: Here we report evidence-based instructions for infection control in the setting of outpatient care for cystic fibrosis patients which are feasible in every day care. Since some instructions could only be assigned low evidence grade levels, i. e. II or 0, a further clarification of these issues by scientific investigations is warranted. Unresolved issues are primarily the recommendation for or against wearing a face mask for patients with certain pathogens and the issues of colonization with Stenotrophomonas maltophilia and Alcaligines xylosidans, but also with Aspergillus spp.. Continuous education of patients and healthcare workers as well as the validation of these practical instructions by a close monitoring and documentation of pathogens are of great importance.

PMID: 16131476 [PubMed - indexed for MEDLINE]

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Changing patterns and trends in systemic fungal infections.

Richardson MD.

Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland. Malcolm.Richardson@helsinki.fi

Invasive mycoses are a significant and growing public health problem. Although bloodstream infections with Candida albicans may be decreasing in frequency, the number of persons at risk for them continues to grow. Moreover, infections with other Candida species, such as Candida glabrata, are increasing in incidence. Invasive mould infections in general, and Aspergillus infections in particular, are becoming more frequent. Fungal opportunistic infections in persons with AIDS are no longer a major problem in developed countries, but are resulting in significant morbidity and mortality in developing countries with AIDS epidemics. Further studies are needed to define populations at very high risk for fungal opportunistic infections who might benefit from targeted antifungal chemoprophylaxis, which remains the most promising of the potential prevention strategies. This review highlights the changing patterns in risk factors, changes in epidemiology, the impact of changes in medical practice in intensive care and organ transplantation on the incidence of systemic fungal infections, and gives an overview of fungal infections in paediatric patients, patients with haematological malignancy, and the emergence of antifungal resistance.

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PMID: 16120635 [PubMed - indexed for MEDLINE]

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The future of animal models of invasive aspergillosis.

Patterson TF.

Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900, USA. patterson@uthscsa.edu

The diagnosis of invasive aspergillosis remains very difficult, coupled with limited treatment options. Animal models have been utilized to evaluate both the diagnosis and treatment of infection and to assess the pathogenicity and virulence of the organism. However, animal models have not been standardized and have been used in only a limited fashion for genomic evaluation in this disease. Extensive efforts are underway to expand significantly the Aspergillus genomic information. Thus, the standardization of animal models of invasive aspergillosis is critical to create a unified platform to enhance evaluation of newer genomic information and allow assessment of pathogenicity and virulence factors. Proposed models, supported by a recently awarded National Institutes of Health/National Institute of Allergy and Infectious Diseases contract, will be developed in close interaction with the extended Aspergillus community (including academia and industry) to answer key questions in this disease. The goal of this work is to provide the framework to evaluate genomic targets in animal models in order to improve the diagnosis and treatment of invasive aspergillosis that will ultimately result in improved outcomes of patients with this frequently fatal infection.

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PMID: 16110802 [PubMed - indexed for MEDLINE]

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Influence of mycotoxin producing fungi (Fusarium, Aspergillus, Penicillium) on gluten proteins during suboptimal storage of wheat after harvest and competitive interactions between field and storage fungi.

Prange A, Modrow H, Hormes J, KrŠmer J, Kšhler P.

Institute for Nutrition and Food Sciences, Food Microbiology and Hygiene, University of Bonn, Meckenheimer Allee 168, D-53115 Bonn, Germany. a.prange@gmx.de

Cereals contaminated by Aspergillus spp., Penicillium spp., and Fusarium spp. and their mycotoxins, for example, ochratoxin A (OTA) and deoxynivalenol (DON), are not only a risk to human and animal health but can also show poor technological properties and baking quality. The influence of these genera on the sulfur speciation of low molecular weight (LMW) subunits of glutenin was characterized by investigating suboptimally stored wheat samples in situ by X-ray absorption near edge structure (XANES) spectroscopy and baking tests. Field fungi of the genus Fusarium have hardly any influence on both the sulfur speciation of wheat gluten proteins and the baking properties, whereas storage fungi of the genera Aspergillus and Penicillium have a direct influence. An increased amount of sulfur in sulfonic acid state was found, which is not available for thiol/disulfide exchange reactions in the gluten network, and thus leads to a considerably reduced baking volume. From changes of the composition of the mould flora during suboptimal storage of wheat and from the mycotoxin contents, it can be concluded that microbial competitive interactions play an important role in the development of the mould flora and the mycotoxin concentrations during (suboptimal) storage of wheat.

Publication Types:
PMID: 16104823 [PubMed - indexed for MEDLINE]

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Pneumothorax in cystic fibrosis.

Flume PA, Strange C, Ye X, Ebeling M, Hulsey T, Clark LL.

Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, 812-CSB, Charleston, SC 29425, USA. flumepa@musc.edu

BACKGROUND: Spontaneous pneumothorax is a complication that is commonly reported in patients with cystic fibrosis (CF). An understanding of the pathophysiology of this complication and its consequences is important for the management of patients with CF. OBJECTIVE: To identify risk factors associated with pneumothorax and to determine the prognosis of CF patients following an episode of pneumothorax. DESIGN: A retrospective observational cohort study of the National Cystic Fibrosis Patient Registry between the years 1990 and 1999. PATIENTS: The registry contained data on 28,858 patients with CF who had been followed up over those 10 years at CF centers across the United States. RESULTS: Pneumothorax occurred with an average annual incidence of 0.64% and in 3.4% of patients overall. There was no increased occurrence by sex, but CF was more prevalent in older patients (mean [+/- SD] age, 21.9 +/- 9.1 years) with more severe pulmonary impairment (nearly 75% of patients with FEV1 of < 40% predicted). The principal risks associated with an increased occurrence of pneumothorax included the presence of Pseudomonas aeruginosa (odds ratio [OR], 2.3), Burkholderia cepacia (OR, 1.8), or Aspergillus (OR, 1.3) in sputum cultures, FEV1 < 30% predicted (OR, 1.5), enteral feeding (OR, 1.7), Medicaid insurance (OR, 1.1), pancreatic insufficiency (OR, 1.4), allergic bronchopulmonary aspergillosis (OR, 1.5), and massive hemoptysis (OR, 1.4). There is an increased morbidity (eg, increased number of hospitalizations and number of days spent in the hospital) and an increased 2-year mortality rate following pneumothorax. CONCLUSION: Pneumothorax is a serious complication in CF patients, occurring more commonly in older patients with more advanced lung disease. Nearly 1 in 167 patients will experience this complication each year. There is an attributable mortality to the complication and considerable morbidity, resulting in increased health-care utilization and a measurable decline in lung function.

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PMID: 16100160 [PubMed - indexed for MEDLINE]

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Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome.

Garnacho-Montero J, Amaya-Villar R, Ortiz-Leyba C, Le—n C, Alvarez-Lerma F, Nolla-Salas J, Iruretagoyena JR, Barcenilla F.

Department of Intensive Care Medicine, Hospital Universitario Virgen del Roc’o, Sevilla, Spain. jose.garnacho.sspa@juntadeandalucia.es

INTRODUCTION: Our aims were to assess risk factors, clinical features, management and outcomes in critically ill patients in whom Aspergillus spp. were isolated from respiratory secretions, using a database from a study designed to assess fungal infections. METHODS: A multicentre prospective study was conducted over a 9-month period in 73 intensive care units (ICUs) and included patients with an ICU stay longer than 7 days. Tracheal aspirate and urine samples, and oropharyngeal and gastric swabs were collected and cultured each week. On admission to the ICU and at the initiation of antifungal therapy, the severity of illness was evaluated using the Acute Physiology and Chronic Health Evaluation II score. Retrospectively, isolation of Aspergillus spp. was considered to reflect colonization if the patient did not fulfil criteria for pneumonia, and infection if the patient met criteria for pulmonary infection and if the clinician in charge considered the isolation to be clinically valuable. Risk factors, antifungal use and duration of therapy were noted. RESULTS: Out of a total of 1756 patients, Aspergillus spp. were recovered in 36. Treatment with steroids (odds ratio = 4.5) and chronic obstructive pulmonary disease (odds ratio = 2.9) were significantly associated with Aspergillus spp. isolation in multivariate analysis. In 14 patients isolation of Aspergillus spp. was interpreted as colonization, in 20 it was interpreted as invasive aspergillosis, and two cases were not classified. The mortality rates were 50% in the colonization group and 80% in the invasive infection group. Autopsy was performed in five patients with clinically suspected infection and confirmed the diagnosis in all of these cases. CONCLUSION: In critically ill patients, treatment should be considered if features of pulmonary infection are present and Aspergillus spp. are isolated from respiratory secretions.

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PMID: 15987390 [PubMed - indexed for MEDLINE]

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Changing face of health-care associated fungal infections.

Bille J, Marchetti O, Calandra T.

Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, CH-1011 Lausanne, Switzerland. jacques.bille@chuv.hospvd.ch

PURPOSE OF REVIEW: The purpose of this review was to evaluate recent publications on the epidemiology, diagnosis and management of invasive fungal infections. RECENT FINDINGS: Epidemiological surveys have highlighted significant differences between Europe and the United States regarding the incidence and etiology of Candida bloodstream infections. Today, invasive aspergillosis is occurring in a much broader patient population than the classical immunocompromised hosts and includes mechanically ventilated intensive care unit patients and patients receiving corticosteroids for treatment of chronic lung diseases. Diagnosis is often delayed in these patients and prognosis is dismal. Measurement of galactomannan, mannan and antimannan antibodies, and beta-(1-3)-D-glucan may help to speed up diagnosis. The epidemiology of invasive mold infections is changing. The frequency of non-fumigatus Aspergillus species is increasing, uncommon hyalo-or phaeo-hyphomycoses are emerging and breakthrough mold infections intrinsically resistant to azoles have been reported. Clinical trials have shown that new azoles and echinocandins are as efficacious as amphotericin B or fluconazole for the treatment of eosophageal or invasive candidiasis, for prophylaxis of invasive fungal infections in transplant patients, or for empirical antifungal therapy in patients with persistent fever and neutropenia. SUMMARY: Recent data suggest that the epidemiology of invasive fungal infections may be changing with the emergence of uncommon molds and the occurrence of invasive aspergillosis in 'nonclassical' immunocompromised hosts. New diagnostic tools and improved antifungal agents are available to facilitate early diagnosis and offer new treatment options.

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PMID: 15985827 [PubMed - indexed for MEDLINE]

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Indoor and outdoor bioaerosol levels at recreation facilities, elementary schools, and homes.

Jo WK, Seo YJ.

Department of Environmental Engineering, Kyungpook National University, Daegu, Republic of Korea. wkjo@knu.ac.kr

One major deficiency in linking environmental exposure to health effects is the current lack of data on environmental exposure. Therefore, to address this issue, the present study measured the bacterial and fungal concentrations in the indoor and outdoor air from two types of recreation facility (42 bars and 41 Internet cafes), 44 classrooms at 11 elementary schools, and 20 homes under uncontrolled environmental conditions during both summer and winter. No major environmental problems were reported at the four microenvironments being investigated during the entire study period. Bacteria and fungi were found in all the air samples, and the environmental occurrence of individual fungi was in the order of Cladosprium, Penicillium, Aspergillus, and Alternaria. The six parameters surveyed in the present study were all found to influence the indoor and outdoor bioaerosol levels: microenvironment type, sampling time in elementary school classrooms, agar type for measuring the fungal species, seasonal variation, facility location, and summer survey periods. The indoor and outdoor air concentrations of bacteria and fungi found in this study were comparable to those in other reports, with GM values for the total bacteria and total fungi between 10 and 10(3) colony-forming units per cubic meter of air (CFU m(-3)). The fungal concentrations found at most of the indoor environments fell within the specified guidelines of the American Conference of Government Industrial Hygienists (ACGIH), between 100 and 1000 CFU m(-3) for the total fungi. However, the indoor bioaerosol concentrations at most of the surveyed environments exceeded the Korean indoor bioaerosol guideline (800 CFU m(-3)). Consequently, the current findings suggest the need for reducing strategy for indoor microorganisms at the surveyed microenvironments.

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PMID: 15982704 [PubMed - indexed for MEDLINE]

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Determination of microbial volatile organic compounds adsorbed on house dust particles and gypsum board using SPME/GC-MS.

Wady L, Larsson L.

Department of Medical Microbiology, Dermatology and Infection, Lund University, Sweden.

Adsorption of microbial volatile organic compounds (MVOCs) on house dust was analyzed by performing solid phase microextraction (SPME) in combination with gas chromatography-mass spectrometry (GC-MS). Settled dust samples were exposed to five selected MVOCs and to cultures of the molds Stachybotrus chartarum, Aspergillus versicolor, and Chaetomium globosum. Considerable desorption of the MVOCs adsorbed on the dust occurred spontaneously within a few hours at room temperature and within several days or weeks after storage at -20 degrees or -80 degrees C. Similar results were found for a sample of a gypsum board cultivated with A. versicolor. SPME/GC-MS analysis performed immediately after sampling revealed several of the studied MVOCs on gypsum board and settled dust collected in a house garage with visible mold growth. MVOCs adsorbed on respirable particles of house dust can be inhaled and reach deep into the respiratory system, which may partly explain health effects that have been found to be associated with the presence of low concentrations of MVOCs in air. Particle-bound MVOCs can easily be detected by SPME/GC-MS analysis, thus this technique may prove to be very useful in indoor air research for identifying factors that affect human health. PRACTICAL IMPLICATIONS: We used SPME combined with GC-MS to study the adsorption and desorption of MVOCs on house dust particles that had been exposed to cultivated molds and molds in a damp building. Adsorbed MVOCs desorb spontaneously but this process can be slowed down by storing samples at -20 degrees or -80 degrees C. This opens up a possibility to apply SPME/GC-MS to reveal mold growth in buildings and to determine MVOCs in respirable dust particles that may reach deep in the respiratory system and lead to respiratory illnesses.

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PMID: 15954244 [PubMed - indexed for MEDLINE]

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Abundant respirable ergot alkaloids from the common airborne fungus Aspergillus fumigatus.

Panaccione DG, Coyle CM.

Division of Plant & Soil Sciences, Genetics & Developmental Biology Program, 401 Brooks Hall, West Virginia University, Morgantown, West Virginia 26506-6058, USA. danpan@mail.wvu.edu

Ergot alkaloids are mycotoxins that interact with several monoamine receptors, negatively affecting cardiovascular, nervous, reproductive, and immune systems of exposed humans and animals. Aspergillus fumigatus, a common airborne fungus and opportunistic human pathogen, can produce ergot alkaloids in broth culture. The objectives of this study were to determine if A. fumigatus accumulates ergot alkaloids in a respirable form in or on its conidia, to quantify ergot alkaloids associated with conidia produced on several different substrates, and to measure relevant physical properties of the conidia. We found at least four ergot alkaloids, fumigaclavine C, festuclavine, fumigaclavine A, and fumigaclavine B (in order of abundance), associated with conidia of A. fumigatus. Under environmentally relevant conditions, the total mass of ergot alkaloids often constituted >1% of the mass of the conidium. Ergot alkaloids were extracted from conidia produced on all media tested, and the greatest quantities were observed when the fungus was cultured on latex paint or cultured maize seedlings. The values for physical properties of conidia likely to affect their respirability (i.e., diameter, mass, and specific gravity) were significantly lower for A. fumigatus than for Aspergillus nidulans, Aspergillus niger, and Stachybotrys chartarum. The demonstration of relatively high concentrations of ergot alkaloids associated with conidia of A. fumigatus presents opportunities for investigations of potential contributions of the toxins to adverse health effects associated with the fungus and to aspects of the biology of the fungus that contribute to its success.

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PMID: 15933008 [PubMed - indexed for MEDLINE]

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A short-term test adapted to detect the genotoxic effects of environmental volatile pollutants (benzene fumes) using the filamentous fungus Aspergillus nidulans.

Domingues Zucchi T, Domingues Zucchi F, Poli P, Soares de Melo I, Zucchi TM.

Department of Parasitology and Biotechnology Research Center, Institute of Biomedical Sciences, University of Sao Paulo, Brazil. tzucchi@uol.com.br

With the recent focus on environmental problems, increasing awareness of the harmful effects of industrial and agricultural pollution has created a demand for progressively more sophisticated pollutant and toxicity detection methods. Using Aspergillus nidulans strains this work presents a new short term-test that, most importantly, enables the rapid and inexpensive detection of volatile pollutants that induce genotoxic/carcinogenic effects in animals. The main aim is to contribute to environmental health protection, and special attention is directed to monitoring the hazard posed by benzene (as a carcinogenic agent model) mainly because its ubiquitous presence often leads to severe noxious effects in humans among whom increased rates of human leukemia have been reported. To evaluate even the submutagenic effects of benzene fumes, two Aspergillus nidulans diploid strains, heterozygous for several auxotrophic mutations, were used. The DNA lesions produced stimulate mitotic recombination and homozygotization of auxotrophic recessive mutations. Conidial exposure to a saturated atmosphere of benzene fumes for 20 s was enough to increase the mitotic recombination frequencies significantly. Genetic analyses of treated diploids evidenced alterations related to mitotic recombination frequencies, gene expression, and allelic segregation rates. Altogether they reflect the potential of benzene to induce alterations in the fungal DNA, and albeit indirectly, they also respond for the genotoxic/carcinogenic harmful side effects widely connected to benzene. This is the first description of a sensitive, rapid and inexpensive test able to detect the submutagenic dose effects of volatile environmental compounds. In addition, despite concentrating on benzene the same test can be applied to many other pollutants, volatile or not. Additionally, the test can also be used to detect the antigenotoxic properties of foods and drugs.

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PMID: 15931421 [PubMed - indexed for MEDLINE]

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The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention.

Safdar N, Crnich CJ, Maki DG.

Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, University of Wisconsin Center for Health Sciences, Madison WI, USA.

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with major morbidity and attributable mortality. Strategies to prevent VAP are likely to be successful only if based upon a sound understanding of pathogenesis and epidemiology. The major route for acquiring endemic VAP is oropharyngeal colonization by the endogenous flora or by pathogens acquired exogenously from the intensive care unit environment, especially the hands or apparel of health-care workers, contaminated respiratory equipment, hospital water, or air. The stomach represents a potential site of secondary colonization and reservoir of nosocomial Gram-negative bacilli. Endotracheal-tube biofilm formation may play a contributory role in sustaining tracheal colonization and also have an important role in late-onset VAP caused by resistant organisms. Aspiration of microbe-laden oropharyngeal, gastric, or tracheal secretions around the cuffed endotracheal tube into the normally sterile lower respiratory tract results in most cases of endemic VAP. In contrast, epidemic VAP is most often caused by contamination of respiratory therapy equipment, bronchoscopes, medical aerosols, water (eg, Legionella) or air (eg, Aspergillus or the severe acute respiratory syndrome virus). Strategies to eradicate oropharyngeal and/or intestinal microbial colonization, such as with chlorhexidine oral care, prophylactic aerosolization of antimicrobials, selective aerodigestive mucosal antimicrobial decontamination, or the use of sucralfate rather than H(2) antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semirecumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of VAP. Measures to prevent epidemic VAP include rigorous disinfection of respiratory equipment and bronchoscopes, and infection-control measures to prevent contamination of medical aerosols. Hospital water should be Legionella-free, and high-risk patients, especially those with prolonged granulocytopenia or organ transplants, should be cared for in hospital units with high-efficiency-particulate-arrestor (HEPA) filtered air. Routine surveillance of VAP, to track endemic VAPs and facilitate early detection of outbreaks, is mandatory.

Publication Types:
PMID: 15913465 [PubMed - indexed for MEDLINE]

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[Aflatoxins in newly harvested corn in Panama]

[Article in Spanish]

Rojas V, Martin MC, Quinzada M.

Laboratorio de Micolog’a, Departamento de Microbiolog’a, Facultad de Medicina, Universidad de Panam‡.

Mycotoxins are fungal metabolites that may contaminate foods and feeds, resulting at times in important disease in humans and animals. Thirty-six samples of nine varieties of newly harvested corn (4 samples each variety) were analyzed in search of aflatoxins by thin layer chromatography and high pressure liquid chromatography, and also cultured for the presence of Aspergillus flavus. Of the 36 samples studied, one was contaminated with 1290 ppb aflatoxin B1, which is 258x the concentration suggested by WHO, placed at 5 ppb in food for human consumption. Culture of the 36 samples of corn resulted in growth of 55 colonies of A. flavus from all but two (1 and 6) of the 9 varieties. Of the 55 colonies of A. flavus obtained, 15 (27.3%) were toxigenic. Comments are made on the public health implications of these findings.

Publication Types:
PMID: 15881740 [PubMed - indexed for MEDLINE]

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Spoilage of vegetable crops by bacteria and fungi and related health hazards.

Tournas VH.

Division of Natural Products, Food and Drug Administration, College Park, Maryland 20740, USA. vtournas@cfsan.fda.gov

After harvest, vegetables are often spoiled by a wide variety of microorganisms including many bacterial and fungal species. The most common bacterial agents are Erwinia carotovora, Pseudomonas spp., Corynebacterium, Xanthomonas campestris, and lactic acid bacteria with E. carotovora being the most common, attacking virtually every vegetable type. Fungi commonly causing spoilage of fresh vegetables are Botrytis cinerea, various species of the genera Alternaria, Aspergillus, Cladosporium, Colletotrichum, Phomopsis, Fusarium, Penicillium, Phoma, Phytophthora, Pythium and Rhizopus spp., Botrytis cinerea, Ceratocystis fimbriata, Rhizoctonia solani, Sclerotinia sclerotiorum, and some mildews. A few of these organisms show a substrate preference whereas others such as Botrytis cinerea, Colletotrichum, Alternaria, Cladosporium, Phytophthora, and Rhizopus spp., affect a wide variety of vegetables causing devastating losses. Many of these agents enter the plant tissue through mechanical or chilling injuries, or after the skin barrier has been broken down by other organisms. Besides causing huge economic losses, some fungal species could produce toxic metabolites in the affected sites, constituting a potential health hazard for humans. Additionally, vegetables have often served as vehicles for pathogenic bacteria, viruses, and parasites and were implicated in many food borne illness outbreaks. In order to slow down vegetable spoilage and minimize the associated adverse health effects, great caution should be taken to follow strict hygiene, good agricultural practices (GAPs) and good manufacturing practices (GMPs) during cultivation, harvest, storage, transport, and marketing.

Publication Types:
PMID: 15839403 [PubMed - indexed for MEDLINE]

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Comment in:
Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India.

Basak SK, Basak S, Mohanta A, Bhowmick A.

Disha Eye Hospital & Research Centre, Barrackpore, North 24-Parganas, West Bengal 700-120, India. disha@cal2.vsnl.net.in.

PURPOSE: To determine the epidemiological pattern and risk factors involved in suppurative corneal ulceration in Gangetic West Bengal, eastern India, and to identify the specific microbial agents responsible for corneal infections. METHODS: All patients with suspected microbial keratitis presenting to the corneal clinic at Disha Eye Hospital, Barrackpore, West Bengal, India, from January 2001 to December 2003 were evaluated. Sociodemographic data and information pertaining to the risk factors were recorded. After diagnosing infective corneal ulcer clinically, corneal scraping and cultures were performed. RESULTS: Over a three-year period, 1198 patients with suppurative keratitis were evaluated. Ocular trauma was the most common predisposing factor in 994 (82.9%) patients (P< 0.0001), followed by use of topical corticosteroids in 231 (19.28%) patients. Cultures were positive in 811 (67.7%) patients. Among these culture positive cases, 509 (62.7%) patients had pure fungal infections (P< 0.001), 184 (22.7%) patients had pure bacterial infections and 114 (14.1%) had mixed fungal with bacterial infections. Acanthamoeba was detected in 4 (0.49%) patients. The most common fungal pathogen was Aspergillus spp representing 373 (59.8%) of all positive fungal cultures (P< 0.0001), followed by Fusarium spp in 132 (21.2%) instances. Most common bacterial isolate was Staphylococcus aureus, representing 127 (42.6%) of all the bacterial culture (P< 0.0001) followed by Pseudomonas spp 63 (21.1%). CONCLUSION: Suppurative keratitis in Gangetic West Bengal, most often occurs after a superficial corneal trauma with vegetative or organic materials. Fungal ulcers are more common than bacterial ulcers. Aspergillus spp and Staphylococcus aureus were the most common fungus and bacteria respectively. These "regional" findings have important public health implications for the treatment and prevention of suppurative corneal ulceration in this region of India.

PMID: 15829742 [PubMed - indexed for MEDLINE]

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Isolation and characterization of microorganisms from instruments used by pedicurists operating within Lagos metropolis, Nigeria.

Adeleye IA, Osidipe OO.

Department of Botany and Microbiology, The University of Lagos, Akoka, Nigeria. adeyemi21@yahoo.com

Eight bacterial and five fungal species were isolated from swab samples taken from instruments used by pedicurists operating at three different sites in Lagos, Nigeria. The bacterial isolates included Micrococcus luteus, Micrococcus roseus, Staphylococcus epidermidis, Staphylococcus aureus, Hafnia spp, Shigella spp, Bacillus subtilis and Bacillus spp. The five fungal isolates were identified as Aspergillus niger, Aspergillus flavus, Mucor spp, Trichophyton spp and Candida albicans. The presence of these microorganisms, some of which are pathogenic, is an indication that pedicurists could be contributing towards the spread of skin and nail infections within the Lagos metropolis.

PMID: 15816270 [PubMed - indexed for MEDLINE]

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[Mycotoxin producing fungi]

[Article in Spanish]

Abarca ML, Bragulat MR, Castell‡ G, Accensi F, Caba–es FJ.

Departament Patologia i Producci— Animals, Facultat de Veterinˆria, UAB, 08193 Bellaterra, Barcelona, Espa–a. Lourdes.Abarca@uab.es.

Mycotoxins are relatively small molecules characterized by a diversity of chemical structure and a diversity of biological activity. They are often genotypically specific for a group of species, but the same compound can also be formed by fungi belonging to different genera. Most of the mycotoxins known have been recognized as metabolic products of Aspergillus, Penicillium and Fusarium species. This review will be focused on aflatoxins, ochratoxins and fumonisins because of their hazard to animal and human health. The production of these mycotoxins have been usually associated with a small number of species but some recent studies have reported the production of these mycotoxins by some other species. These results show that mycotoxin production is broader than is normally thought, so the possibility can not be ruled out that new species may be a new source of unexpected mycotoxins in their natural substrates.

Publication Types:
PMID: 15813690 [PubMed]

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[Aflatoxin contamination level in artisanal and industrial peanut butter food in Dakar (Senegal)]

[Article in French]

Diop YM, Ndiaye B, Fall M, Diouf A, Sall A, Ciss M, Ba D.

Laboratoire de Chimie Analytique et de Toxicologie, FacultŽ de MŽdecine et de Pharmacie, UniversitŽ Cheikh Anta Diop de Dakar.

Aflatoxins are mycotoxins produced by some strains of fungus (Aspergillus) which develop in peanut seeds. Peanut oil and past are very used up in Senegal, then the aflatoxin poisoning risk is very actual. The aim of this study was to determinate the aflatoxin level in artisanal and industrial peanut pastry food from Dakar (SŽnŽgal). High Performance Liquid Chromatography (HPLC) analysis of the different samples showed that the most contaminated by aflatoxins are artisanal pastry sold in different market of Dakar (SŽnŽgal). Indeed, 40% of these samples contained mean values of aflatoxin B1 (the most dangerous) widely over allowable EEC specifications (5ppb). Furthermore, most of industrial and domestic peanut pastry were cleaned and could be consumed without risk.

Publication Types:
PMID: 15779168 [PubMed - indexed for MEDLINE]

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Laboratory diagnosis in ulcerative keratitis.

Khanal B, Deb M, Panda A, Sethi HS.

Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

AIMS: To identify the common bacterial and fungal isolates from corneal ulcers and to determine the antimicrobial susceptibility patterns of bacterial isolates to commonly used antibiotics at B.P. Koirala Institute of Health Sciences (BPKIHS), eastern Nepal. Culture and direct microscopic correlation and reliability were also compared. METHODS: All patients with suspected corneal ulceration presenting to the Ophthalmology Department of BPKIHS from 1st August 1998 to 31st July 2001 were evaluated. Corneal scraping was performed and processed for direct microscopy and culture for bacterial and fungal isolates. Bacterial isolates were subjected to antimicrobial susceptibility testing. RESULTS: Of 447 specimens examined direct microscopy was positive in 216 (48%) specimens. Culture positivity could be correlated with direct microscopy in 179 (83%) of specimens. Growth of etiologic agents was found in 303 (67.8%) samples. Of these 145 (47.8%) had pure fungal growth, 103 (34%) had pure bacterial growth and 55 (18.2%) had mixed fungal and bacterial infection. The commonest fungal pathogen was Aspergillus spp.in 78 (38.4%) followed by Fusarium spp. in 45 (22%). Aureobasidium sp. was isolated in 25 (12.3%) samples. Staphylococcus aureus (93, 56.7%) dominated the scene as the commonest bacterial agent. Streptococcus pneumoniae (33, 20%) was second in the list. Most of the bacterial isolates were sensitive to commonly used antibiotics. CONCLUSION: This study emphasizes the importance and need of the continued surveillance of the agents and their antimicrobial susceptibility for the prevention and management of corneal ulcers and their complications. Copyright (c) 2005 S. Karger AG, Basel.

PMID: 15746569 [PubMed - indexed for MEDLINE]

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Characterization of mold and moisture indicators in the home.

Mahooti-Brooks N, Storey E, Yang C, Simcox NJ, Turner W, Hodgson M.

University of Connecticut Health Center, Division of Occupational and Environmental Medicine, Farmington, Connecticut 06030-6210, USA.

As studies increasingly support the presence of health risks associated with mold and moisture, understanding fungal concentrations and physical measurements as they relate to the microenvironment becomes more important. We conducted a cross-sectional study in the homes of 64 subjects. The primary objective of this study was to use trained inspectors' list of indicators in rooms (bathroom, bedroom, and basement) and determine whether these indicators are associated with higher fungal levels or physical measurements. A new category for combining the concentrations of fungal species, referred to as moisture indicator fungi (MIF), is used in the analysis. Our results show that basements with a musty odor, efflorescence, water sources, or mold have a two- to threefold increase in fungal concentrations over basements without these indicators. The regression model for the basement was highly predictive of indoor MIF concentrations (r2 = .446, p = .017). Basement water sources are substantial predictors of indoor total fungi, MIF, and Aspergillus/Penicillium spp. MIF concentrations are higher in homes with basement water sources, and most notably, the increase in MIF concentrations is significant in other living spaces (bathroom and bedroom) of the dwelling. Basement water sources are important moisture/mold indicators for epidemiologists to use in exposure assessments performed in residential dwellings.

Publication Types:
PMID: 15742712 [PubMed - indexed for MEDLINE]

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Pulmonary complications after bone marrow transplantation: an autopsy study from a large transplantation center.

Roychowdhury M, Pambuccian SE, Aslan DL, Jessurun J, Rose AG, Manivel JC, Gulbahce HE.

University of Minnesota Medical School, Fairview-University Medical Center, Minneapolis, USA.

CONTEXT: Bone marrow transplantation (BMT) is used to treat various malignant and nonmalignant disorders. Pulmonary complications are some of the most common causes of mortality in BMT recipients. Poor general health and bleeding tendency frequently preclude the use of definitive diagnostic tests, such as open lung biopsy, in these patients. OBJECTIVE: To identify pulmonary complications after BMT and their role as the cause of death (COD). DESIGN: The autopsy and bronchoalveolar lavage (BAL) slides and microbiology studies of BMT recipients from a 7-year period were reviewed. RESULTS: Pulmonary complications were identified in 40 (80%) of the 50 cases. The most common complications were diffuse alveolar damage (DAD) and diffuse alveolar hemorrhage (DAH). Pulmonary complications were the sole or 1 of multiple CODs in 37 cases (74%). All complications were more common in allogeneic BMT recipients. In 19 (51%) of the 37 cases in which pulmonary complications contributed to the death, cultures were negative. Both DAD and DAH, complications commonly reported in the early post-BMT period, were seen more than 100 days after BMT in 33% and 12% of cases, respectively. Five (83%) of 6 cases of invasive pulmonary aspergillosis diagnosed at autopsy were negative for fungi ante mortem (by BAL and cultures). CONCLUSIONS: Pulmonary complications are a significant COD in BMT recipients, many of which, especially the fungal infections, are difficult to diagnose ante mortem. The etiology of DAD and DAH is likely to be multifactorial, and these complications are not limited to the early posttransplantation period. Autopsy examination is important in determining the COD in BMT recipients.

PMID: 15737032 [PubMed - indexed for MEDLINE]

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Pollution status of swimming pools in south-south zone of south-eastern Nigeria using microbiological and physicochemical indices.

Itah AY, Ekpombok MU.

Department of Microbiology, University of Uyo, Uyo, Akwa Ibon State, Nigeria.

Microbiological and physicochemical characteristics of swimming pools in South Eastern states of Nigeria (Akwa Ibom and Cross River) were investigated. The bacterial isolates included Enterococcus faecalis, Clostridium perfringens, Bacillus cereus and Escherichia coli. Others were Pseudomonas aeruginosa, Staphylococcus aureus, Proteus vulgaris and Staphylococcus epidermidis, while fungal isolates were Penicillium sp, Rhizopus sp, Aspergillus versicolor Fusarium sp, Trichophyton mentagrophytes, Mucor sp, Candida albicans, Aspergillus niger and Absidia sp. The total viable count of microorganims in Ibeno (B) and Uyo (E) swimming pools were 6 x 10(6) cfu/ml and for Calabar (H) swimming pool, 3.3 x 10(7) cfu/ml. The total coliform counts were 10(6) cfu/100 ml for Calabar (G) swimming pools and 2 x 10(7) cfu/100 ml for Calabar (H) swimming pools while the fungal count ranged from 5 x 10(6) cfu/ml to 3 x 10(7) cfu/ml. Physical and chemical parameters known to be hazardous to health were also identified. The presence of high levels of coliform and fecal coliform bacteria (E. coli) revelaed that the swimming pools have not met the World Health Organization (WHO) standard for recreational waters. The swimming pools constitute a serious public health hazard.

PMID: 15691161 [PubMed - indexed for MEDLINE]

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[Farmer's lung cases of a farmer and his son with high BAL fluid beta-D glucan levels]

[Article in Japanese]

Imai K, Ashitani J, Imazu Y, Yanagi S, Sano A, Tokojima M, Nakazato M.

Third Department of Internal Medicine, Miyazaki Medical College.

A farmer and his son, who treated straw in a cowshed, were admitted to our hospital because of severe dyspnea during summer time. Their chest X-ray films revealed bilateral reticulonodular shadows in the middle to lower lung fields. Bronchoalveolar lavage (BAL) fluid analyses showed a high proportion of lymphocytes and an increased CD4/8 ratio. They were diagnosed with farmer's lung and treated with pulse therapy with methylprednisolone and tapering of steroid. Hypoxemia and interstitial shadow improved, though the farmer relapsed one day after getting home. Immune precipitation showed positive reactions against Aspergillus fumigatus, Aspergillus terreus and Nocardiopsis alba. Their beta D-glucan levels in BAL fluid were higher than those of healthy normal volunteers, whereas their beta D-glucan levels in serum were below the detection levels. Ventilation of the cowshed and wearing a mask should prevent recurrence of the disease.

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PMID: 15678910 [PubMed - indexed for MEDLINE]

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Development of a method to detect and quantify Aspergillus fumigatus conidia by quantitative PCR for environmental air samples.

McDevitt JJ, Lees PS, Merz WG, Schwab KJ.

Bloomberg School of Public Health, Department of Environmental Health Sciences, Division of Environmental Health Engineering, The Johns Hopkins University, Rm. E6620, 615 N. Wolfe St., Baltimore, MD, 21205, USA.

Exposure to Aspergillus fumigatus is linked with respiratory diseases such as asthma, invasive aspergillosis, hypersensitivity pneumonitis, and allergic bronchopulmonary aspergillosis. Molecular methods using quantitative PCR (qPCR) offer advantages over culture and optical methods for estimating human exposures to microbiological agents such as fungi. We describe an assay that uses lyticase to digest A. fumigatus conidia followed by TaqMan qPCR to quantify released DNA. This method will allow analysis of airborne A. fumigatus samples collected over extended time periods and provide a more representative assessment of chronic exposure. The method was optimized for environmental samples and incorporates: single tube sample preparation to reduce sample loss, maintain simplicity, and avoid contamination; hot start amplification to reduce non-specific primer/probe annealing; and uracil-N-glycosylase to prevent carryover contamination. An A. fumigatus internal standard was developed and used to detect PCR inhibitors potentially found in air samples. The assay detected fewer than 10 A. fumigatus conidia per qPCR reaction and quantified conidia over a 4-log10 range with high linearity (R2 >0.99) and low variability among replicate standards (CV=2.0%) in less than 4 h. The sensitivity and linearity of qPCR for conidia deposited on filters was equivalent to conidia calibration standards. A. fumigatus DNA from 8 isolates was consistently quantified using this method, while non-specific DNA from 14 common environmental fungi, including 6 other Aspergillus species, was not detected. This method provides a means of analyzing long term air samples collected on filters which may enable investigators to correlate airborne environmental A. fumigatus conidia concentrations with adverse health effects.

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PMID: 15645173 [PubMed - indexed for MEDLINE]

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Assessment of human exposure to airborne fungi in agricultural confinements: personal inhalable sampling versus stationary sampling.

Adhikari A, Reponen T, Lee SA, Grinshpun SA.

Center for Health-Related Aerosol Studies, Department of Environmental Health, University of Cincinnati, 3223 Eden Avenue, PO Box 670056, Cincinnati, Ohio 45267-0056, USA. adhikaa@email.uc.edu

Accurate exposure assessment to airborne fungi in agricultural environments is essential for estimating the associated occupational health hazards of workers. The objective of this pilot study was to compare personal and stationary sampling for assessing farmers' exposure to airborne fungi in 3 different agricultural confinements located in Ohio, USA (hog farm, dairy farm, and grain farm), using Button Personal Inhalable Samplers. Personal exposures were measured with samplers worn by 3 subjects (each carrying 2 samplers) during 3 types of activities, including animal feeding in the hog farm, cleaning and animal handling in the dairy farm, and soybean unloading and handling in the grain farm. Simultaneously, the stationary measurements were performed using 5 static Button Samplers and 1 revolving Button Sampler. The study showed that the total concentration of airborne fungi ranged from 1.4 x 10(4)-1.2 x 10(5) spores m(-3) in 3 confinements. Grain unloading and handling activity generated highest concentrations of airborne fungi compared to the other 2 activities. Prevalent airborne fungi belonged to Cladosporium, Aspergillus/Penicillium, Ascospores, smut spores, Epicoccum, Alternaria, and Basidiospores. Lower coefficients of variations were observed for the fungal concentrations measured by personal samplers (7-12%) compared to the concentrations measured by stationary samplers (27-37%). No statistically significant difference was observed between the stationary and personal measurement data for the total concentrations of airborne fungi (p > 0.05). Revolving stationary and static stationary Button Samplers demonstrated similar performance characteristics for the collection of airborne fungi. This reflects the low sensitivity of the sampler's efficiency to the wind speed and direction. The results indicate that personal exposure of agricultural workers in confinements may be adequately assessed by placing several Button Samplers simultaneously operating in a static stationary mode throughout the work site.

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PMID: 15627336 [PubMed - indexed for MEDLINE]

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Ochratoxin A in grain dust--estimated exposure and relations to agricultural practices in grain production.

Halstensen AS, Nordby KC, Elen O, Eduard W.

National Institute of Occupational Health, PO Box 8149, N-0033 Oslo, Norway. anne.s.halstensen@stami.no

Ochratoxin A (OTA) is a nephrotoxin frequently contaminating grains. OTA inhalation during grain handling may therefore represent a health risk to farmers, and was the subject of this study. Airborne and settled grain dust was collected during grain work on 84 Norwegian farms. Climate and agricultural practices on each farm were registered. Penicillium spp., Aspergillus spp. and OTA in settled dust were measured. Settled dust contained median 4 microg OTA/kg dust (range 2-128), correlating with Penicillium spp. (median 40 cfu/mg; range 0-32000, rs =0.33; p < 0.01). Similar levels were found across grain species, districts and agricultural practices. Penicillium levels, but not OTA levels, were higher in storage than in threshing dust (p=0.003), and increased with storage time (rs =0.51, p < 0.001). Farmers were exposed to median 1 mg/m3 (range 0.2-15) dust during threshing and median 7 mg/m3 (range 1-110) dust during storage work, equalling median 3.7 pg/m3 (range 0.6-200) and median 40 pg/m3 (range 2-14000) OTA, respectively (p < 0.001). Agricultural practices could not predict OTA, Penicillium or Aspergillus contamination. Compared to oral intake of OTA, the inhalant exposure during grain work was low, although varying by more than 1,000-fold. However, the farmers may occasionally be highly exposed, particularly during handling of stored grain.

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PMID: 15627332 [PubMed - indexed for MEDLINE]

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Anti-fungal and anti-bacterial activity of some herbal remedies from Tanzania.

de Boer HJ, Kool A, Broberg A, Mziray WR, Hedberg I, Levenfors JJ.

Department of Systematic Botany, Evolutionary Biology Centre, Uppsala University, NorbyvŠgen 18 D, SE-75236 Uppsala, Sweden. hugo@.deboer@ebc.uu.se

Plants are not only important to the millions of people to whom traditional medicine serves as the only opportunity for health care and to those who use plants for various purposes in their daily lives, but also as a source of new pharmaceuticals. During interviews with the Pare people from Northeastern Tanzania, 29 plants that are used for medicinal purposes as well as 41 plants used for non-medicinal purposes were reported. Six medicinally used plants were selected for bioactivity analysis. Extracts of Coccinia adoensis, Cineraria grandiflora, Pavonia urens, Marattia fraxinea, Clutia abyssinica var. usambarica, and Vangueria infausta were made using ethyl acetate, methanol, cold water and boiling water. The antimicrobial activity was tested on Candida albicans, Aspergillus fumigatus, Fusarium culmorum, Staphylococcus aureus, Pseudomonas syringae, and Erwinia amylovora. All plants showed activity against several test organisms.

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PMID: 15619565 [PubMed - indexed for MEDLINE]

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A survey of anti-fungal management in lung transplantation.

Dummer JS, Lazariashvilli N, Barnes J, Ninan M, Milstone AP.

Division of Infectious Diseases, Vanderbilt Transplant Center, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.

BACKGROUND: Fungal infections are an important complication of lung transplantation, but no controlled studies of their management have been performed. Knowledge of actual anti-fungal strategies may aid in the design of future prospective studies. METHODS: Thirty-seven of 69 active lung transplant centers, accounting for 66% of all US lung transplantations, responded to our survey. The survey focused on fungal surveillance, pre- and post-transplant prophylaxis, and approach to fungal colonization. RESULTS: The median number of lung transplantations performed by the centers in 1999 was 14 per year (range, 1-52), and median time that centers were in in operation was 9 years (range, 2-15 years). Seventy percent of centers had a transplant infectious diseases specialist. Pre-transplant fungal surveillance was performed by 81% of centers, with 67% of these surveying all patients and the remainder surveying only sub-sets of patients. Seventy-two percent of all centers started anti-fungal treatment if Aspergillus spp were isolated before transplantation. Itraconazole was the preferred agent (86%). After transplantation, 76% of centers gave anti-fungal prophylaxis, although 24% of these did so only in selected patients. Prophylactic agents in order of preference were inhaled amphotericin B (61%), itraconazole (46%), parenteral amphotericin formulations (25%), and fluconazole (21%); many centers used more than 1 agent. Prophylaxis was initiated within 24 hours by 71% and within 1 week by all centers. Median duration of prophylaxis was 3 months (range, <1 month-lifetime). All 37 centers used anti-fungal therapy if colonization with Aspergillus spp was detected for a median duration of 4.5 months. Itraconazole was the preferred agent. Only 59% of centers treated patients colonized with Candida spp. In a statistical analysis, centers with larger volumes were less likely to treat pre-transplant colonization with Candida spp but more likely to use agents other than itraconazole for post-transplant colonization with Aspergillus spp. Only 14% of centers engaged in any anti-fungal research at the time of the survey. CONCLUSIONS: The majority of surveyed lung transplant programs actively manage fungal infection with prophylaxis or pre-emptive therapy, despite the absence of controlled trials. This survey may provide an impetus and a basis for designing prospective studies.

PMID: 15607667 [PubMed - indexed for MEDLINE]

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Mycotoxins as harmful indoor air contaminants.

Jarvis BB, Miller JD.

Department of Chemistry and Biochemistry, University of Maryland, College Park, MD 20742, USA. bj6@umail.umd.edu

Fungal metabolites (mycotoxins) that pose a health hazard to humans and animals have long been known to be associated with mold-contaminated food and feed. In recent times, concerns have been raised about exposures to mycotoxin-producing fungi in indoor environments, e.g., damp homes and buildings. The principal mycotoxins that contaminate food and feed (alfatoxins, fumonisins, ochratoxin A, deoxynivalenol, zearalenone) are rarely if ever found in indoor environments, but their toxicological properties provide an insight into the difficulties of assessing the health effects of related mycotoxins produced by indoor molds. Although the Penicillium and Aspergillus genera of fungi are major contaminants of both food and feed products and damp buildings, the particular species and hence the array of mycotoxins are quite different in these environments. The mycotoxins of these indoor species and less common mycotoxins from Stachybotrys and Chaetomium fungi are discussed in terms of their health effects and the need for relevant biomarkers and long-term chronic exposure studies.

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PMID: 15565335 [PubMed - indexed for MEDLINE]

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Missense mutations that inactivate the Aspergillus nidulans nrtA gene encoding a high-affinity nitrate transporter.

Kinghorn JR, Sloan J, Kana'n GJ, Dasilva ER, Rouch DA, Unkles SE.

School of Biology, University of Saint Andrews, Fife, Scotland, UK. jrk@st-andrews.ac.uk

The transport of nitrate into prokaryotic and eukaryotic cells, of considerable interest to agriculture, ecology, and human health, is carried out by members of a distinct cluster of proteins within the major facilitator superfamily. To obtain structure/function information on this important class of nitrate permeases, a collection of chemically induced mutations in the nrtA gene encoding a 12-transmembrane domain, high-affinity nitrate transporter from the eukaryote Aspergillus nidulans was isolated and characterized. This mutational analysis, coupled with protein alignments, demonstrates the utility of the approach to predicting peptide motifs and individual residues important for the movement of nitrate across the membrane. These include the highly conserved nitrate signature motif (residues 166-173) in Tm 5, the conserved charged residues Arg87 (Tm 2) and Arg368 (Tm 8), as well as the aromatic residue Phe47 (Tm 1), all within transmembrane helices. No mutations were observed in the large central loop (Lp 6/7) between Tm 6 and Tm 7. Finally, the study of a strain with a conversion of Trp481 (Tm 12) to a stop codon suggests that all 12 transmembrane domains and/or the C-terminal tail are required for membrane insertion and/or stability of NrtA.

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PMID: 15545642 [PubMed - indexed for MEDLINE]

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Cytotoxic substances from Aspergillus fumigatus in oxygenated or poorly oxygenated environment.

Watanabe A, Kamei K, Sekine T, Higurashi H, Ochiai E, Hashimoto Y, Nishimura K.

Research Center for Pathogenic Fungi and Microbial Toxicoses, Chiba University, Chiba City, Japan. fewata@restaff.chiba-u.jp

Aspergillus fumigatus often causes serious health problems. The airway of the human body, the most common initial site of damage, is always exposed to an oxygenated condition, and the oxygen concentration may play a critical role in the virulence of A. fumigatus. In this study, oxygen content, fungal growth, the production of cytotoxic substance(s) in the fungal culture, and their relationship were investigated. Two clinical strains of A. fumigatus were cultured under certain oxygen contents (10, 14 and 20%), and cytotoxicity of their culture filtrates on murine macrophages and their fungal growth were evaluated. The components of these filtrates were analyzed by gas chromatography-mass spectrometry. All culture filtrates contained gliotoxin and showed potent cytotoxicity on macrophages at very low concentration. The amount of gliotoxin in the culture filtrate prepared at 10% oxygen was markedly less, but diminutions in fungal growth and cytotoxicity of this culture filtrate were negligible. These results suggest that a well-oxygenated condition is suitable for the production of gliotoxin by A. fumigatus. A significant role of cytotoxic substances(s) other than gliotoxin is also suggested.

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PMID: 15487313 [PubMed - indexed for MEDLINE]

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Amoebae and other protozoa in material samples from moisture-damaged buildings.

Yli-PirilŠ T, Kusnetsov J, Haatainen S, HŠnninen M, Jalava P, Reiman M, Seuri M, Hirvonen MR, Nevalainen A.

Department of Environmental Health, National Public Health Institute, PO Box 95, FIN-70701 Kuopio, Finland. terhi.yli-pirila@ktl.fi

Mold growth in buildings has been shown to be associated with adverse health effects. The fungal and bacterial growth on moistened building materials has been studied, but little attention has been paid to the other organisms spawning in the damaged materials. We examined moist building materials for protozoa, concentrating on amoebae. Material samples (n = 124) from moisture-damaged buildings were analyzed for amoebae, fungi, and bacteria. Amoebae were detected in 22% of the samples, and they were found to favor cooccurrence with bacteria and the fungi Acremonium spp., Aspergillus versicolor, Chaetomium spp., and Trichoderma spp. In addition, 11 seriously damaged samples were screened for other protozoa. Ciliates and flagellates were found in almost every sample analyzed. Amoebae are known to host pathogenic bacteria, such as chlamydiae, legionellae, and mycobacteria and they may have a role in the complex of exposure that contributes to the health effects associated with moisture damage in buildings.

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PMID: 15364591 [PubMed - indexed for MEDLINE]

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Erratum in:
  • World Health Organ Tech Rep Ser. 2005;928:157.

Evaluation of certain food additives and contaminants.

[No authors listed]

This report represents the conclusions of a Joint FAO/WHO Expert Committee convened to evaluate the safety of various food additives, with a view to recommending acceptable daily intakes (ADIs) and to prepare specifications for the identity and purity of food additives. The first part of the report contains a general discussion of the principles governing the toxicological evaluation of food additives (including flavouring agents) and contaminants, assessments of intake, and the establishment and revision of specifications for food additives. A summary follows of the Committee's evaluations of toxicological and intake data on various specific food additives (alpha-amylase from Bacillus lichenformis containing a genetically engineered alpha-amylase gene from B. licheniformis, annatto extracts, curcumin, diacetyl and fatty acid esters of glycerol, D-tagatose, laccase from Myceliophthora thermophila expressed in Aspergillus oryzae, mixed xylanase, beta-glucanase enzyme preparation produced by a strain of Humicola insolens, neotame, polyvinyl alcohol, quillaia extracts and xylanase from Thermomyces lanuginosus expressed in Fusarium venenatum), flavouring agents, a nutritional source of iron (ferrous glycinate, processed with citric acid), a disinfectant for drinking-water (sodium dichloroisocyanurate) and contaminants (cadmium and methylmercury). Annexed to the report are tables summarizing the Committee's recommendations for ADIs of the food additives, recommendations on the flavouring agents considered, and tolerable intakes of the contaminants considered, changes in the status of specifications and further information requested or desired.

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PMID: 15354533 [PubMed - indexed for MEDLINE]

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Indoor air quality during renovation actions: a case study.

Abdel Hameed AA, Yasser IH, Khoder IM.

Air Pollution Department, National Research Centre, Dokki, Giza, Egypt. hameed_33@yahoo.com

A temporary renovation activity releases considerably high concentrations of particulate matter, viable and non-viable, into air. These pollutants are a potential contributor to unacceptable indoor air quality (IAQ). Particulate matter and its constituents lead, sulfate, nitrate, chloride, ammonium and fungi as well as fungal spores in air were evaluated in a building during renovation action. Suspended dust was recorded at a mean value of 6.1 mg m(-3) which exceeded the Egyptian limit values for indoor air (0.15 mg m(-3)) and occupational environments (5 mg m(-3)). The highest particle frequency (23%) of aerodynamic diameter (dae) was 1.7 microm. Particulate sulfate (SO(4)(2-)), nitrate (NO(3)(-)), chloride (Cl(-)), ammonium (NH(4)(+)) and lead components of suspended dust averaged 2960, 28, 1350, 100 and 13.3 microg m(-3), respectively. Viable fungi associated with suspended dust and that in air averaged 1.11 x 10(6) colony forming unit per gram (cfu g(-1)) and 92 colony forming unit per plate per hour (cfu p(-1) h(-1)), respectively. Cladosporium(33%), Aspergillus(25.6%), Alternaria(11.2%) and Penicillium(6.6%) were the most frequent fungal genera in air, whereas Aspergillus(56.8%), Penicillium(10.3%) and Eurotium(10.3%) were the most common fungal genera associated with suspended dust. The detection of Aureobasidium, Epicoccum, Exophiala, Paecilomyces, Scopulariopsis, Ulocladium and Trichoderma is an indication of moisture-damaged building materials. Alternaria, Aureobasidium, Cladosporium, Scopulariopsis and Nigrospora have dae > 5 microm whereas Aspergillus, Penicillium and Verticillium have dae < 5 microm which are suited to penetrate deeply into lungs. Particulate matter from the working area infiltrates the occupied zones if precautionary measures are inadequate. This may cause deterioration of IAQ, discomfort and acute health problems. Renovation should be carefully designed and managed, in order to minimize degradation of the indoor and outdoor air quality.

PMID: 15346177 [PubMed - indexed for MEDLINE]

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Cytotoxicity of occupationally and environmentally relevant mycotoxins.

BŸnger J, Westphal G, Mšnnich A, Hinnendahl B, Hallier E, MŸller M.

Department of Occupational and Social Medicine, Georg-August-University of Gšttingen, Waldweg 37, Lower Saxony, Gšttingen D-37073, Germany. jbuenge@gwdg.de

Mycotoxins can cause various toxic effects in humans. Acute and chronic respiratory diseases were reported after inhalation of organic dust containing toxigenic moulds and mycotoxins, respectively. To gain first insights into health effects from airborne exposure to these compounds, five toxigenic airborne moulds of the genera Aspergillus and Penicillium collected at composting plants and eight reference mycotoxins were tested for cytotoxicity in four established cell lines as a surrogate of tissues known or suspected to be targets of toxic effects of mycotoxins. The known mycotoxins sterigmatocystin, fumagillin, verruculogen, penitrem A, and roquefortine C were detected in extracts of the moulds. All five extracts caused serious toxic effects in the cell lines. Sterigmatocystin caused a 80-fold higher toxicity in the A-549 lung cell line compared to Hep-G2 liver cells indicating a specific susceptibility of A-549 to this agent. Since only a minor part of the toxic effects of the extracts in A-549 cells and--to a lesser extent--in the other cell lines could be explained by contents of the identified mycotoxins, the presence of additional mycotoxins or other toxic principles is assumed in the mould extracts. However, the detected mycotoxins in the mould extracts and their distinctive cytotoxicity support the hypothesis that mycotoxins may be involved in the aetiology of lung diseases due to the inhalation of organic dust.

PMID: 15337583 [PubMed - indexed for MEDLINE]

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Comparison of the toxicity of reference mycotoxins and spore extracts of common indoor moulds.

Schulz T, Senkpiel K, Ohgke H.

Institute of Microbiology and Hygiene, University of LŸbeck, LŸbeck, Germany.

There is an unclear endangering potential by toxic influences of inhaled conidiospores and therefore the conidia of indoor mould species were cultured and toxicologically examined after their mechanical disintegration. For this purpose high-performance liquid chromatography (HPLC) and three colorimetric bioassays, the PTGT (pollen tube growth test), the MB (methylene blue) and the MTT (methylthiazoltetrazolium) assay were applied. The sensitivity of the biological methods was evaluated by using 12 reference mycotoxins and 3 structural cell wall components. Only in one extract of disintegrated spores (Aspergillus fumigatus) a mycotoxin (0.22 microg gliotoxin/6.2 x 10(8) spores) was determined. All nine spore extracts, however, turned out to be cytotoxic and in this case the MTT assay was remarkably more sensitive than the two other test methods. The IC50 values of six different spore extracts determined by the MTT assay were lower than 10(6) spores/well (well = 0.2 ml) whereas the IC50 values determined by the MB assay and PTGT were higher than 10(6) spores per 0.2 ml for each spore extract. An examination of four spore extracts, which were fractionated depending on their polarity by HPLC, showed that single substances as well as synergistic effects contribute to the toxic properties of the spores. The results of this work indicate a health hazard due to toxic effects after the inhalation of extremely high spore concentrations of indoor moulds. This risk will also exist if the spores do not contain any mycotoxins.

PMID: 15330395 [PubMed - indexed for MEDLINE]

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Liver cells respond to Aspergillus fumigatus with an increase in C3 secretion and C3 gene expression as well as an expression increase in TLR2 and TLR4.

Wright MS, Clausen HK, Abrahamsen TG.

Department of Pediatric Research, Rikshospitalet University Hospital, N-0027 Oslo, Norway. marianne.wright@klinmed.uio.no

Fungal infections by molds like Aspergillus fumigatus are an increasing health problem which can be fatal in immuno-compromised patients. In healthy individuals, these infections are easily eliminated by the innate and acquired immune system. Complement factor 3 (C3) has a key place within the complement cascade and C3 RNA expression can therefore be used to monitor an impending immune response. Employing a liver cell line (HepG2) as a model system, we have examined their responses to A. fumigatus or beta-glucan, a major component of the fungal wall. C3 RNA expression was increased after stimulation with both LPS and A. fumigatus as well as after incubation with beta-glucan, although with different kinetics. C3 protein release into the supernatant followed an inverse bell-shaped curve when cells were incubated with A. fumigatus or beta-glucan while during LPS stimulation, the release was more stable. HepG2 cells also express Toll-like receptors (TLRs) and both for TLR2 and TLR4, an expression increase was found. These data demonstrate that liver cells are able to react specifically to a fungal pathogen without the help of Kupffer cells.

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PMID: 15325794 [PubMed - indexed for MEDLINE]

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Immunologic reactivity to work-related airborne allergens in people occupationally exposed to dust from herbs.

Golec M, Sk—rska C, Mackiewicz B, Dutkiewicz J.

Department of Occupational Biohazards, Institute of Agricultural Medicine, Jaczewskiego 2, 20-090 Lublin, Poland. msgolec@yahoo.com

A group of 150 people occupationally exposed to dust from herbs were examined. The examined group consisted of 47 thyme farmers, 32 chamomile farmers, 31 sage farmers and 40 workers of herbs processing industry. As a reference group, 50 urban dwellers, not exposed to any kind of organic dust, were examined. Skin prick tests and precipitin tests were conducted with, respectively, 4 and 11 microbial antigens associated with organic dust. Both skin and precipitin tests were also conducted with herbal extracts of chamomile and sage. Precipitin tests were carried out with sera not concentrated and sera 3-fold concentrated. Tests for inhibition of leukocyte migration (MIF) were also conducted with 4 microbial antigens. People occupationally exposed to dust from herbs showed a higher frequency of positive skin reactions to microbial antigens compared to the reference group. The results of precipitin test also revealed greater reactivity to the environmental microbial antigens in the examined group, compared to the reference group. The highest frequency of positive results was noted with the antigen of Pantoea agglomerans (30.6 % with sera not concentrated and 48.3 % with sera 3-fold concentrated) - the difference compared to the reference group (12.0 %) was highly significant (p < 0.01). The frequencies of positive results of MIF test in the examined group were high with all antigens tested: Arthrobacter globiformis (12.6 %), Pantoea agglomerans (11.1 %), Saccharopolyspora rectivirgula (17.0 %), Aspergillus fumigatus (13.3 %), and, compared to the reference group with no positive result for any antigen, all the differences were significant (p < 0.05). In conclusion, the frequency of positive allergological reactions to airborne microorganisms was high in people occupationally exposed to dust from herbs and suggests a potential role of microbial allergens in the pathogenesis of work-related health disorders among herb workers. The risk of sensitization seems to be greatest among thyme farmers, who showed the highest positive response. The results confirmed the particular allergenic importance of Gram-negative bacterium Pantoea agglomerans.

PMID: 15236509 [PubMed - indexed for MEDLINE]

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Airborne fungi in industrial environments--potential agents of respiratory diseases.

Lugauskas A, Krikstaponis A, Sveistyte L.

Institute of Botany, Zaliuju ezeru 49, LT-2021 Vilnius, Lithuania. lugauskas@botanika.lt

Investigations on airborne fungi in a poultry house, a swinery, a feed preparing and storing house, a grain mill, a wooden panel producing factory, and organic waste recycling facilities have been carried out in Lithuania. Low concentrations of fungal spores were detected in the wooden panel producing factory, the swinery, the feed preparing and storing house, and the poultry house; moderate concentrations were found in the organic waste recycling facilities; high concentrations were revealed at the grain mill. Species of Aspergillus oryzae, A. nidulans, P. expansum, Penicillium olivinoviride, P. claviforme and Botryotrichum longibrachiatum prevailed in the poultry farm; Geotrichum candidum, Cladosporium cladosporioides, C. herbarum, Penicillium viridicatum and P. fellutanum dominated in the swinery. Fungi of Penicillium viridicatum, P. expansum, Staphylotrichum coccosporum and Aspergillus oryzae prevailed in the feed preparing and storing house at the swinery. Cladosporium cladosporioides, C. herbarum, Penicillium viridicatum and Geotrichum candidum prevailed in the grain mill. Fungi ascribed as Paecilomyces puntonii, Rhizopus nodosus and R. stolonifer dominated in the wooden panel producing factory. Species of Aspergillus raperi, P. paxilli, P. oxalicum, and Cladosporium herbarum prevailed at the organic waste recycling facilities. According to published data, the majority of the identified fungal species are characterized as allergenic and an exposure to their spores may provoke adverse health effects (such as allergic rhinitis, bronchial asthma or extrinsic allergic alveolitis) in susceptible individuals.

PMID: 15236494 [PubMed - indexed for MEDLINE]

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Ochratoxin A in conventional and organic cereal derivatives: a survey of the Italian market, 2001-02.

Biffi R, Munari M, Dioguardi L, Ballabio C, Cattaneo A, Galli CL, Restani P.

Toxicology Laboratory, Department of Pharmacological Sciences, University of Milan, via Balzaretti 9, I-20133 Milan, Italy.

Ochratoxin A is a mycotoxin produced mainly by Penicillium verrucosum and Aspergillus ochraceus. Although typically considered a cereal contaminant, it has also been detected in dried fruit, nuts, meat and derivatives. To estimate the quantity of ochratoxin A that might be ingested by Italian consumers from these foods, 211 cereal derivatives (flours and bakery products) were analysed by high-performance liquid chromatography. Products were from conventional and organic agriculture and from integrated pest management agriculture. All commercial flours and derivatives examined contained ochratoxin A at concentrations very much below the legal limit (3 microg kg(-1)): the highest value, 0.816 microg kg(-1), was detected in a sample of spelt whole flour from organic agriculture. In many samples, the ochratoxin content was below the limit of detection; only rarely did values exceed 0.5 microg kg(-1). In baby foods, four samples were above the particularly restrictive Italian legal limit of 0.5 microg kg(-1). Although some significant differences were found between samples from conventional and organic agriculture when some product categories were examined (namely, baby foods as semolina and rice creams), no important difference was found between the two types of agricultural practice when all types of cereal derivatives were considered together.

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PMID: 15204537 [PubMed - indexed for MEDLINE]

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Health symptoms caused by molds in a courthouse.

Lee TG.

Faculty of Environmental Design, The University of Calgary, Calgary, Alberta, Canada. lee@ucalgary.ca

A majority of occupants of a newly renovated historic courthouse in Calgary, Alberta, Canada, reported multiple (3 or more) health-related symptoms, and several reported more than 10 persistent symptoms. Most required at least 1 day outside of the building to recover from their symptoms. Molds that produce mycotoxins, such as Stachybotrys chartarum and Emericella nidulans, were identified in the building, along with fungal organisms of the genera Aspergillus, Penicillium, Streptomyces, Cladosporium, Chaetomium, Rhizopus/Mucor, Alternaria, Ulocladium, and Basidiomycetes. Renovations to this historic had building failed to provide adequate thermal and vapor barriers, thus allowing moist indoor air to migrate into the building enclosure, causing condensation to develop. Mold grew on the condensation and was dispersed throughout the courthouse, including on furniture and files. The courthouse was closed and a new facility was modified with low-offgassing materials, better ventilation and air filtration, and strict building maintenance to accommodate those occupants of the older building who had developed multiple chemical sensitivities.

PMID: 15143857 [PubMed - indexed for MEDLINE]

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Antibodies to molds and satratoxin in individuals exposed in water-damaged buildings.

Vojdani A, Thrasher JD, Madison RA, Gray MR, Heuser G, Campbell AW.

Immunosciences Lab, Inc., Beverly Hills, California, USA. immunsci@ix.netcom.com

Immunoglobulin (Ig)A, IgM, and IgG antibodies against Penicillium notatum, Aspergillus niger, Stachybotrys chartarum, and satratoxin H were determined in the blood of 500 healthy blood donor controls, 500 random patients, and 500 patients with known exposure to molds. The patients were referred to the immunological testing laboratory for health reasons other than mold exposure, or for measurement of mold antibody levels. Levels of IgA, IgM, and IgG antibodies against molds were significantly greater in the patients (p < 0.001 for all measurements) than in the controls. However, in mold-exposed patients, levels of these antibodies against satratoxin differed significantly for IgG only (p < 0.001), but not for IgM or IgA. These differences in the levels of mold antibodies among the 3 groups were confirmed by calculation of z score and by ScheffŽ's significant difference tests. A general linear model was applied in the majority of cases, and 3 different subsets were formed, meaning that the healthy control groups were different from the random patients and from the mold-exposed patients. These findings indicated that mold exposure was more common in patients who were referred for immunological evaluation than it was in healthy blood donors. The detection of antibodies to molds and satratoxin H likely resulted from antigenic stimulation of the immune system and the reaction of serum with specially prepared mold antigens. These antigens, which had high protein content, were developed in this laboratory and used in the enzyme-linked immunosorbent assay (ELISA) procedure. The authors concluded that the antibodies studied are specific to mold antigens and mycotoxins, and therefore could be useful in epidemiological and other studies of humans exposed to molds and mycotoxins.

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PMID: 15143855 [PubMed - indexed for MEDLINE]

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PCR-restriction fragment length analysis of aflR gene for differentiation and detection of Aspergillus flavus and Aspergillus parasiticus in maize.

Somashekar D, Rati ER, Chandrashekar A.

Food Microbiology Department, Central Food Technological Research Institute, Mysore-570 013, Karnataka, India.

Contamination of food and feedstuffs by Aspergillus species and their toxic metabolites is a serious problem as they have adverse effects on human and animal health. Hence, food contamination monitoring is an important activity, which gives information on the level and type of contamination. A PCR-based method of detection of Aspergillus species was developed in spiked samples of sterile maize flour. Gene-specific primers were designed to target aflR gene, and restriction fragment length polymorphism (RFLP) of the PCR product was done to differentiate Aspergillus flavus and Aspergillus parasiticus. Sterile maize flour was inoculated separately with A. flavus and A. parasiticus, each at several spore concentrations. Positive results were obtained only after 12-h incubation in enriched media, with extracts of maize inoculated with A. flavus (101 spores/g) and A. parasiticus (104 spores/g). PCR products were subjected to restriction endonuclease (HincII and PvuII) analysis to look for RFLPs. PCR-RFLP patterns obtained with these two enzymes showed enough differences to distinguish A. flavus and A. parasiticus. This approach of differentiating these two species would be simpler, less costly and quicker than conventional sequencing of PCR products. Copyright 2003 Elsevier B.V.

PMID: 15135586 [PubMed - indexed for MEDLINE]

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Phyllanthus piscatorum, ethnopharmacological studies on a women's medicinal plant of the Yanomam• Amerindians.

Gertsch J, Niomaw‘ , Gertsch-Roost K, Sticher O.

Swiss Federal Institute of Technology Zurich, Institute of Pharmaceutical Sciences, Winterthurerstrasse 190, 8057 Zurich, Switzerland. juerg.gertsch@pharma.ethz.ch

The shrub Phyllanthus piscatorum Kunth (Euphorbiaceae) is cultivated by various ethnic groups of the Amazon because of its piscicidal properties. During ethnobotanical fieldwork among the Yanomam• Amerindians in Venezuela we observed that Phyllanthus piscatorum was exclusively cultivated and used by the women. Aerial parts of this herbaceous shrub are employed as fish poison and medicine to treat wounds and fungal infections. In addition, the leaves are used as tobacco substitute. Ethnobotanical data regarding the context of the use of this plant are presented. To validate ethnobotanical information related to its medicinal indications, antimicrobial, and antiprotozoal properties of water, methanol (MeOH) and dichloromethane (DCM) extracts were studied. No activity against Gram-positive bacterial strains but significant activity against the fungi Aspergillus fumigatus, Aspergillus flavus and the yeast Candida albicans were found. All extracts showed weak in vitro activity against Plasmodium falciparum and Trypanosoma brucei rhodesiense. The extracts were further investigated for cytotoxic effects in an in vitro test system with leukemia Jurkat T, HeLa, and human peripheral mononuclear blood cells (PBMCs). During the first 48 h the extracts did not exhibit any cytotoxicity. After 72 h the DCM extract potently inhibited viability of HeLa cells. Although in several communities along the upper Orinoco the cultivation and use of Phyllanthus piscatorum is being lost because of the ongoing acculturation, the traditional medicinal use of Phyllanthus piscatorum might provide an effective and cheap remedy against dermatological diseases linked with Candida albicans infections.

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PMID: 15120438 [PubMed - indexed for MEDLINE]

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Comment on:
Management of invasive aspergillosis in high-risk patients.

Olyaei AJ.

Division of Nephrology and Hypertension, Oregon Health and Science University, Portland, USA.

Invasive aspergillosis can be difficult to diagnose and control, and conventional drug treatment is often highly toxic, producing medical complications that further compromise patients' health status and escalate health care costs. This article describes the clinical manifestations of Aspergillus infection and discusses approaches to its therapy, including newer pharmaceutical agents with fewer adverse effects, which offer the potential to improve outcomes and substantially lower the cost of treating aspergillosis.

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PMID: 15115332 [PubMed - indexed for MEDLINE]

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Erratum in:
  • J Hosp Infect. 2005 Apr;59(4):379.

Invasive aspergillosis in critically ill patients: attributable mortality and excesses in length of ICU stay and ventilator dependence.

Vandewoude KH, Blot SI, Benoit D, Colardyn F, Vogelaers D.

Department of Intensive Care, Ghent University Hospital, De Pintelaan 185 B-9000 Gent, Belgium. koenraad.vandewoude@ugent.be

Invasive aspergillosis is a rare disease in intensive care unit (ICU) patients and carries a poor prognosis. The aim of the present study was to determine the attributable mortality due to invasive aspergillosis in critically ill patients. In a retrospective, matched cohort study (July 1997-December 1999), 37 ICU patients with invasive aspergillosis were identified together with 74 control patients. Matching of control (1:2) patients was based on the acute physiology and chronic health evaluation (APACHE) II classification: an equal APACHE II score (+/-1 point) and diagnostic category. This matching procedure results in an equal expected in-hospital mortality for cases and controls. Additionally, control patients were required to have an ICU stay equivalent to or longer than the case before the first culture positive for Aspergillus spp. Patients with invasive aspergillosis were more likely to experience acute renal failure (43.2% versus 20.5%; P = 0.020). They also had a longer ICU stay (median: 13 days versus seven days; P < 0.001) as well as a more extended period of mechanical ventilator dependency (median: 13 days versus four days; P < 0.001). Hospital mortalities for cases and controls were 75.7% versus 56.8%, respectively (P=0.051). The attributable mortality was 18.9% (95% CI: 1.1-36.7). A multivariate survival analysis showed invasive aspergillosis [hazard ratio (HR): 1.9, 95% CI: 1.2-3.0; P = 0.004] and acute respiratory failure (HR: 6.5, 95%: 1.4-29.3; P < 0.016) to be independently associated with in-hospital mortality. In conclusion, it was found that invasive aspergillosis in ICU patients carries a significant attributable mortality of 18.9%. In a multivariate analysis, adjusting for other co-morbidity factors, invasive aspergillosis was recognized as an independent predictor of mortality.

PMID: 15066736 [PubMed - indexed for MEDLINE]

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Spatiotemporal distribution of airborne mould spores in apartments.

Herbarth O, Schlink U, MŸller A, Richter M.

Department of Human Exposure Research and Epidemiology, TUFZ Centre for Environmental Research Leipzig-Halle, Leipzig, Germany. olf.herbarth@ufz.de

Indoor air contamination with mould spores currently experiences an increasing interest with respect to their relevance to health. To assess adverse health effects, epidemiological studies combine the health outcome of individuals with their concomitant exposure to airborne spores, which is observed, for example, during the current month. While the latter is representative for the studied period, health effects might also be the result of long term-exposure or emerge in consequence of a peak of pollution throughout the year. To consider such questions, additional information about the spatiotemporal distribution of airborne spores is necessary. This paper aims at elucidating the spatial and temporal variation of spore concentrations in Leipzig, Germany. The analysis is based on 1165 matched pairs of indoor and outdoor measurements taken in the period 1998-2002. All data were collected in the frame of previous epidemiological studies and refer to apartments. The analysis comprised spore concentrations (as CFU m(-3) in air) of the most important genera, such as Penicillium, Aspergillus, Alternaria, Mucorales, Cladosporium, and also for yeasts. We found two groups of fungi differing in their spatiotemporal distribution. As this behaviour can be explained by the predominant origin and growing conditions, we call them indoor-relevant and outdoor-relevant genera. Penicillium species are a representative of the former group, while the latter is well represented by Cladosporium. In the studied period we did not observe a clear trend in the spore concentration. Outdoors there is a year-to-year variation of Cladosporium spore concentrations, which follow the prevalent climatic conditions. For the spore concentration of the outdoor-relevant group a significant annual cycle was observed. Highest concentrations occurred during the summer months and were about 100 x the winter burden. That means, for a direct comparison of measurements of spore concentrations taken during different months the season has to be considered. We summarise the findings in a seasonal model, which is fitted to our measurements. Based on the model we developed a procedure for seasonal adjustment, which enabled us to estimate the annual peak spore concentration utilising one monthly observation.

PMID: 15000238 [PubMed - indexed for MEDLINE]

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Chronic bilateral otomycosis caused by Aspergillus niger.

Mishra GS, Mehta N, Pal M.

Department of ENT, Shree Krishna Hospital and Pramukhswami Medical College, Karamsad, Gujarat, India. dakshagiri@yahoo.com

Aspergillus niger, an opportunistic filamentous fungus, was identified as the cause of chronic bilateral otomycosis in a 46-year-old female patient who was unresponsive to different drugs. The patient showed signs of erythema, otalgia, itching, otorrhoea and presence of greyish black coloured mass in both the ear canals. The direct microscopical examination of the ear debris in potassium hydroxide preparations, Giemsa, phase contrast and Gram revealed many thin, branched septate hyphae, condia and conidiophores morphologically indistinguishable from Aspergillus spp. The histopathological section of the ear wax mass by haematoxylin and eosin and periodic acid-Schiff techniques also showed similar fungal elements. The patient responded to 1% solution of mercurochrome. The use of mercurochrome in developing countries like India may be recommended to treat the fungal otitis in patients. We also emphasize that 'Narayan' stain should be routinely employed by microbiology and public health laboratories to study the morphology of pathogenic fungi.

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PMID: 14998406 [PubMed - indexed for MEDLINE]

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Burden of hospitalization of patients with Candida and Aspergillus infections in Australia.

Slavin M, Fastenau J, Sukarom I, Mavros P, Crowley S, Gerth WC.

Infectious Diseases, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia.

OBJECTIVES: This study examined the burden of hospitalization of patients with Aspergillus and Candida infections in Australia from 1995 to 1999. METHODS: Data were extracted from the National Hospital Morbidity Database. A hospitalization with an aspergillosis diagnosis was defined as any discharge with a diagnosis of aspergillosis. A hospitalization with a candidiasis diagnosis was defined as any discharge with a diagnosis of disseminated, invasive, or non-invasive candidiasis. Outcome measures included number of hospitalizations, length of stay (LOS), cost (AUS$), and mortality. RESULTS: 4583 hospitalizations with an aspergillosis diagnosis and 57,758 hospitalizations with a candidiasis diagnosis were identified. These hospitalizations were associated with a total of 813,398 hospital days, AUS$563 million in cost, and 4967 in-hospital deaths during the study period. The mean LOS for a hospitalization with an aspergillosis diagnosis was 12 days, cost AUS$9,334, and was associated with 8% mortality. For disseminated, invasive, and non-invasive candidiasis, the respective mean LOS were 31, 17, and 12 days; costs were AUS$33,274, AUS$12,954, and AUS$7,694; and mortality was 26%, 9%, and 8%. CONCLUSIONS: Hospitalizations with diagnoses for fungal infections were associated with lengthy hospital stays, high costs, and high mortality.

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PMID: 14732329 [PubMed - indexed for MEDLINE]

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Concentration and species diversity of airborne fungi near busy streets in Lithuanian urban areas.

Lugauskas A, Sveistyte L, Ulevicius V.

Institute of Botany, Laboratory of Biodeterioration Research, Zaliuju ezeru 49, LT-2021 Vilnius, Lithuania. lugauskas@botanika.lt

The investigations on air pollution in industrial cities of Lithuania: Vilnius, Alytus, Kaunas, Marijampole and Elektrenai were aimed at detecting the presence of fungi and aerosol particles during different seasons of the year. Sampling of fungal spores was carried out at 20 sampling sites. Active air sampling was performed simultaneously with the use of passive sedimentation plates. Data on the spread of various micromycete species in the air of cities contaminated with various pollutants are presented. Micromycetes of 430 species belonging to 165 genera, 19 families, 13 orders, 4 classes, and 3 phylla were isolated and identified. We found 21 species, 11 genera, 7 families from Ascomycota, 6 species, 1 genus, 1 family from Oomycota, 45 species, 15 genera, 8 families from Zygomycota. Mitosporic fungi comprised 138 genera, 358 species, and comprised the vast majority of identified species: 358 out of 430 (83.25 %). Conditionally pathogenic species were also isolated. It was concluded that the abundance of such fungi as Aspergillus niger, A. fumigatus, Cladosporium herbarum, Alternaria alternata, Aureobasidium pullulans in the air can be a significant criterion for the evaluation of air pollution.

PMID: 14677918 [PubMed - indexed for MEDLINE]

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An environmental assessment of mold concentrations and potential mycotoxin exposures in the greater Southeast Texas area.

Khan NN, Wilson BL.

Department of Chemistry, Texas Southern University, Houston, Texas 77004, USA.

An assessment of indoor air quality in homes from the greater Houston and Southeast Texas area was sampled over a three-month period to ascertain the potential toxic exposure to molds and mycotoxins. In 2001 Houston experienced widespread flooding due to Tropical Storm Allison. The slow receding waters allowed molds to proliferate to great levels and affected many homes and businesses in and around the Houston area. Source (air) and surface (swab, tape, and bulk) samples were taken in fungal contaminated residences to measure the amounts of airborne and surface contaminants. Indoor airborne counts of fungal spores that were identified to be 80% or more of the outside counts of similar fungal genera were classified as indoor air contaminants. This study identified species of Aspergillus, Penicilliulm, and Cladosporium at levels ranging from 80% to 20 times greater than the corresponding outdoor readings in the greater Southeast Texas area. Aspergillus and Penicillium species are considered potentially toxic to humans at elevated levels due to their ability to produce mycotoxins. Cladosporium is considered nonpathogenic, but can still cause allergenic reactions from hyphal fragments. Surface sampling which is utilized for identification of visible mold contaminants, identified species of Aspergillus. Penicillium, Chaetomium, Cladosporium, and Stachybotrys ranging from 1 to 100 total colony counts (1-100% for tape and bulk noncultured assays) contingent upon the extent of visual contamination. The numerical values from surface sampling were used primarily to identify the degree of visual contamination, as well as, identify any molds that may have been too heavy to become aerosolized.

PMID: 14672314 [PubMed - indexed for MEDLINE]

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Mold-specific immunoglobulin G antibodies in a child population.

Korppi M, Laitinen S, Taskinen T, Reiman M, Nevalainen A, Husman T.

Department of Paediatrics, Kuopio University and University Hospital, Kuopio, Finland. matti.korppi@kuh.fi

The determination of immunoglobulin G (IgG) antibodies to molds has been used as an objective evidence of significant mold exposure. Until present, no data have been published on antibody responses to molds in healthy children living in normal housing conditions. The microbe-specific IgG antibody concentrations of 21 molds and 3 actinobacteria were determined by enzyme-linked immunosorbent assay (ELISA) in 103 1- to 6-year-old children (12.4% of the population of that age), and in 111 7- to 14-year-old school children (12.1%). The international standard sera were available, and the IgG concentrations of the test sera could be expressed in mg/l. On average, IgG concentrations increased in relation to age until the age of 6-7 years. At school age the increase still continued but more slowly. Actinobacteria were the only exceptions; all three tested strains Sreptomyces albus, S. griseus and S. halstedii resulted in rather high concentrations until 3 years of age. If the children lived in a farm, mold-specific IgG concentrations increased at an earlier age than in other children. The results between farmers' children and other children differed significantly before school age for 20 of the 24 microbes tested, the four exceptions being the 3 actinobacteria and the mold Aspergillus versicolor. The reference values must be age related, and separate references are needed for farmers' children before school age.

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PMID: 14641607 [PubMed - indexed for MEDLINE]

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An assessment of the genotoxicity and human health risk of topical use of kojic acid [5-hydroxy-2-(hydroxymethyl)-4H-pyran-4-one].

Nohynek GJ, Kirkland D, Marzin D, Toutain H, Leclerc-Ribaud C, Jinnai H.

L'Oreal Recherche, Corporate Safety, 25-29, quai Aulagnier, 92600 Asnires, France. gnohynec@recherche.loreal.com

Kojic acid (KA), a natural substance produced by fungi or bacteria, such as Aspergillus, Penicillium or Acetobacter spp, is contained in traditional Japanese fermented foods and is used as a dermatological skin-lightening agent. High concentrations of KA (>or=1000 microg/plate) were mutagenic in S. typhimurium strains TA 98, TA 100, TA 1535, TA102 and E. coli WP2uvrA, but not in TA 1537. An Ames test following the "treat and plate" protocol was negative. A chromosome aberration test in V79 cells following a robust protocol showed only a marginal increase in chromosome aberrations at cytotoxic concentrations after prolonged (>or=18 h) exposure. No genotoxic activity was observed for hprt mutations either in mouse lymphoma or V79 cells, or in in vitro micronucleus tests in human keratinocytes or hepatocytes. All in vivo genotoxicity studies on KA doses were negative, including mouse bone marrow micronucleus tests after single or multiple doses, an in vivo/in vitro unscheduled DNA synthesis (UDS) test, or a study in the liver of the transgenic Muta(TM) Mouse. On the basis of pharmacokinetic studies in rats and in vitro absorption studies in human skin, the systemic exposure of KA in man following its topical application is estimated to be in the range of 0.03-0.06 mg/kg/day. Comparing these values with the NOAEL in oral subchronic animal studies (250 mg/kg/day), the calculated margin of safety would be 4200- to 8900-fold. Comparing human exposure with the doses that were negative for micronuclei, UDS and gene mutations in vivo, the margins of safety are 16000 to 26000-fold. In conclusion, the topical use of KA as a skin lightening agent results in minimal exposure that poses no or negligible risk of genotoxicity or toxicity to the consumer.

PMID: 14630133 [PubMed - indexed for MEDLINE]

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Mould specific IgG antibodies connected with sinusitis in teachers of mould damaged school: a two-year follow-up study.

Patovirta RL, Reiman M, Husman T, Haverinen U, Toivola M, Nevalainen A.

Department of Environmental Health, National Public Health Institute, Kuopio, Finland. riitta.patovirta@ktl.fi

OBJECTIVES: The aim of this study was to describe the relationship between mould exposure induced by moisture damage and mould specific immunoglobulin G antibodies to 20 common mould species and their association with respiratory diseases. MATERIALS AND METHODS: Mould specific immunoglobulin G (IgG) antibodies were monitored in teachers in a follow-up after an extensive mould remediation process in school buildings. IgG antibodies to 20 different microbes were determined from the sera of 26 teachers (19 exposed and 7 references) by enzyme-linked immunosorbent assay (ELISA). The serum samples were drawn twice, firstly at the completion of the remediation in the spring of 1997 and secondly, two years later in the spring of 1999. Health data was collected with self-administered questionnaires. RESULTS: No statistical differences were found in the overall concentrations of 20 mould-specific IgG-antibodies between the study and control groups at the beginning of the study. An association between sinusitis and elevated mould-specific IgG-levels forAspergillus fumigatus, Aspergillus versicolor, Aureobasidium pullulans, Chaetomium globosum, Cladosporium cladosporioides, Phialophora bubakii, Rhodotorula glutinis, Sporobolomyces salmonicolor, Stachybotrys atra, and Tritirachium roseum was found in the study group. CONCLUSIONS: In a two-year follow-up the total concentration of the IgG antibodies for Tr. toseum was lower at the end than at the beginning of the follow-up and this remained significant for the group of teachers with sinusitis. The decrease in mould specific IgG to Cl. cladosporioides, Geotrichum candidum, Ph. bubakii and Rhizopus nigricans was associated with bronchitis. According to our knowledge, this is the first study in which the association between elevated mould specific IgG antibodies and sinusitis was found in the school environment.

Publication Types:
PMID: 14587535 [PubMed - indexed for MEDLINE]

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Familial presentation of occupational hypersensitivity pneumonitis caused by aspergillus-contaminated esparto dust.

Moreno-Ancillo A, Dom’nguez-Noche C, Carmen Gil-Adrados A, Cosmes PM.

Allergy Unit, Hospital Virgen del Puerto, Plasencia, C‡ceres, Spain. alanaro@telefonica.net

Esparto grass (Stipa tenacissima), which is commonly found in the Mediterranean area, has a wide variety of uses. Five plaster workers from the same family developed cough, dyspnea, malaise, and fever after exposure to the esparto fiber used in their work for the previous few years. They showed a significant decrease in symptoms when away from work. Precipitating antibodies against an esparto extract were found in the sera of all patients. Specific IgG antibodies against Aspergillus fumigatus were detected. A. fumigatus was identified after microbiologic evaluation of esparto fiber samples. The dust derived from fungi-contaminated esparto fibers can cause hypersensitivity pneumonitis in exposed subjects. The causative antigen is A. fumigatus. When esparto fibers were strongly contaminated by fungi, all the workers developed a clinical picture compatible with hypersensitivity pneumonitis. The coincidental finding of an occupational and a familiar condition is unusual.

Publication Types:
PMID: 14572421 [PubMed - indexed for MEDLINE]

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Susceptibility and biomarker knowledge for improvement of environmental health.

Salama SA, Au WW.

Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas 77555-1110, USA.

At the international level, environmental health problems are usually most serious in countries that have the least resources to deal with the problems. Therefore, international efforts have been initiated to achieve equitable environmental health globally. One approach is to conduct international collaborative studies. This approach has been successful in the building of scientific infrastructure in these countries so that they can address their own environmental health concerns and to sustain the environmental health programs. Using liver and oral cancers as models for discussion, examples of success in the identification of etiology and the mechanisms for the diseases are provided. For example, biomarkers are used to provide early warning signals for the disease. In addition, the application of the collected information for developing disease prevention and intervention programs is presented. Expertise in genetic susceptibility is used to provide a more precise understanding of the cancer process. With the precise knowledge, the information can potentially be used to screen for high-risk individuals and to develop "designer" intervention procedures against specific biochemical defects. Success in disease prevention is dependent upon multidisciplinary collaborations at the local and international levels.

Publication Types:
PMID: 12971696 [PubMed - indexed for MEDLINE]

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Immediate skin reactivity to histamine and to allergens in cohorts of 9-year-old schoolchildren studied 16 years apart.

Ronchetti R, Villa MP, Pagani J, Martella S, Guglielmi F, Paggi B, Bohmerova Z, Falasca C, Barreto M.

Department of Pediatrics, Second School of Medicine, University La Sapienza, Rome, Italy. ronchetti@uniroma1.it

BACKGROUND: Differing or increasing prevalence of positive allergen skin-prick tests observed in Europe could at least in part be explained by population changes in histamine skin reactivity. These changes would also alter the relationship between positive allergen skin-prick tests and serum IgE. OBJECTIVE: To assess changes in histamine reactivity, allergen skin-prick tests and serum IgE in our geographical setting. METHODS: We compared the outcome of two epidemiological surveys conducted 16 years apart in unselected 9-year-old schoolchildren (170 in 1983 and 176 in 1999) from a semi-rural region in central Italy. Outcome measures were skin-prick tests with two histamine concentrations (10 and 1 mg/mL) and 11 locally relevant allergens; serum total and specific IgE for positive allergens. RESULTS: The two histamine concentrations induced significantly larger mean weal diameters in 1999 than in 1983 (10 mg/mL: 5.28+/-0.82 mm vs. 3.25+/-0.97 mm; P<0.001). Whereas the prevalence of subjects with at least one positive allergen-induced weal reaction (>or=3 mm) increased over the 16 years (from 15.3% in 1983 to 25.6% in 1999), the prevalence of positive skin-prick tests, expressed as the allergen/ histamine weal ratio, remained almost unchanged. A given allergen weal diameter yielded less total (P<0.05 by Student's t-test for cumulative weals <8 mm) and specific (P<0.01 by Student's t-test for weals <3 mm, P<0.05 by Kruskal-Wallis test) serum IgE in 1999 than in 1983. CONCLUSIONS: Although the causes and mechanisms remain unclear, the increased histamine skin reactivity over time is associated with an increase in positive allergen skin-prick tests. In the presence of increased tissue and organ susceptibility to histamine, minute amounts of specific IgE could have important biological consequences.

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PMID: 12956744 [PubMed - indexed for MEDLINE]

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Molds in the homes of asthmatic patients in Isparta, Turkey.

Unlu M, Ergin C, Cirit M, Sahin U, Akkaya A.

Afyon Kocatepe University, Medical School, Department of Chest Disease, Afyon, Turkey.

This study was planned in order to determine the fungal spores in the air of inside the homes of asthmatic patients living in Isparta (from southwest region of Turkey). The seasonal properties of mold spores in the air of homes of 24 asthmatic and 14 control subjects living in the city of Isparta over a period of one year were investigated. Viable molds were recovered from all 38 houses. Twenty different molds were isolated and identified from the indoor air of the houses in which asthmatic patients and controls lived. The most common isolated genera were Penicillium spp. (27.9%), followed by Cladosporium spp. (26.3%), Aspergillus spp. (14.7%) and Alternaria spp. (13.1%) in the indoor air of the houses of asthmatic patients. No differences in colony numbers were observed between asthmatics and control groups. The percentage of molds was higher in kitchens than other parts of the houses such as living rooms and bedrooms (p < 0.05). A seasonal variety of the fungal flora in Isparta city region was observed. It is concluded that viable molds are common in houses in Isparta. Reducing indoor molds may improve the health of individuals with fungal-induced diseases like asthma.

PMID: 12931747 [PubMed - indexed for MEDLINE]

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Active elimination of causative PCDFs/DDs congeners of Yusho by one year intake of FBRA in Japanese people.

Nagayama J, Takasuga T, Tsuji H, Umehara M, Sada T, Iwasaki T.

Laboratory of Environmental Molecular Epidemiology, School of Health Sciences, Faculty of Medicine, Kyushu University, Fukuoka 812-8582.

Thirty-five years have been passing since the outbreak of Kanemi rice oil poisoning, namely, Yusho in the western Japan. However, even now the patients with Yusho have been still suffering from several objective and subjective symptoms. In order to improve or, if possible, to cure the such symptoms, the most important therapeutic treatment is considered to actively excrete the most toxic causative PCDFs/DDs congeners, that is, 2,3,4,7,8-pentachlorodibenzofuran (PenCDF) and 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin (HxCDD) from the bodies of the patients and to reduce their body burdens. In rats, dietary fiber and chlorophyll have been shown to promote the fecal excretion of dioxins and to reduce their levels in rat liver. In this study, we examined whether such kinds of effect were also observed by FBRA, which was the health food and relatively rich with dietary fiber and chlorophyll in nine married Japanese couples. As a result, concentrations of PenCDF and HxCDD on the lipid weight basis in the blood of the FBRA-intake group in which they took 7.0 to 10.5 g of FBRA after each meal and three times a day for one year were more lowered than those in the blood of the non-intake group; Blood levels of PenCDF and HxCDD in the FBRA-intake group were decreased by 30.5 and 33.9%, respectively, and those decreases were 22.0 and 24.5% in the non-intake group. Their total body burdens just before and one year after the study were calculated on the assumptions that the body fat was also contaminated with these congeners at their blood levels on the lipid weight basis and the content of body fat was 20% of the body weight. Then, we computed the average amounts in excretion of PenCDF and HxCDD from the body in both the FBRA-intake and non-intake groups. Consequently, the amounts of excretion of PenCDF and HxCDD in the FBRA-intake group were 2.1 and 1.9 times, respectively, greater than those in the non-intake group. Therefore, FBRA seemed to promote the fecal excretion of PenCDF and HxCDD, the main causative PCDFs/DDs congeners of Yusho, from the human body. We also expect FBRA to reduce their body burdens of patients with Yusho and to improve some objective and subjective symptoms of Yusho patients.

Publication Types:
PMID: 12872712 [PubMed - indexed for MEDLINE]

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Potential risk of acute hepatotoxicity of kodo poisoning due to exposure to cyclopiazonic acid.

Antony M, Shukla Y, Janardhanan KK.

National Environmental Engineering Research Institute (NEERI), CSIR Complex South Kalamassery, Cochin, 693 109, India.

Kodo millet (Paspalum scrobiculatum L.) is a staple food of some sections of people of North India. Consumption of Kodo millet is often found to cause intoxication and poisoning. The grains are frequently infested with Aspergillus tamarii Kita, which produced substantial amount of a mycotoxin, cyclopiazonic acid (CPA). Investigations were carried out to evaluate the hepatotoxic/preneoplastic changes in rat liver following single and multiple dose administration of CPA. Results showed a marked increase in the activity of glutamate pyruvate transaminase (GPT) and glutamate oxaloacetate transaminase (GOT) following CPA exposures, suggesting acute hepatotoxicity. Significant increase was also observed in gamma glutamyl transpeptidase (GGT) activity following CPA exposures, indicating preneoplastic changes in the liver. The results reveal that Kodo poisoning might cause acute hepatotoxicity in men and animals. The findings thus suggest that the consumption of contaminated Kodo millet is a serious health hazard due to exposure to CPA produced by Aspergillus tamarii associated with the millet.

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PMID: 12860310 [PubMed - indexed for MEDLINE]

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Effective protection of allogeneic stem cell recipients against Aspergillosis by HEPA air filtration during a period of construction--a prospective survey.

KrŸger WH, Zšllner B, Kaulfers PM, Zander AR.

Bone Marrow Transplantation Centre, University-Hospital Hamburg-Eppendorf, Germany. william.krueger@uni-greifswald.de

High incidence of aspergillosis on transplant units or hematological wards without HEPA air conditioning during periods of demolishing or construction has been reported by several investigators. Here we report monitoring of fungal air contamination during a period of construction on a stem cell transplantation ward using the gravity air-setting plate (GASP) method. Fungal air contamination in HEPA-conditioned patient rooms was constantly low, independent from construction activity. Outside of the patient rooms at the ward's corridor, the fungal load was significantly higher with some peak values. Outside the transplant unit measures of construction led to a significant increase of fungal spore concentration in air. Transplant activity was not reduced during construction and patients were nursed strictly under HEPA conditions. Patients were monitored prospectively for incidence of infections since 1990 and data of patients grafted during construction (n = 28) were compared to those grafted outside building activity (n = 652). An increase of aspergillosis during construction could be clearly excluded. It can be concluded: Nursing of patients undergoing stem cell transplantation in HEPA-conditioned rooms is an effective protection against acquisition of aspergillus-infection, even under environmental conditions with increased air contamination by conidia. The gravity air-setting plate (GASP) method is not expensive and easy to use and allows reliable and quantitative aerobiological spore monitoring.

PMID: 12857371 [PubMed - indexed for MEDLINE]

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Opportunistic mycelial fungal infections in organ transplant recipients: emerging importance of non-Aspergillus mycelial fungi.

Husain S, Alexander BD, Munoz P, Avery RK, Houston S, Pruett T, Jacobs R, Dominguez EA, Tollemar JG, Baumgarten K, Yu CM, Wagener MM, Linden P, Kusne S, Singh N.

University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

To determine the spectrum and impact of mycelial fungal infections, particularly those due to non-Aspergillus molds, 53 liver and heart transplant recipients with invasive mycelial infections were prospectively identified in a multicenter study. Invasive mycelial infections were due to Aspergillus species in 69.8% of patients, to non-Aspergillus hyalohyphomycetes in 9.4%, to phaeohyphomycetes in 9.4%, to zygomycetes in 5.7%, and to other causes in 5.7%. Infections due to mycelial fungi other than Aspergillus species were significantly more likely to be associated with disseminated (P=.005) and central nervous system (P=.07) infection than were those due to Aspergillus species. Overall mortality at 90 days was 54.7%. The associated mortality rate was 100% for zygomycosis, 80% for non-Aspergillus hyalohyphomycosis, 54% for aspergillosis, and 20% for phaeohyphomycosis. Thus, non-Aspergillus molds have emerged as significant pathogens in organ transplant recipients. These molds are more likely to be associated with disseminated infections and to be associated with poorer outcomes than is aspergillosis.

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PMID: 12856215 [PubMed - indexed for MEDLINE]

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Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).

Sehulster L, Chinn RY; CDC; HICPAC.

Division of Healthcare Quality Promotion, National Center for Infectious Diseases.

The health-care facility environment is rarely implicated in disease transmission, except among patients who are immunocompromised. Nonetheless, inadvertent exposures to environmental pathogens (e.g., Aspergillus spp. and Legionella spp.) or airborne pathogens (e.g., Mycobacterium tuberculosis and varicella-zoster virus) can result in adverse patient outcomes and cause illness among health-care workers. Environmental infection-control strategies and engineering controls can effectively prevent these infections. The incidence of health-care--associated infections and pseudo-outbreaks can be minimized by 1) appropriate use of cleaners and disinfectants; 2) appropriate maintenance of medical equipment (e.g., automated endoscope reprocessors or hydrotherapy equipment); 3) adherence to water-quality standards for hemodialysis, and to ventilation standards for specialized care environments (e.g., airborne infection isolation rooms, protective environments, or operating rooms); and 4) prompt management of water intrusion into the facility. Routine environmental sampling is not usually advised, except for water quality determinations in hemodialysis settings and other situations where sampling is directed by epidemiologic principles, and results can be applied directly to infection-control decisions. This report reviews previous guidelines and strategies for preventing environment-associated infections in health-care facilities and offers recommendations. These include 1) evidence-based recommendations supported by studies; 2) requirements of federal agencies (e.g., Food and Drug Administration, U.S. Environmental Protection Agency, U.S. Department of Labor, Occupational Safety and Health Administration, and U.S. Department of Justice); 3) guidelines and standards from building and equipment professional organizations (e.g., American Institute of Architects, Association for the Advancement of Medical Instrumentation, and American Society of Heating, Refrigeration, and Air-Conditioning Engineers); 4) recommendations derived from scientific theory or rationale; and 5) experienced opinions based upon infection-control and engineering practices. The report also suggests a series of performance measurements as a means to evaluate infection-control efforts.

Publication Types:
PMID: 12836624 [PubMed - indexed for MEDLINE]

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[Ochratoxin A and human health]

[Article in Chinese]

Li F, Ji R.

Institute of Nutrition and Food Safety, Chinese Center for Disease Control and Prevention, Beijing 100021, China.

Ochratoxin A (OA) is produced mainly by Penicillium verrucosum, Aspergillus ochraceus and A. carbonarius and it was found as a contaminant in the large number of agricultural commodities, feedstuffs and animal organs such as kidney and liver of pig. Toxicological studies indicated that OA is a teratogenic, mutagenic and carcinogenic mycotoxin with the strong toxic effects on liver and kidney. In some endemic areas in the world, OA was suspected to be related to swine nephropathy and has been detected in blood samples from inhabitants in these areas as well. More and more attention was paid to the relationship between the consumption of food contaminated with OA and human health. In this paper, OA--producing fungi, the contamination of it to the agricultural commodities, its toxicity and risk assessment are reviewed.

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PMID: 12793017 [PubMed - indexed for MEDLINE]

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[Occupational ophthalmology and ergoophthalmology: a developing field]

[Article in Italian]

Piccoli B, Zambelli PL, Grosso D, Assini R.

Dipartimento di Medicina del Lavoro Clinica del Lavoro L. Devoto, Universitˆ degli Studi di Milano.

In 1979 it was decided to activate, within the Institute of Occupational Health of the Milan "Universitˆ degli Studi", a new Unit of Ergophthalmology. This decision was taken owing to the progressive diffusion of "optical instruments", particularly computer-based equipment, in the world of work and to the relevance that this topic assumed among Italian occupational physicians. Since its beginning, one of the main characteristics of the Ergophthalmology Unit was an interdisciplinary approach, where occupational physicians, ophthalmologists, occupational hygienists and lighting engineers were collaborating on a daily basis. Research activities, which developed over many years and in several phases, were concerned with four main topics: 1. analysis and quantification of "near work load"; initially the investigations were mainly aimed at the evaluation of the observation distance in different tasks, followed by the development of a method which, by means of specifically designed electronic equipment, allows quantification of the accommodation and convergence required by the task; 2. development of a new method aimed at evaluating, by a photometric procedure, the luminance ratios in the "occupational visual field"; this research was carried out, both in the laboratory and during on-site investigations, in collaboration with the Dept. of Electrotechnics of Milan Polytechnic; 3. studies on the relationships between indoor microbial pollution and Computer Assisted Design work, considering that ocular conjunctiva and cornea, due to their external position, can be easily inoculated by micro-organisms present on periocular tissue and hands; this research showed that bacteria and fungi pathogenic for the eye (Staphylococcus aureus, Candida sp., Aspergillus sp.) are present on desk, keyboard and mouse, as well as in the conjunctival sac of the exposed operators; 4. studies on "blue light" and its effects on the Pigmented Retinal Epithelium (PRE) in workers exposed to halide lamps, like electricians, installers, maintenance staff, polymerization operators, etc.; the laboratory and on-site investigation that was carried out in cooperation with the Health Physics Dept. of the Milan ICP Hospital, showed that long-term exposure to low levels of irradiation could constitute an eye risk for these working populations.

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PMID: 12768961 [PubMed - indexed for MEDLINE]

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Prevalence of otomycosis in outpatient department of otolaryngology in Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

Pradhan B, Tuladhar NR, Amatya RM.

Department of Otolaryngology-Head and Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. bibhuduga@yahoo.com

Otomycosis is a not-uncommon clinical problem encountered in our otolaryngology practice. We report 100 diagnoses (107 ears) of otomycosis, of which, on microbiological examination, 87 specimens (81.3%) showed positive fungal cultures. Of these, a single isolate was found in 85 cases (79.4%), mixed isolates were found in 2 cases, and 20 cases (18.7%) had no growth. The most common fungal pathogen found was Aspergillus, followed by Candida albicans. The causative factors for otomycosis were examined. The results of treatment with clotrimazole were analyzed.

PMID: 12731637 [PubMed - indexed for MEDLINE]

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Effects of bioaerosol polluted outdoor air on airways of residents: a cross sectional study.

Herr CE, Zur Nieden A, Jankofsky M, Stilianakis NI, Boedeker RH, Eikmann TF.

Institute of Hygiene and Environmental Medicine, Medical Centre, Faculty of Medicine, Justus-Liebig-University of Giessen, Germany. caroline.herr@hygiene.med.uni-giessen.de

BACKGROUND: Bioaerosol pollution of workplace and home environments mainly affects airways and mucous membranes. The effect of environmental outdoor residential bioaerosol pollution, for example, livestock holdings, farming, and waste disposal plants, is unclear. AIMS: To investigate the perceived health of residents living in areas with measurable outdoor bioaerosol pollution (for example, spores of Aspergillus fumigatus and actinomycetes), and effects of accompanying odours. METHODS: In a cross sectional study, double blinded to ongoing microbial measurements, doctors collected 356 questionnaires from residents near a large scale composting site, and from unexposed controls in 1997. Self reported prevalence of health complaints during the past year, doctors' diagnoses, as well as residential odour annoyance were assessed. Microbiological pollution was measured simultaneously in residential outdoor air. RESULTS: Concentrations of >10(5) colony forming units of thermophilic actinomycetes, moulds, and total bacteria/m(3) air were measured 200 m from the site, dropping to near background concentrations within 300 m. Positive adjusted associations were observed for residency within 150-200 m from the site versus unexposed controls for self reported health complaints: "waking up due to coughing", odds ratio (OR) 6.59 (95% confidence interval (CI) 2.57 to 17.73); "coughing on rising or during the day", OR 3.18 (95% CI 1.24 to 8.36); "bronchitis", OR 3.59 (95% CI 1.40 to 9.4); and "excessive tiredness", OR 4.27 (95% CI 1.56 to 12.15). Reports of irritative airway complaints were associated with residency in the highest bioaerosol exposure, 150-200 m (versus residency >400-500 m) from the site, and period of residency more than five years, but not residential odour annoyance. Lifetime prevalence of self reported diseases did not differ with exposure. CONCLUSIONS: Bioaerosol pollution of residential outdoor air can occur in concentrations found in occupational environments. For the first time residents exposed to bioaerosol pollution were shown to report irritative respiratory complaints similar to mucous membrane irritation independently of perceived odours.

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PMID: 12709518 [PubMed - indexed for MEDLINE]

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Mycotoxins of aspergilli: exposure and health effects.

Reijula K, Tuomi T.

Finnish Institute of Occupational Health, Uusimaa Regional Institute, Arinatie 3 A FIN-00370 Helsinki, Finland. kari.reijula@occuphealth.fi

Mycotoxins derived from Aspergilli can be encountered both in domestic and occupational environments, and the exposure may lead to severe health hazards. Several Aspergillus species are associated with mycotoxin production: A. ochraceus with ochratoxin A, A. fumigatus with fumitremorgins, gliotoxin and verrucologen, A. versicolor with sterigmatocystin, and A. flavus and A. parasiticus with aflatoxins. Sterigmatocystin may also be produced by A. flavus, A. nidulans, A. rugulosus, and A. unguis. Exposure to mycotoxin may occur via enteric, inhalation or direct contact to skin and mucosa. Acute and chronic disorders, irritation, systemic reactions and even cancer may develop after the exposure to these toxins. Mycotoxins act as immunosuppressants which may be in association with an increased prevalence of repeated infections found among the inhabitants of buildings with moisture problems.

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PMID: 12700107 [PubMed - indexed for MEDLINE]

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Stachybotrys chartarum (chartarum = atra = alternans) and other problems caused by allergenic fungi.

Chapman JA.

Stachybotrys chartarum is a cellulose-decaying fungus with worldwide distribution. It grows well at room temperature and with humidity above 93%. S. chatarum requires special media high in cellulose and low in sugar and nitrogen to compete with Penicillium and Aspergillus. Ninety percent of field-collected spores are not culturable. S. chartarum can produce macrocyclic trichothecenes but is highly dependent on strain and environmental conditions. In strains implicated in mycotoxicosis, not all produce detectable trichothecenes. Therefore, the presence of S. chartarum is not proof of toxin presence. Trichothecenes are potent inhibitors of protein and DNA synthesis. By the inhalation route, occupational stachybotrytoxicosis causes chest and upper airway symptoms, fever, leucopenia, dermatitis; starts in 2-3 days of exposure; and lasts 3 weeks. Investigation of the environment of the cluster of pulmonary hemorrhage in 10 infants in Cleveland, Ohio, and similar cases elsewhere are presented. The Centers for Disease Control and Prevention considers S. chartarum a serious health threat. However, even though there are now techniques of measuring S. chartarum conidia and estimating trichothecene mycotoxin in indoor air samples, no standards exist that relate to health effects. Those standards available are numerical or comparison of indoor/outdoor counts or both. Upper limit of noncontaminated indoor environment is 100-1000 colony-forming units (CFU) m3. There is no compelling evidence that exposures expected in most mold-contaminated indoor environments are likely to result in measurable health effects. However, when the health care worker suspects a problem in the home environment, a questionnaire and home visit may be helpful. High indoor exposures are associated with infrequent ventilation or vacuuming, pets, visible mold, and old carpets. To screen the indoor air, an experienced pollen and mold counter could use a Burkard personal air sampler. Health-based exposure standards for molds and mycotoxins do not exist. When available data indicate extremely high mold levels, cleanup consisting of removal of all contaminated material, cleaning accessible heating, ventilation, and airconditioning parts and filters, and preventive maintenance are indicated. There is a brief summary of the diseases of plants, animals, and humans caused by several common allergenic fungi and the mycotoxins they produce.

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PMID: 12635571 [PubMed - indexed for MEDLINE]

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Reproductive tract infections among married women in Upper Egypt.

Sullam SA, Mahfouz AA, Dabbous NI, el-Barrawy M, el-Said MM.

Department of Epidemiology, High Institute of Public Health, University of Alexandria, Alexandria, Egypt.

In a house-to-house survey using cluster sampling, 1344 married women from urban and rural areas of Upper Egypt (Minia, Assiut and Sohag) were interviewed and examined to study the magnitude and determinants of reproductive tract infections. Overall prevalence was found to be 52.8%, with the most prevalent forms being Candida albicans (28.0%), Trichomonas vaginalis (8.7%), Aspergillus species (7.4%), streptococci (4.6%) and Chlamydia trachomatis (4.2%). Multivariate analysis identified certain groups of women at high risk of developing reproductive tract infections (those currently using an intrauterine device, those who regularly practised internal vaginal washing). Discriminant analysis showed that symptoms were of low discriminating value. There is a great need to increase community and women's understanding of reproductive tract infections.

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PMID: 12596963 [PubMed - indexed for MEDLINE]

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Cytotoxic response of Aspergillus fumigatus-produced mycotoxins on growth medium, maize and commercial animal feed substrates.

Wenehed V, Solyakov A, Thylin I, HŠggblom P, Forsby A.

Department of Neurochemistry and Neurotoxicology, Stockholm University, SE-106 91 Stockholm, Sweden. viktoria@neurochem.su.se

The occurrence of mycotoxin-producing moulds in animal feed is a severe problem since the quality of the feed is reduced and thereby both animal and human health can be affected. Aspergillus fumigatus is a common fungus found in improperly stored animal feed and the abundance of spores of the fungus is frequently spread into the air, exposing individuals who stay in areas where the fungus develops. The cytotoxic activities of extracts from three different A. fumigatus-inoculated substrates: (i) CzDox-broth; (ii) maize; and (iii) commercial feed grain as well as from gliotoxin, a mycotoxin produced by A. fumigatus, were studied in vitro using human neuroblastoma (SH-SY5Y) cells. Extracts of cultures from the gliotoxin-producing strain of A. fumigatus possessed cytotoxic activity in the cell system. Pure gliotoxin caused a 20% reduction of total protein content (EC(20)) at 0.12+/-0.02 microM, but also a 20% reduction in the number of neurites per cell body as compared with control cells (ND(20)) at 0.06+/-0.01 microM. The results show that use of the SH-SY5Y cell model is a promising approach for detecting toxic activity in animal feed. Furthermore, the neurite degeneration of gliotoxin has to be investigated for estimation of a potentially neurotoxic risk.

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PMID: 12504172 [PubMed - indexed for MEDLINE]

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Toxin producing micromycetes on fruit, berries, and vegetables.

Lugauskas A, Stakeniene J.

Institute of Botany, Biodestruction Research Laboratory, Vilnius, Lithuania. lugauskas@botanika.lt

In 1999-2001 the investigations on mycological state of stored and sold fruit, berries, and vegetables grown in Lithuania and imported from other countries were performed. The samples of foodstuff were taken from storehouses, various supermarkets, and market places. Such ecological conditions lead to a rapid spreading of micromycetes and contamination of other articles of food stored and sold nearby. On fresh fruit and berries the development of microorganisms is slow. However, microorganisms penetrate into internal tissues of berries and fruit, thus becoming difficult to notice visually. Some microorganisms, especially micromycetes of some species belonging to the Penicillium Link, Aspergillus Mich. ex Fr., and other genera, are able to produce secondary metabolites (mycotoxins) of various compositions that are toxic to plants, animals, and humans. Therefore, the ability of micromycetes to synthesise and excrete toxic secondary metabolites was examined. Considering this issue, 393 micromycete strains ascribed to 54 genera and 176 species were tested. 46 strains were identified as active producers of toxic substances and were selected for further examinations. Most of them belonged to the Penicillium, Aspergillus and Fusarium genera. Their detection frequency on the investigated berries, fruit, and vegetables was determined, and the impact upon warm-blooded animals (BALB/c mice) was tested. Significant changes of the internal organs and blood composition were found in mice infected with toxic micromycetes. In conclusion, it was evidenced that more than 10% of micromycete strains developing on incorrectly-preserved fruit, berries and vegetables, produce toxic secondary metabolites that pose a potential health hazard for people eating or handling the foodstuff.

PMID: 12498588 [PubMed - indexed for MEDLINE]

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Brainstem auditory evoked response in adolescents with acoustic mycotic neuroma due to environmental exposure to toxic molds.

Anyanwu E, Campbell AW, High W.

Center for Immune, Environmental and Toxic Disorders, 25010 Oakhurst, Suite 200, Spring, Texas 77386, USA. eanyanwu@hotmail.com

Indoor air contamination with toxic opportunistic molds is an emerging health risk worldwide. Some of the opportunistic molds include: Stachybotrys chartarum, Aspergillus species (A. fumigatus, A. flavus, A. niger, A. versicolor etc.), Cadosporium, Alternaria, Penicillium, Trichoderma, Fusarium graminearum etc. These molds flourish in homes that are moist and damp. Reports of floods are now evident in many parts of the world. With these global changes in climatic conditions that favor the opportunistic mode of living among these molds, some health authorities are beginning to feel concerned about the diversity and the extent to which opportunistic molds can cause adverse health effects in humans. Mycotoxicosis is the collective name for all the diseases caused by toxic molds. Frequently, we have cases of acoustic neuroma due to mycotoxicity in our Center. Mycotic neuroma probably has not been reported before and the application of brainstem auditory evoked response (BAER) techniques in acoustic mycotic neuroma have not been reported either. The aim of this study, therefore, was to report cases and measurements of acoustic mycotic neuroma in adolescents using the brainstem auditory evoked response. The patients' case history, clinical neurological and neurobehavioral questionnaires were assessed. Then, the BAERs were recorded between Cz and Ai, with a second channel, Cz-Ac. The case histories and the questionnaires were analyzed in conjunction with the outcome of the objective brainstem auditory evoked response measurements. The prevalent subjective findings in the patients were headaches, memory loss, hearing loss, lack of concentration, fatigue, sleep disturbance, facial swelling, rashes, nosebleeds, diarrhea, abdominal pains and respiratory difficulties. Objective BAER showed overall abnormalities in all the patients. Although the waveform abnormalities varied, 1-3 interpeak latencies were abnormal in all the patients. Overall results showed the presence of acoustic mycotic neuroma and confirmed the sensitivity and usefulness of BAER in screening acoustic mycotic neuroma and sensorineural auditory dysfunction.

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PMID: 12467209 [PubMed - indexed for MEDLINE]

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Occurrence and densities of fungi from northern Greek coastal bathing waters and their relation with faecal pollution indicators.

Arvanitidou M, Kanellou K, Katsouyannopoulos V, Tsakris A.

Department of Hygiene, Medical School, Aristotle University of Thessalonoki, Greece.

The objective of this study was to determine the frequency and densities of yeasts and filamentous fungi in coastal water samples as well as their correlation with the indicator bacteria of faecal pollution. The prevalence of fungi was investigated in parallel with the standard pollution indicator microorganisms in 197 marine water samples from six northern Greek prefectures during the bathing season May-October 1999. Filamentous fungi were isolated from all the examined samples and yeasts from 29 (14.7%) of them; among the positive samples, their mean counts were 90.9 and 38.4cfu/100 ml, respectively. A total of 23 genera of filamentous fungi and four genera of yeasts were identified. Prevailing genera of filamentous fungi were Penicillium, Aspergillus and Alternaria spp., whereas Candida spp. was the most frequently isolated yeast. Counts of yeasts were significantly (p < 0.01) correlated with those of total and faecal coliforms, whereas no correlation was found between filamentous fungi and the indicator bacteria of faecal pollution. Significantly higher counts of total and faecal coliforms (p < 0.05), and enterococci (p < 0.001), were found during the months with the higher water temperatures and bather numbers. In the six prefectures, significant differences were observed in the counts of filamentous fungi and yeasts as well as in the counts of all the faecal pollution indicators. The results of this study indicate that coastal water can be a path for contamination of swimmers with yeasts and filamentous fungi and that the pollution indicator microorganisms cannot always predict their presence.

PMID: 12448561 [PubMed - indexed for MEDLINE]

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Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features.

Baddley JW, Salzman D, Pappas PG.

Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, 35294-0006, USA. jbaddley@uab.edu

Fungal brain abscess is an unusual but serious complication associated with solid organ and hematopoietic stem cell transplantation. To examine the epidemiology and clinical features of fungal brain abscess in transplant recipients, we reviewed retrospectively all cases of fungal brain abscess diagnosed during a 3-yr period among 1,620 adult patients who underwent allogeneic or autologous stem cell, liver, heart, lung, or renal transplantation at one institution. Seventeen cases of fungal brain abscess were identified and occurred a median of 140 d post-transplantation. Fungal brain abscess was more common among allogeneic stem cell transplant recipients (p < 0.01). Aspergillus species were most commonly isolated, but unusual, opportunistic molds were also identified. Altered mental status was present in 65% of patients, and multiple brain lesions were commonly seen on imaging studies. Although fungal brain abscess is an uncommon disease in this population, outcome was poor, suggesting that early recognition of this disease might be helpful.

PMID: 12437621 [PubMed - indexed for MEDLINE]

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Spectrum of antimicrobial activity and user acceptability of the hand disinfectant agent Sterillium Gel.

Kampf G, Rudolf M, Labadie JC, Barrett SP.

Scientific Affairs, Bode Chemie GmbH & Co, Melanchthonstr 27, 22525, Hamburg, Germany. guenter.kampf@bode-chemie.de

The antimicrobial efficacy of alcohol-based hand gels has been shown to be significantly less than liquid hand rubs probably because of a lower concentration of alcohol. Sterillium Gel is the first hand gel with 85% ethanol. Its antimicrobial efficacy and user acceptability was studied. Bactericidal activity was tested according to prEN 12054 against Staphylococcus aureus, Enterococcus hirae, Pseudomonas aeruginosa and Escherichia coli (suspension test) and EN 1500 (15 volunteers; four replicates), fungicidal activity according to EN 1275 against Candida albicans and spores of Aspergillus niger (suspension test) and tuberculocidal activity against Mycobacterium terrae using the DGHM suspension test. Virucidal activity was determined in suspension tests based on reduction of infectivity with and without interfering substances (10% fetal calf serum; 0.3% erythrocytes and 0.3% bovine serum albumin). Ninety-six healthcare workers in hospitals in France and the UK used the gel for four weeks and assessed it by filling out a questionnaire. The gel was bactericidal (a reduction factor of > 10(5)-fold), tuberculocidal (reduction factor > 10(5)) and fungicidal (reduction factor > 10(4)) in 30 s. Irrespective of interfering substances the gel inactivated orthopoxvirus and herpes simplex virus type 1 and 2 in 15 s, adenovirus in 2 min, poliovirus in 3 min and papovavirus in 15 min by a factor of > 10(4)-fold. Rotavirus and human immunodeficiency virus were inactivated in 30 s (without interfering substances). Under practical use conditions it was as effective in 30 s as the reference alcohol in 60 s. Most users described the tackiness, aggregation, skin feeling after use and smell as positive or acceptable. A total of 65.6% assessed the new gel to be better than a comparator irrespective of its type (gel or liquid). Overall Sterillium Gel had a unique spectrum of antimicrobial activity. It is probably the first alcohol-based hand gel to pass EN 1500 in 30 s. Due to the excellent acceptance by healthcare workers it may significantly improve compliance for hand hygiene and thereby help to reduce the incidence of nosocomial infection. Copyright 2002 The Hospital Infection Society

PMID: 12392906 [PubMed - indexed for MEDLINE]

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Measuring, monitoring, and reducing medical harm from a systems perspective: a medical director's personal reflections.

Larson EB.

University of Washington Medical Center, and University of Washington School of Medicine, Seattle, Washington 98195-6330, USA. ebl@u.washington.edu

The author describes five critical elements for reducing and, ultimately, preventing harm to patients-from a systems perspective. In the element called leadership and culture, leaders must advocate patient safety as a primary goal and foster an institutional culture where change that promote patient safety can occur. In internal surveillance, systems are established to actively monitor for deviations in quality and guide efforts to engineer risk of harm out of the institution's practices; they can also demonstrate absence of risk or harm. Although incident reporting can be controversial and is sometimes avoided because its use in "blame attacks," etc., it can be valuable if built on a continuous improvement approach and a system approach to error prevention. External surveillance involves the identification and response to "sentinel events," such as wrong-sided surgery, and serves to remind all those involved in care just how risky and unforgiving medical practice can be. Finally, those involved in promoting safety must believe that hazard and risk are not inevitable and can be managed. The author illustrates this approach by describing his hospital's successful efforts to prevent the rise of aspergillus infections during a major hospital construction project. The author closes by describing selected challenges and opportunities to reduce harm from a systems perspective, such as using teams, involving patients and the public, using lessons learned from other industries with strong safety cultures, and using advances in information systems for a variety of safety-oriented tasks.

PMID: 12377673 [PubMed - indexed for MEDLINE]

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Erratum in:
  • J Asthma 2002 Oct;39(7):675. Chopra, Rajkumar Deepti [corrected to Kumar, Raj]; Chopra, Rajkumar Deepti [corrected to Chopra, Deepti].

Evaluation of allergic bronchopulmonary aspergillosis in patients with and without central bronchiectasis.

Kumar R, Chopra D.

Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, India. rajneel44@rediffmail.com

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder induced by Aspergillus species colonizing the bronchial tree. Thirty one patients fulfilling criteria of ABPA were evaluated in the present study. Eleven patients were diagnosed as ABPA-S (serological positive) and 20 patients as ABPA-CB (with central bronchiectasis). The two groups of patients were compared on the basis of clinical, serological, and radiographic observations. Serum anti Aspergillus fumigatus IgG was positive in 72% of cases of ABPA-S and 85% of ABPA-CB patients at the time of presentation. Specific IgE against A. fumigatus and total IgE were significantly lower in ABPA-S (specific IgE= 7.42 IU and total IgE= 1127 ng/mL) as compared to ABPA-CB (specific IgE = 44 IU and total IgE = 2874 ng/mL). The spirometric changes in ABPA-S (normal 80%, mild obstruction 10%, and severe obstruction 10%) were milder than in ABPA-CB (normal 40%, mild obstruction 10%, moderate obstruction 20%, and severe obstruction 30%). These patients were monitored closely for seasonal exacerbation with new pulmonary infiltrates which gave lower recordings in ABPA-S patients. No patient in the ABPA-S group progressed to end-stage lung disease. This may be due to early recognition and treatment. The present data suggest that ABPA-S represents the early stage of an apparently less aggressive form of ABPA than ABPA-CB.

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PMID: 12375705 [PubMed - indexed for MEDLINE]

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Aflatoxin B1 content in patients with hepatic diseases.

L—pez C, Ramos L, Bulacio L, Ramad‡n S, Rodr’guez F.

Centro de Referencia de Micolog’a (CEREMIC), Facultad de Ciencias Bioqu’micas y FarmacŽuticas, Universidad Nacional de Rosario. clopez@fbioyf.unr.edu.ar

Aflatoxins are toxic metabolites of some Aspergillus flavus, A. parasiticus and A. nomius strains that occur in many foods and feeds. There are four major natural occurring aflatoxins: B1, B2, G1 and G2. These toxins can cause illness in human beings and animals. Aflatoxin B1 is the most abundant and toxic member of the family, and it is also the most potent hepatocarcinogen known. In order to estimate the potential human health risk of AFB1, it is useful to measure blood concentration. The presence of aflatoxin B1 in patients was evaluated by high-performance liquid chromatography, in serum samples, obtained from 20 patient volunteers with hepatic disease. Out of the 20 patients, the presence of AFB1 was detected in only one of them, in a concentration of 0.47 ng/cm3. Nevertheless, this result should draw the attention of control organizations in Argentina to the need for a thorough food and feed inspection.

PMID: 12325486 [PubMed - indexed for MEDLINE]

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Indoor air microbes and respiratory symptoms of children in moisture damaged and reference schools.

Meklin T, Husman T, VepsŠlŠinen A, Vahteristo M, Koivisto J, Halla-Aho J, HyvŠrinen A, Moschandreas D, Nevalainen A.

National Public Health Institute, Department of Environmental Health, Department of Environmental Sciences, University of Kuopio, Kuopio, Finland. teija.meklin@ktl.fi

Microbial indoor air quality and respiratory symptoms of children were studied in 24 schools with visible moisture and mold problems, and in eight non-damaged schools. School buildings of concrete/brick and wooden construction were included. The indoor environment investigations included technical building inspections for visible moisture signs and microbial sampling using six-stage impactor for viable airborne microbes. Children's health information was collected by questionnaires. The effect of moisture damage on concentrations of fungi was clearly seen in buildings of concrete/brick construction, but not in wooden school buildings. Occurrence of Cladosporium, Aspergillus versicolor, Stachybotrys, and actinobacteria showed some indicator value for moisture damage. Presence of moisture damage in school buildings was a significant risk factor for respiratory symptoms in schoolchildren. Association between moisture damage and respiratory symptoms of children was significant for buildings of concrete/brick construction but not for wooden school buildings. The highest symptom prevalence was found during spring seasons, after a long exposure period in damaged schools. The results emphasize the importance of the building frame as a determinant of exposure and symptoms.

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PMID: 12244747 [PubMed - indexed for MEDLINE]

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[Mycologic surveillance of the environment for preventive invasive aspergillosis. Proposals for standardization of the methodologies and implementation]

[Article in French]

Gangneux JP, Poirot JL, Morin O, Derouin F, Bretagne S, Datry A, Kauffmann-Lacroix C, Paugam A, Chandenier J, Bouakline A, Bordes M, Chachaty E, Dupeyron C, Grawey I, Lecso G, Lortholary J, Mourlhou P, Nesa D, Saheb F, Cornet M, Vimont AM, Cordonnier C.

CHU de Rennes, Collge hospitalo-universitaire et professionnel de la SociŽtŽ Franaise d'HŽmatologie 2-H™pital Saint-Antoine, Paris, France.

A MAJOR RISK: The infection of immunodepressed patients by Aspergillus-type fungi increases morbidity and mortality, particularly in hematology units or during solid organ transplantation. Although present diagnostic means benefit from the progress over the last years, they remain limited and chemoprophylaxis protocols have still not demonstrated significant efficacy. THE NEED FOR RECOMMENDATIONS: Today, the handling of environmental risks is the only strategy that has proved its efficacy and usefulness. On the basis of administrative recommendations and data from the literature, a multicentric and pluri-disciplinary task force, grouping clinicians, microbiologists and hygienists, has assessed different methods and has proposed recommendations for the standardization and optimization of fungal surveillance of the environment.

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PMID: 12148454 [PubMed - indexed for MEDLINE]

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The epidemiological features and laboratory results of fungal keratitis: a 10-year review at a referral eye care center in South India.

Gopinathan U, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GN.

Jhaveri Microbiology Center, L.V. Prasad Eye Institute, L.V. Prasad Marg, Banjara Hills, Hyderabad 500 034, India. usha@lvpeye.stph.net

PURPOSE: To report the epidemiological features and laboratory results of 1,352 cases of fungal keratitis diagnosed at the L.V. Prasad Eye Institute (LVPEI) in south India. METHODS: The medical and microbiology records of 1,352 culture proven cases (1,354 eyes) of fungal keratitis diagnosed at the LVPEI between January 1991 to December 2000 was retrospectively reviewed for demographic features, risk factors, seasonal variation, and laboratory findings. RESULTS: Males (962) were affected significantly more (p< 0.0001) than females (390). Of 1,352 patients, 853 (64.4%) were in the younger age group (16-49 years). Ocular trauma predisposed to infection in 736 (54.4%) of 1,354 eyes. There was a higher incidence of fungal keratitis during the monsoon and winter than summer. A fungal cause was established by smears of corneal scrapings in 1,277 (95.4%) eyes. The potassium hydroxide preparation (KOH), Calcofluor white (CFW), Gram-, and Giemsa-stained smears revealed fungus in 1,219 (91.0%), 1,224 (91.4%), 1,181 (88.2%), and 1,139 (85.1%) eyes, respectively. Fusarium(506, 37.2%) and Aspergillus species (417, 30.7%) predominated the hyaline fungal spectrum (1,133) and Curvularia species (39, 2.8%) were the highest among the dematiaceous isolates (218). CONCLUSIONS: To the best of our knowledge, this review presents the epidemiological features and laboratory results of the largest series of fungal keratitis ever reported in the literature. Keratomycosis is predominant in young adults with trauma as the major predisposing factor. With fungal keratitis being a major ophthalmologic problem in the tropical regions of the world, data available on the epidemiological features of a large series would greatly help medical practitioners at primary and secondary health care centers in the management of the disease. A simple KOH preparation of corneal scraping alone is highly beneficial in confirming the diagnosis.

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PMID: 12131029 [PubMed - indexed for MEDLINE]

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Indoor exposure to molds and allergic sensitization.

Jacob B, Ritz B, Gehring U, Koch A, Bischof W, Wichmann HE, Heinrich J.

GSF-Institute of Epidemiology, Munich, Germany. beate.jacob@t-online.de

Evidence that indoor dampness and mold growth are associated with respiratory health has been accumulating, but few studies have been able to examine health risks in relation to measured levels of indoor mold exposure. In particular, little is known about the contribution of indoor molds to the development of allergic sensitization. As a part of an ongoing study examining the effects of ambient air pollutants on respiratory health and atopic diseases in German school children, we examined the relation between viable mold levels indoors and allergic sensitization in 272 children. We examined whether allergic sensitization in children is associated with higher fungal spore count in settled house dust sampled from living room floors. Adjusting for age, sex, parental education, region of residency, and parental history of atopy, we found that mold spore counts for Cladosporium and Aspergillus were associated with an increased risk of allergic sensitization. Sensitized children exposed to high levels of mold spores (> 90th percentile) were more likely to suffer from symptoms of rhinoconjunctivitis. We conclude that elevated indoor concentrations of molds in wintertime might play a role in increasing the risk of developing atopic symptoms and allergic sensitization not only to molds but also to other common, inhaled allergens. These effects were strongest in the group of children who had lived in the same home since birth.

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PMID: 12117641 [PubMed - indexed for MEDLINE]

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Ochratoxin a contamination of cereal grains and coffee in Hungary in the year 2001.

Fazekas B, Tar AK, Zomborszky-Kov‡cs M.

Veterinary Institute of Debrecen, H-4031 Debrecen, Bornemissza u. 3-5, Hungary. fazekasb@indigo2.oai.hu

Ochratoxin A (OTA) is a nephrotoxic and carcinogenic mycotoxin, a secondary metabolite produced by mould fungi belonging to several Aspergillus and Penicillium species. It is formed during the storage of cereal grains and other plant-derived products. OTA ingested by humans and animals with the food or feed may exert deleterious effects on health. The purpose of this study was to investigate the ochratoxin contamination of the most important potential sources of OTA. The OTA content of cereal samples for human consumption (36 baking wheat, 16 wheat flour and 6 maize coarse meal samples) and feed grain samples (30 feeding wheat, 32 feeding maize and 20 feeding barley samples) collected in the mid-phase or at the end of the storage period and of 50 commercial coffee samples was determined. The analyses were performed by immunoaffinity column--high-performance liquid chromatography (IAC-HPLC). The limit of detection of the method was 0.1 ng/g. Of the wheat samples intended for human consumption, 8.3% contained OTA at 0.29 ng/g on the average (OTA ranges: 0.12-0.5 ng/g; Table 2). The OTA contamination of wheat flour and maize meal samples for human consumption was similar to that of the baking wheat samples. OTA contamination was found in 26.7% of the feeding wheat, 15.6% of the feeding maize and 35% of the feeding barley samples. The average values and the ranges of OTA levels found in the above samples were 12.2 and 0.3-62.8 ng/g, 4.9 and 1.9-8.3 ng/g, and 72 and 0.14-212 ng/g, respectively (Table 3). Sixty-six percent of the coffee samples were contaminated with OA (average level: 0.57 ng/g, ranges: 0.17-1.3 ng/g; Table 4). OTA contamination of baking wheat samples was found to be relatively low, presumably as a result of the favourable weather at harvest and the optimal storage conditions. Calculations made on the basis of the obtained results show that the daily OTA intake of an adult human from edible cereals is only 6.7 ng, while the amount taken up with coffee is 4.1 ng daily. The high prevalence and high levels of OTA contamination in feed grains can be explained by the unfavourable storage conditions, and this finding suggests that OA-related health problems may arise in animals, and that foods of animal origin may be contaminated with this mycotoxin.

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PMID: 12113173 [PubMed - indexed for MEDLINE]

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Fungal fragments as indoor air biocontaminants.

G—rny RL, Reponen T, Willeke K, Schmechel D, Robine E, Boissier M, Grinshpun SA.

Center for Health-Related Aerosol Studies, Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio 45267-0056, USA.

The aerosolization process of fungal propagules of three species (Aspergillus versicolor, Penicillium melinii, and Cladosporium cladosporioides) was studied by using a newly designed and constructed aerosolization chamber. We discovered that fungal fragments are aerosolized simultaneously with spores from contaminated agar and ceiling tile surfaces. Concentration measurements with an optical particle counter showed that the fragments are released in higher numbers (up to 320 times) than the spores. The release of fungal propagules varied depending on the fungal species, the air velocity above the contaminated surface, and the texture and vibration of the contaminated material. In contrast to spores, the release of fragments from smooth surfaces was not affected by air velocity, indicating a different release mechanism. Correlation analysis showed that the number of released fragments cannot be predicted on the basis of the number of spores. Enzyme-linked immunosorbent assays with monoclonal antibodies produced against Aspergillus and Penicillium fungal species showed that fragments and spores share common antigens, which not only confirmed the fungal origin of the fragments but also established their potential biological relevance. The considerable immunological reactivity, the high number, and the small particle size of the fungal fragments may contribute to human health effects that have been detected in buildings with mold problems but had no scientific explanation until now. This study suggests that future fungal spore investigations in buildings with mold problems should include the quantitation of fungal fragments.

PMID: 12089037 [PubMed - indexed for MEDLINE]

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Bacterial and fungal aerosols in indoor environment in Central and Eastern European countries.

G—rny RL, Dutkiewicz J.

Institute of Occupational Medicine and Environmental Health, 13 Koscielna St., 41-200 Sosnowiec, Poland.

Studies of indoor bioaerosols conducted in Central and Eastern European countries, as a result of the scarcity of funding, mostly do not attain the level presented by similar studies in Northern America and Western Europe. For socio-economic reasons, most of the intense studies on indoor bioaerosols in Central and Eastern European countries were carried out in industrial facilities and have contributed significantly to occupational health science. In contrast, until recently, insufficient of studies have been conducted on bioaerosols of residential and communal premises (dwellings, offices, schools, etc.) and no network for monitoring the microbiological quality of air in such premises exists. In Poland, in the mid-1990s complex bioaerosol investigations were carried out by the Bioaerosol Group at the Institute of Occupational Medicine and Environmental Health in Sosnowiec. The concentrations of airborne bacteria and fungi in dwellings without mold problems were between 88-4297 cfu/m(3) and 0-1997 cfu/m(3), while in moldy homes they were 178-4751 cfu/m(3) and 49-16,968 cfu/m(3), respectively. As many as 167 microbial species were isolated from the air of examined dwellings. Most frequently occurred Gram-positive cocci (Micrococcus/ Kocuria spp., Staphylococcus spp.), endospore-forming bacilli (Bacillus spp.), Gram-negative bacteria (Pseudomonadaceae, Aeromonas spp.), filamentous fungi (Penicillium spp., Aspergillus spp.), and yeasts. Notable studies of indoor bioaerosols have also been performed in the other Central and Eastern European countries: Lithuania, Latvia, Estonia, Russian Federation, Ukraine, Czech Republic, Slovakia, Bulgaria and Hungary, are reviewed in this article. The lack of reference limit values for bioaerosols seriously hinders interpretation of results obtained in various countries. The following residential limit values (RLV) for dwellings and communal premises are proposed for the concentration of airborne bacteria, fungi and bacterial endotoxin: 5 x 10(3) cfu/m(3), 5 x 10(3) cfu/m(3) and 5 ng/m(3) (50 EU), respectively. The proposed values of occupational exposure limit (OEL) for industrial settings contaminated by organic dust are 100 x (3) cfu/m(3), 50 x (3) cfu/m(3) and 200 ng/m(3) (2000 EU), respectively. It is also proposed that the presence in indoor air of microorganisms from risk groups 3 and 4 of European Community Directive 2000/54/EC (e.g., Mycobacterium tuberculosis, Bacillus anthracis, Coxiella burnetii), independently of the concentration, should always be inadmissible and result in preventive actions.

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PMID: 12088392 [PubMed - indexed for MEDLINE]

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Fungal flora in groundwater-derived public drinking water.

Gšttlich E, van der Lubbe W, Lange B, Fiedler S, Melchert I, Reifenrath M, Flemming HC, de Hoog S.

IWW Rheinisch WestfŠlisches Institut fŸr Wasserforschung, MŸlheim an der Ruhr, Germany. goettlich.elke@gmx.net

In order to assess the dissemination of hygienically relevant fungi via the public drinking water distribution system, a 12-month survey was performed on groundwater-derived drinking water from 29 water supplies in North Rhine-Westphalia, Germany. Frequencies of contaminated water samples, and the prevalent species and patterns of occurrence in raw water, waterworks, the network and house installations were studied on the basis of 2657 water samples. Results were obtained by long-term incubation of 1 ml aliquots of water samples on agar-based culture media, following bacteriological procedures documented in the German drinking water regulations (Anon, 1990). No correlation with standard hygiene indicators, such as E. coli or other coliform bacteria was observed. Common opportunistic and allergenic Aspergillus species were encountered only rarely. The fungal flora was dominated by a limited number of species of Acremonium, Exophiala, Penicillium and particularly Phialophora; some of them occurred throughout the entire drinking water system and are thought to constitute a resident fungal flora. Phialophora sp. nov., to be described as a new species elsewhere, was ubiquitous; it was found in 26.6% of the samples positive for fungi (7.5% of 2657). Fungal diversity in the network itself was significantly lower than in raw water and house installations, indicating that not all fungi gaining access to the system are capable of surviving for longer periods. For species such as Verticillium lecanii, found exclusively after the introduction of newly buried pipes and remaining localized at those sites, introduction via arthropod vectors is likely. The resident species of Phialophora, Exophiala and Acremonium are particularly significant as they are shown to be disseminated efficiently by public drinking water.

PMID: 12068746 [PubMed - indexed for MEDLINE]

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Update of survey, regulation and toxic effects of mycotoxins in Europe.

Creppy EE.

Department of Toxicology, University of Bordeaux 2, 146 rue LŽo, Saignat 33076, France. edmond.creppy@tox-bordeaux2.fr

The most frequent toxigenic fungi in Europe are Aspergillus, Penicillium and Fusarium species. They produce aflatoxin B1 transformed into aflatoxin M1 found in the milk, as well as Ochratoxins and Zearalenone, Fumonisin B1, T-2 toxin, HT-2 toxin and deoxynivalenol (vomitoxin), which are of increasing concern in human health. These mycotoxins are under continuous survey in Europe, but the regulatory aspects still need to be set up and/or harmonised at European level. They are found in foodstuffs and are not destroyed by normal industrial processing or cooking since they are heat-stable. Some of their metabolites are still toxic and may be involved in human diseases. Their toxic effects (liver, kidney and hematopoetic toxicity, immune toxicity, reproduction toxicity, foetal toxicity and teratogenicity, and mainly carcinogenicity) are mostly known in experimental models, the extrapolation to humans being always inaccurate. The inaccuracy of extrapolation to humans may be explained by the lack of adequate food consumption data, lack of knowledge about relative health risks associated with specifically proposed limits and by the possibility of synergism with other mycotoxins present in the same food commodities. Other pathological causes are viral hepatitis, immune or hormonal deficiencies or organ dysfunction. Even when a specific biomarker of a given mycotoxin is identified in humans, it remains difficult to establish the relation with a given illness, because of genetic polymorphism and the possible beneficial influence of diet, and because other environmental toxicants may well interfere. The acceptable daily intake limits are mostly based on animal data and may be too high, due to the differences in the sensitivity of different animal species. The prevention involves first reduction of mycotoxin levels in foodstuffs and further increasing the intake of diet components such as vitamins, antioxidants and substances known to prevent carcinogenesis.

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PMID: 12052637 [PubMed - indexed for MEDLINE]

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On ochratoxin A and fungal flora in Polish cereals from conventional and ecological farms - Part 1: occurrence of ochratoxin A and fungi in cereals in 1997.

Czerwiecki L, Czajkowska D, Witkowska-Gwiazdowska A.

Institute of Agricultural and Food Biotechnology, 36, Rakowiecka St., 02-532 Warsaw, Poland. czerwiecki@ibprs.pl

Over 200 samples of Polish cereal grain from the 1997 harvest obtained from conventional and ecological farms were tested for the presence of ochratoxin A as well as for contamination by microscopic fungi. Ochratoxin A contamination of rye from ecological farms was over six times more frequent than that from conventional cultivation. The ochratoxin A content in wheat and barley samples from ecological farms was also higher. No wheat sample from conventional farms contained the mycotoxin. In the group of ecological farms, there were differences in the percentage of cereal samples containing ochratoxin A. The ochratoxin A levels ranged from 0.2 to 57 microg kg(-1). The mean concentration of ochratoxin A in investigated cereal grain was 5.7 microg kg(-1). From samples containing detectable amounts of ochratoxin A, fungi producing ochratoxin A under laboratory conditions were isolated. They were classified as belonging to the species Penicillium cyclopium, P. viridicatum, P. chrysogenum and also Aspergillus alliaceus, A. versicolor, A. glaucus and A. flavus. Penicillium strains - producers of ochratoxin A - were isolated from 93% of the samples; in 7% of samples, only Aspergillus strains producing this mycotoxin were noted. Rye samples mainly from one farm with an ecological type of cultivation and from one conventional farm were contaminated with both Aspergillus and Penicillium mycotoxigenic strains.

Publication Types:
PMID: 12028646 [PubMed - indexed for MEDLINE]

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Microbiology on indoor air '99--what is new and interesting? An overview of selected papers presented in Edinburgh, August, 1999.

Gravesen S.

Energy and Indoor Climate Division, Danish Building Research Institute, Dr. Neergaardsvej 15, DK-2970 H¿rsholm, Denmark. sug@sbi-dk

A multidisciplinary approach to microbiological implications of indoor air is fruitful for research as well as management of health and building problems. The Finnish and the Danish mold programs are examples of such productive collaborative studies. Dust samples taken from classrooms in schools where occupants complain of building-related symptoms (BRS) demonstrated an inflammatory potential in vitro, measured as a release of cytokine interleukin (IL)-8. An increase of the metabolite NO and liberation of tumor necrosis factor (TNF)-alpha and other cytokines during exposure were obtained in vivo, was presented based on these programs and on epidemiological studies on residential fungal contamination and health conducted in Canada and The Netherlands. New methods for assessing fungal exposure are PCA analysis for the toxigenic mold Stachybotrys chartarum and EPS-Asp/Pen for detecting of Aspergillus and Penicillium in dust. Based on a limited data set it is shown that emission rates of fungal spores are inversely proportional to relative humidity (RH), directly related to flow rate and to surface loading. Poor maintenance, risk constructions and risk materials are described in several studies as the main causes of water damage in buildings.

Publication Types:
PMID: 11980105 [PubMed - indexed for MEDLINE]

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Biology and ecology of mycotoxigenic Aspergillus species as related to economic and health concerns.

Wilson DM, Mubatanhema W, Jurjevic Z.

Department of Plant Pathology, University of Georgia, Coastal Plain Experiment Station, Tifton 31793, USA.

The fungal genus Aspergillus was established in 1729, and includes species that are adapted to a wide range of environmental conditions. Many aspergilli produce mycotoxins in foods that may be toxic, mutagenic or carcinogenic in animals. Most of the Aspergillus species are soil fungi or saprophytes but some are capable of causing decay in storage, disease in plants or invasive disease in humans and animals. Major agricultural commodities affected before or after harvest by fungal growth and mycotoxins include corn, peanuts, cottonseed, rice, tree nuts, cereal grains, and fruits. Animal products (meat, milk and eggs) can become contaminated because of diet. Aspergillus flavus, A. parasiticus, A. ochraceus, A. niger, A. fumigatus and other aspergilli produce mycotoxins of concern. These include the aflatoxins and ochratoxins, as well as cyclopiazonic acid, patulin, sterigmatocystin, gliotoxin, citrinin and other potentially toxic metabolites.

Publication Types:
PMID: 11922097 [PubMed - indexed for MEDLINE]

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Risk assessment of ochratoxin: current views of the European Scientific Committee on Food, the JECFA and the Codex Committee on Food Additives and Contaminants.

Walker R.

School of Biological Sciences, University of Surrey, Guildford, UK.

The chlorinated isocoumarin compound, ochratoxin A (OTA), together with some related derivatives (ochratoxins B, C, alpha, beta) are produced by Penicillium verrucosum and by several spp. of Aspergillus, most notably A. ochraceus. P. verrucosum is the principal source of OTA contamination of stored foods in temperate climates while Aspergillus spp. predominate in warmer countries. The major dietary sources of OTA are cereals but significant levels of contamination may be found in grape juice and red wine, coffee, cocoa, nuts, spices and dried fruits. Because of the chemical stability of OTA and long half-life in mammalian tissues, contamination may also carry over into pork and pig blood products and into beer. OTA is potently nephrotoxic and carcinogenic, the potency varying markedly between species and sexes; it is also teratogenic and immunotoxic. There have been different approaches to the risk assessment of OTA in different jurisdictions, largely arising from whether or not the carcinogenicity of OTA is considered to arise through a thresholded or non-thresholded mechanism. Consequently the tolerable intakes have variously been estimated at 100 ng/kg bw/week (JECFA), 1.5 to 5.7 ng/kg bw/day (Canada) and not more than 5 ng/kg bw/day (European Commission). These differences are also reflected in risk management measures that have been implemented or proposed with different maximum contamination levels being applied to different commodities and to the same commodity in different countries. Prevention of contamination at source is considered to be the most effective public health measure. There is also a need to harmonise the risk assessment and management processes to a greater extent than currently exist if barriers to trade are to be avoided.

Publication Types:
PMID: 11922092 [PubMed - indexed for MEDLINE]

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Increased incidence of allergic sensitisation and respiratory diseases due to mould exposure: results of the Leipzig Allergy Risk children Study (LARS).

MŸller A, Lehmann I, Seiffart A, Diez U, Wetzig H, Borte M, Herbarth O.

Department of Human Exposure Research and Epidemiology, UFZ-Centre for Environmental Research Leipzig-Halle Ltd., Permoserstr. 15, PF 02, D-04301 Leipzig, Germany. amueller@expo.ufz.de

To investigate mould effects on health, the concentration of mould spores in air and dust was determined during a prospective cohort study. Clinical outcome was estimated by questionnaires and determination of specific IgE antibodies and intracellular cytokine production of T cells. A significant association was observed between the incidence of respiratory tract infections and exposure to Penicillium spores. Moreover, Aspergillus exposure was found to be associated with allergic rhinitis or related symptoms. In addition, T cells of children exposed to Aspergillus showed a significantly lower content of TH1 cytokines (IFN-gamma, TNF-alpha, IL-2) producing cells. Our data suggest that mould exposure is associated with several effects on health, depending on the species involved.

Publication Types:
PMID: 11885362 [PubMed - indexed for MEDLINE]

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Role of increased environmental Aspergillus exposure for patients with chronic obstructive pulmonary disease (COPD) treated with corticosteroids in an intensive care unit.

Kistemann T, HŸneburg H, Exner M, Vacata V, Engelhart S.

Institute of Hygiene and Public Health, University of Bonn, Sigmund-Freud-Str. 25, D-53105 Bonn, Germany.

We report about a 75-year-old woman and a 62-year-old man hospitalised for infection-related exacerbation of chronic obstructive pulmonary disease (COPD). In both patients, respiratory function worsened after initial stabilisation and the disease took a fatal course. A careful inspection of the intensive care unit (ICU) revealed several circumstances known to be risk factors for invasive aspergillosis (reconstruction activities near to the ICU, contamination of the window sills with pigeon droppings, moist building materials due to water leakage). The case reports suggest that both critically ill patients receiving high dose corticosteroid medication possibly have acquired aspergillosis on account of increased environmental exposure to Aspergillus conidia (> 10(2) CFU/m3 air). However, due to the severity of the disease confirmation by invasive diagnostic procedures was not possible. The role of high dose corticosteroid treatment as a risk factor for invasive aspergillosis should be taken into consideration, and increased exposure to fungi consequently be reduced in health care environments, especially for patients at risk.

Publication Types:
PMID: 11885359 [PubMed - indexed for MEDLINE]

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Invasive aspergillosis in allogeneic stem cell transplant recipients: increasing antigenemia is associated with progressive disease.

Boutboul F, Alberti C, Leblanc T, Sulahian A, Gluckman E, Derouin F, Ribaud P.

Laboratoire de Parasitologie-Mycologie, H™pital Saint-Louis, Paris, France.

The kinetics of serum Aspergillus galactomannan, as determined by enzyme-linked immunosorbent assay, was examined in 37 allogeneic stem cell transplant (SCT) recipients treated for invasive aspergillosis (IA). Fifty-eight periods of response ("response episodes") were evaluated. There were 42 response episodes that were considered "treatment failures" and 16 that were considered "good" (that is, complete or partial) responses. At baseline (the first day of each new response episode), the patients who experienced treatment failure and those who had good responses did not differ significantly with regard to median galactomannan index (GMI) value. Thereafter, GMI values significantly increased in the treatment failure group, whereas no significant changes were observed in the good response group (P=.002). An increase in the GMI value of 1.0 over the baseline value during the first week of observation was predictive of treatment failure with a sensitivity of 44%, a specificity of 87%, and a positive predictive value of 94%. We conclude that serial determination of serum GMI values is a useful tool for assessing prognosis of IA in allogeneic SCT recipients during treatment.

PMID: 11880959 [PubMed - indexed for MEDLINE]

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Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients.

Marr KA, Carter RA, Crippa F, Wald A, Corey L.

Program in Infectious Diseases, Fred Hutchinson Cancer Research Center; and Department of Medicine, University of Washington, Seattle, WA, USA. kmarr@fhcrc.org

Reports have focused on the emergence of moulds as pathogens in recipients of hematopoietic stem cell transplants. To review the incidence of and risks for mould infections, we examined the records of 5589 patients who underwent hematopoietic stem cell transplantation at the Fred Hutchinson Cancer Research Center (Seattle) from 1985 through 1999. After 1992, the incidence of invasive aspergillosis increased in allograft recipients and remained high through the 1990s. Infections with non-fumigatus Aspergillus species, Fusarium species, and Zygomycetes increased during the late 1990s, especially in patients who received multiple transplants. Although infection caused by Scedosporium species was common in patients who had neutropenia, infection caused by Zygomycetes typically occurred later after transplantation, when patients had graft-versus-host disease. The overall 1-year survival rate was equally poor (similar20%) for all patients with mould infections. The results of the present study demonstrate the changing epidemiology of mould infections, emphasizing the increasing importance of amphotericin B--resistant organisms and the differences in risks and outcome of infection with different filamentous fungi.

Publication Types:
PMID: 11880955 [PubMed - indexed for MEDLINE]

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Assessing risk factors for systemic fungal infections.

Maertens J, Vrebos M, Boogaerts M.

Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium. johan.maertens@uz.kuleuven.ac.be

The incidence of invasive fungal infection has increased in recent years. Most infections are caused by Candida albicans and Aspergillus spp. but the emergence of other fungal infections is changing the spectrum of disease. Immunosuppression and breakdown of anatomical barriers such as the skin are the major risk factors for fungal infections. Health care workers encounter at-risk patients in various settings, including AIDS clinics and intensive care, transplantation and oncology units. Patients with prolonged and deep neutropenia (haematological malignancy patients) are most at risk and are therefore most likely to receive prophylactic therapy. Practical measures can be taken to avoid exposing the patient to fungi (air filtration, regular hand washing, avoiding plants and flowers) and antifungal agents can be administered to prevent systemic fungal infection. Most fungal infections have non-specific symptoms; this makes recognition of the signs and symptoms of the disease important but also makes diagnosis difficult and empirical treatment necessary. Some antifungal agents have limitations but new formulations will improve therapy and play a key role in future antifungal strategies.

Publication Types:
PMID: 11827268 [PubMed - indexed for MEDLINE]

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The fungal profile of otomycosis patients in Ilorin, Nigeria.

Nwabuisi C, Ologe FE.

Department of Medical Microbiology, Faculty of Health Sciences, University of Ilorin, P.M.B. 1515, Ilorin, Kwara State.

The pathogenic fungi associated with ear infection among 142 patients with clinical signs of otomycosis are reported. 76(54%) were positive for at least one organism. The isolates included: Aspergillus (63.2%), Candida (35.5%), and Mucor (0.7%). Further analysis showed that Candida species comprised C. albicans (18.4%), C. tropicalis (10.5%), and C. pseudotropicalis (6.6%), while A. fumigatus (39.5%), A. niger (23.7), and Mucor (0.7%), were other significant pathogens. Males and females were almost equally affected, while the preponderance of positive patients (79%) were +21 years old. There were 7(9%) bilateral, 29(38%) left unilateral and 40(53%) right unilateral ear infections respectively. This report has provided useful information on the prevalence, health implications, and preventive measures against causative agents of otomycosis, an infection grossly neglected in our environment.

PMID: 11806011 [PubMed - indexed for MEDLINE]

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Cyclophilins, a new family of cross-reactive allergens.

FlŸckiger S, Fijten H, Whitley P, Blaser K, Crameri R.

Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.

Type I allergic reactions occur by immediate release of anaphylactogenic mediators due to cross-linking of IgE bound to the high-affinity Fc(epsilon)RI on the surface of effector cells of sensitized individuals after allergen exposure. IgE-mediated hypersensitivity against normally innocuous environmental antigens is of clinical importance because of an increasing incidence of asthma and severe atopic diseases causing raising health care burdens to the society. A vast variety of different molecular structures has been shown to be able to induce hypersensitivity reactions. However, the high structural homology between phylogenetically conserved allergenic proteins present in different, apparently unrelated sources of exposure seems to play an important role in IgE-mediated poly-sensitization. These allergen families, formally termed pan-allergens, represent proteins sharing a high degree of sequence homology. Here we report cloning, production and serological investigations of a new pan-allergen family, the cyclophilins, found to be cross-reactive across species including humans. IgE-mediated cross-reactivity against autoantigens may contribute to perpetuation of severe atopic disorders even in the absence of exogenous allergen exposure. The molecular definition of pan-allergen families may substantially contribute to reduce the number of structures needed for diagnosis and therapy of allergic diseases based on highly pure, standardized recombinant allergens.

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PMID: 11753999 [PubMed - indexed for MEDLINE]

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Bioaerosol emissions from a suburban yard waste composting facility.

Hryhorczuk D, Curtis L, Scheff P, Chung J, Rizzo M, Lewis C, Keys N, Moomey M.

Environmental and Occupational Health Sciences, University of Illinois at Chicago, 2121 W. Taylor (M/C 922), Chicago, Illinois 60612, USA. dhryhorc@uic.edu

The purpose of this study was to assess worker and community exposure to bioaerosols emitted from a suburban yard waste composting facility in northern Illinois, USA. Characterization of on- and off-site viable bioaerosols was undertaken through a total of 288 on- and off-site Andersen samples conducted over 10 sampling days. A total of 46 dust samples and 38 Kramer-Collins spore samples were also collected in this period. Evaluation of the impact of the facility on community bioaerosol concentrations was undertaken by comparing on- and off-site measurements by sampling locations, wind direction, and site activity. On-site concentrations of total spores, Aspergillus/Penicillium spores, total bacteria, Gram-positive bacteria, Gram-negative bacteria, actinomycetes, total particulates, endotoxin, and beta-1,3 glucans were higher than off-site concentrations. Total fungal spores averaged 13,451 spores/m3 (range 5,223-26,067) on-site and 8,772 spores/m3 (range 243-18,276) off-site. Viable bacterial airborne concentrations (in cfu/m3) averaged 11,879 on-site (range 480-78,880) and 3,204 off-site (range 160-17,600). Mean levels of endotoxins (in ng/m3) were 1.94 on-site (range 0.12-6.06) and 0.14 off-site (range 0.01-0.41). Mean levels of beta-1,3 glucans (in ng/m3) were 2.17 on-site (range 0.12-14.45) and 0.24 off-site (range 0.01-0.78). Mean total viable fungi, on the other hand, were higher off-site than on-site (8,651 vs 3,068 cfu/m3). On-site concentrations of total bacteria, Gram-positive bacteria, Gram-negative bacteria, and actinomycetes demonstrated a statistically significant pattern of decreasing concentration with distance from pile and higher downwind vs upwind concentrations. Mean on-site concentrations of viable bacteria, viable fungi, and endotoxins were significantly higher during periods of activity compared to periods of no activity. Off-site concentrations of bacteria were also significantly higher during periods of activity compared to no activity. The highest concentrations of total particulates, endotoxin, and beta-1,3-glucans were observed in the personal samplers worn by workers at the facility. One personal sampler measured an Asp f1 exposure of 22.17 ng/m3 during turning activity. Peak exposures to several bioaerosol constituents were sufficiently high to warrant use of respirators by workers during periods of pile activity that lead to dust generation.

PMID: 11748875 [PubMed - indexed for MEDLINE]

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Differences in concentrations of allergenic pollens and spores at different heights on an agricultural farm in West Bengal, India.

Chakraborty P, Gupta-Bhattacharya S, Chowdhury I, Majumdar MR, Chanda S.

Division of Palynology and Environmental Biology, Department of Botany, Bose Institute, 93/1 Acharya Prafulla Chandra Road, Calcutta 700 009, India.

The aim of the study was to assess the vertical profile of the major airborne pollen and spore concentration in the lower heights (up to six meters) and to check their allergenic potential causing respiratory allergy in agricultural workers. The study was conducted using rotorod samplers mounted at different heights at weekly intervals for two consecutive years (November 1997-October 1999). The major pollen grains and fungal spores (from mass culture) were collected in bulk and studied by skin-prick tests to detect allergenicity. Of the recorded pollen, 10 major and perennial types (e.g., Poaceae, Cheno-Amaranthaceae, Cyperaceae, Areca, etc.) were considered for comparative analyses. The tree pollen count showed more or less good correlation with increasing heights, whereas herb/shrub members are dominant at lower heights during all the three seasons (winter, summer and rains). The 10 major and perennial fungal spore types included Aspergilli group, Cladosporium, Nigrospora, etc. The smaller spores were dominant at greater heights and larger spores and conidia were more prevalent at lower levels. The total spore count was higher just after the rainy season during winter. In terms of allergenicity, Saccharum officinarum (sugar cane) of Poaceae, showed highest reactivity (70.58%) in skin test carried out in 189 adult agricultural field workers with respiratory disorders living inside the study area. Among fungal spores, Aspergillus japonicus was the strongest allergen, evoking 74.07% positive reactions. Drechslera oryzae, the pathogen causing brown spot of rice was also found to be a potent allergen.

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PMID: 11748868 [PubMed - indexed for MEDLINE]

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Concomitant allergic bronchopulmonary aspergillosis and allergic Aspergillus sinusitis: a review of an uncommon association*.

Shah A, Panchal N, Agarwal AK.

Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India. ashokshah99@hotmail.com

BACKGROUND: Although thought to have common immunopathological processes, concomitant occurrence of allergic bronchopulmonary aspergillosis (ABPA) and allergic Aspergillus sinusitis (AAS) appears to be rarely reported as to date only five detailed case reports are available. OBJECTIVE: To present a review of seven cases of concomitant ABPA and AAS, three of whom were earlier reported for their unusual presentations. METHODS: Patients with ABPA with nasal symptoms were evaluated radiologically. Consent was taken for antral wash and/or Caldwell-Luc operation in those with radiological evidence of sinusitis and the material was sent for histopathological and mycological studies. RESULTS: Of the 95 patients with ABPA, 22 had radiological evidence of sinusitis. Nine consented to surgery, seven of whom were diagnosed as concomitant AAS. Nasal symptoms preceded chest symptoms in two patients, vice versa in one and occurred simultaneously in four. Familial occurrence of ABPA, middle lobe syndrome and collapse with effusion along with an operated aspergilloma were seen in one patient each. Transient pulmonary infiltrates and central bronchiectasis were seen in all patients. Computed tomography of the paranasal sinuses, carried out in six patients, revealed mucosal thickening with hyperdense lesions, without any bony erosion or destruction. All patients had positive skin tests, positive precipitin study and raised total and specific IgE. Allergic mucin was seen in all patients, fungal hyphae in five, and culture grew Aspergillus spp. in four. All patients responded favourably to oral prednisolone. CONCLUSION: Concomitant occurrence of ABPA and AAS seems to be infrequently recognized. Since asthma and sinusitis are often seen by two different specialities, the occurrence of AAS in ABPA and ABPA in AAS may easily be overlooked.

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PMID: 11737042 [PubMed - indexed for MEDLINE]

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Epidemiology and Prevention of Invasive Aspergillosis.

Warnock DW, Hajjeh RA, Lasker BA.

Mycotic Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-11, Atlanta, GA 30333, USA. DWarnock@cdc.gov

Aspergillus species are the most common causes of invasive mold infections in immunocompromised persons. This review examines the available information regarding the rising incidence of invasive aspergillosis in different high-risk groups, including persons with acute leukemia, hematopoietic stem cell transplant recipients, and liver and lung transplant recipients. The risk factors for infection in these groups are discussed. Because Aspergillus species are widespread in the environment, it is difficult to link specific sources and exposures to the development of human infections. However, molecular strain typing and other studies indicate that a significant number of Aspergillus infections are now being acquired outside the health care setting, either before patients are admitted to hospital, or after they have been discharged. The role of environmental control measures and antifungal drug prophylaxis in the prevention of hospital- and community-acquired aspergillosis is discussed.

PMID: 11722807 [PubMed - as supplied by publisher]

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Construction-related nosocomial infections in patients in health care facilities. Decreasing the risk of Aspergillus, Legionella and other infections.

[Article in English, French]

[No authors listed]

Construction and renovation projects in health care facilities are a risk for certain patients, particularly those who are immunocompromised. A proactive approach must be taken to limit construction-related nosocomial infections. This requires having a multidisciplinary team, supported by administration, to plan and implement preventive measures throughout the duration of the construction project. The ICP should be an active team member in all phases of the project. The ICP plays a major role by providing education to personnel; ensuring that preventive measures are identified, initiated, and maintained; and carrying out surveillance for infections in patients. By ensuring that the appropriate preventive measures are in place and clear lines of communication exist among the personnel, patient safety will be enhanced.

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PMID: 11593827 [PubMed - indexed for MEDLINE]

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Infection control considerations during construction activities: land excavation and demolition.

Cheng SM, Streifel AJ.

Infection Prevention and Control Unit, University Health Network, Toronto, Ontario, Canada.

Because current trends in hospital restructuring in North America, amalgamations and mergers, and the aging of health care facilities, the need to restructure physical buildings has become greater. Hospital construction carries with it risks to patients. One key concern is the risk of aspergillosis associated with hospital construction. Infection control practitioners must consider some key factors when addressing land excavation and building demolition, which differ in some ways from construction that occurs within a health care facility. The key factors to consider are project concept, risk assessment of patients, procedures and environment, air quality, routes of entry and egress, soil management, conducting inspections, contingency planning, housekeeping, and lines of cooperation and communication with various stakeholders. Considering these areas will help ensure that health care facility personnel and the workers have exercised diligence in patient care.

PMID: 11584259 [PubMed - indexed for MEDLINE]

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Therapeutic approach in pulmonary mycetoma. Analysis of 27 patients.

Mariotta S, Giuffreda E, Tramontano F, Treggiari S, Ricci A, Schmid G.

Section of Respiratory Diseases, Department of Respiratory and Cardiovascular Sciences, University La Sapienza, Rome, Italy. salvatore.mariotta@uniroma1.it

BACKGROUND: Pulmonary mycetoma is a characteristic clinical-radiological lesion due to colonization of aspergillus or candida species in pre-existing pulmonary cavities following a number of diseases. METHODS: We revisited 27 records of such admitted patients (19 M, 8 F; range age 16-27 yrs) analysing diagnostic approach and therapy. Predisposing conditions were sequelae of tuberculosis or lung abscess, bronchiectasis, bullous emphysema, leukaemia/ lymphoma, diabetes mellitus, corticosteroids and/or immunosuppressant administration and antiblastic chemotherapy. All patients had a characteristic chest X-ray and the most common symptoms were cough and haemoptysis. Diagnosis of pulmonary mycetoma was based on positive sputum culture for aspergillus or candida species and/or positive result for aspergillus precipitin test. Eleven patients received only medical treatment, eight pts only a surgical one and eight patients both medical and surgical ones. Antifungal drugs administered were itraconazole or amphotericin B or fluconazole. RESULTS: In the follow-up, six out of eleven patients who had received only medical treatment, cannot be found; five patients or their relatives were interviewed by phone: two of them enjoyed good health and three had died. Sixteen patients underwent thoracic surgery and one of them died because of postsurgical complications. In the follow-up, only nine patients out of this last group were interviewed by phone 2 to 8 years after surgery: seven of them enjoyed good health while two patients had died because of disease not related to pulmonary mycetoma. CONCLUSIONS: Aspergilloma treatment is related to the extension of disease and clinical conditions of patients but surgical resection associated with drug administration, when possible, is the treatment of choice.

PMID: 11579328 [PubMed - indexed for MEDLINE]

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Determination of selected microbial volatile organic compounds by diffusive sampling and dual-column capillary GC-FID--a new feasible approach for the detection of an exposure to indoor mould fungi?

Elke K, Begerow J, Oppermann H, KrŠmer U, Jermann E, Dunemann L.

Medizinisches Institut fŸr Umwelthygiene, Auf'm Hennekamp 50, D-40225 DŸsseldorf, Germany.

A new, analytically valid procedure is described to assess the exposure of human beings to the so-called microbial volatile organic compounds (MVOCs) in air. The method can be used routinely for large sample numbers and is especially valuable as a basis for further research on the correlation between single MVOCs and indoor mould growth. The procedure is based on the fact that fungi produce a variety of volatile organic compounds, such as 3-methylbutan-1-ol, 3-methylbutan-2-ol, fenchone, heptan-2-one, hexan-2-one, octan-3-one, octan-3-ol, pentan-2-ol, alpha-terpineol, and thujopsene, which they emit into the indoor environment. Using diffusive samplers, these MVOCs are adsorbed onto charcoal during a sampling interval of four weeks. The described method is thus superior to existing methods which use short-term active sampling. After desorption with carbon disulfide, the MVOCs were determined by dual-column gas chromatography with flame ionization detection using the large-volume injection technique for sample introduction. The detection limits ranged between 0.15 and 0.53 microgram m-3, within-series precision was found to range between 6.5 and 19.0%, and recovery was between 77 and 118%. The procedure has been successfully applied in the context of a large field study to measure the indoor MVOC exposure in children's rooms of 132 dwellings. The objective of the study was to examine the relation between indoor mould growth, the indoor MVOC exposure and the prevalence of adverse health effects. Information about mould formation has been obtained by a questionnaire and by the determination of colony forming units of mould fungi in mattress dust. With the exception of 3-methylbutan-2-ol, fenchone, nonan-2-one, octan-2-one, and thujopsene, indoor air concentrations of all MVOCs under investigation were significantly higher inside damp and mouldy dwellings. From the primary MVOCs under investigation, 3-methylbutan-1-ol, hexan-2-one, heptan-2-one, and octan-3-ol were found to be most reliable indicators for mould formation. A correlation was also found between selected MVOCs and the occurrence of mould species in mattress dust. Aspergillus sp. correlated with heptan-2-one, hexan-2-one, octan-3-ol, octan-3-one, and alpha-terpineol, while the occurrence of Eurotium sp. was correlated with higher indoor air concentrations of 3-methylbutan-1-ol, 3-methylbutan-2-ol, heptan-2-one, hexan-2-one, octan-3-ol, and thujopsene. Children living in dwellings with elevated MVOC levels had a higher prevalence of asthma, hay fever, wheezing, and irritations of the eyes. These positive associations persisted after controlling for confounding factors such as age, sex, body-mass index, number of siblings, social status, passive smoking, type of heating, and ventilation habits. However, they were not statistically significant. This lack of significance may be a result of the small number of investigated samples.

Publication Types:
PMID: 11529162 [PubMed - indexed for MEDLINE]

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[Occupational allergic asthma in greenhouses. Report of a clinical case]

[Article in Italian]

Farruggia E, Bellia M.

Unitˆ operativa di Medicina del Lavoro, Azienda Ospedaliera Garibaldi, Catania.

The Authors report a particular case of occupational asthma observed in a greenhouse worker. They describe the diagnostic procedure followed after identification on the cultivated plants of colonies of aspergillus niger, a fungus identified as an etiologic agent of the allergic disease. The peculiarity of the causative agent is stressed and it is recommended that environmental and health prevention measures be improved for this poorly protected class of workers.

Publication Types:
PMID: 11515153 [PubMed - indexed for MEDLINE]

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[Fungal allergy - fungal ecology in dwelling environments]

[Article in Japanese]

Takatori K.

National Institute of Health Sciences 1-18-1, Kamiyoga, Setagaya, Tokyo 158-8501 Japan.

Fungi related to allergies are commonly found in dwelling environments. The predominant fungi Cladosporium, Penicillium, Aspergillus, Alternaria, Wallemia and Rhodotorula live mainly in indoor air, house dust (HD), futons, clothes and contaminated building materials. Fungi in HD are especially important allergens. The fungal CFU and predominant fungi in HD are 10(4) - 10(6)/g and are composed of xerophilic or osmophilic species Aspergillus restrictus, Wallemia and Eurotium but not many yeasts and actinomycetes. Fungal contamination of materials is a serious human health problem because the fungal cells scatter from the materials in the air or HD. The biological activities by fungi also have health implications from the viewpoint of fungal allergens. In this paper, fungal germination, enzyme activities, contaminating cell form and viable or nonviable cells are also discussed.

Publication Types:
PMID: 11479530 [PubMed - indexed for MEDLINE]

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Fungal flora on board the Mir-Space Station, identification by morphological features and ribosomal DNA sequences.

Makimura K, Hanazawa R, Takatori K, Tamura Y, Fujisaki R, Nishiyama Y, Abe S, Uchida K, Kawamura Y, Ezaki T, Yamaguchi H.

Teikyo University Institute of Medical Mycology, Hachioji, Tokyo, Japan. makimura@main.teikyo-u.ac.jp

This report is on the morphological and molecular biological identification, using 18S- and ITS1-rDNA sequences, of the "space fungi" isolated on board the Russian Mir-Space Station as the major constituents of the fungal flora. The six fungal strains were isolated from air by using an air sampler or from condensation. Strains were identified as Penicillium chrysogenum, Aspergillus versicolor, or Penicillium sp. by both methods. The species of space fungi were common saprophytic fungi in our living environment, potential pathogens, and allergens. This study concluded that the environment on board the space station Mir allows the growth of potentially pathogenic fungi as true in residential areas on the earth. Therefore, to prevent infection or other health disorders caused by these fungi, easy and reliable methods should be established to survey the fungal flora in a space station.

Publication Types:
PMID: 11471823 [PubMed - indexed for MEDLINE]

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Bioaerosol lung damage in a worker with repeated exposure to fungi in a water-damaged building.

Trout D, Bernstein J, Martinez K, Biagini R, Wallingford K.

Division of Surveillance, Hazard Evaluation and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA. DTrout@cdc.gov

There has been increased concern over health effects related to potential exposure of building occupants to bioaerosols. We report the case of a worker with a respiratory illness related to bioaerosol exposure in a water-damaged building with extensive fungal contamination. We performed environmental tests to evaluate potential exposure to fungi, and we used mycotoxin-specific IgG antibody in serologic studies in the attempt to evaluate exposure to mycotoxins. Extensive fungal contamination was documented in many areas of the building. Penicillium, Aspergillus, and Stachybotrys species were the most predominant fungi found in air sampling. Our serologic test was not useful in differentiating workers who were probably occupationally exposed to mycotoxins from those who were not; however, it did yield evidence that individuals may make specific IgG antibodies to macrocyclic tricothecene mycotoxins. Further research is needed concerning health effects related to bioaerosol exposures, particularly regarding markers of exposure to specific fungi that may produce mycotoxins. In the absence of clinical tools specific for evaluation of mycotoxin-related illness, a systematic clinical approach for evaluating persons with suspected building-related respiratory illness is warranted.

Publication Types:
PMID: 11445520 [PubMed - indexed for MEDLINE]

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Emissions of chemical compounds and bioaerosols during the secondary treatment of paper mill effluents.

Goyer N, Lavoie J.

Institut de recherche en santŽ et en sŽcuritŽ du travail du QuŽbec, Montreal, Canada.

This study identified and quantified the main chemical compounds--the substances responsible for the disagreeable odors--and the bioaerosols emitted during the biological treatment of paper mill effluents. It also identified the characteristics of the process that effects the generation or diffusion of these substances. All treatment stages were evaluated. Measuring sites were located as closely as possible to the potential emission sources. Measurements were taken in the summer in 11 paper mills during a 2- to 3-day period in each mill. Chemical compounds were evaluated by direct-reading instruments; bioaerosols were sampled by impaction and counted. Sulfur compounds, emitted into the air when the effluent or the sludge is stirred, had the highest concentrations; their presence was attributable to such things as kraft-type paper pulp. Next in concentration were the carbon and nitrogen oxides, ammonia, and some organic acids, produced by the action of microorganisms. These acids are found mainly in the sludge environment. Terpenes, which come from wood, are present at various locations in paper mills. Odor perception thresholds for most of these substances are much lower than those established to protect the health of workers. Significant concentrations of total bacteria, total molds, and endotoxins were measured at several sites. Gram-negative bacteria were high at only one site, whereas the mold Aspergillus fumigatus was occasionally present at low concentration. No actinomycetes bacteria were detected. The highest concentrations were measured where there was water or dust aerosolization. Emissions are therefore controlled by controlling the operations that lead to the dispersion of water and particles into the air.

PMID: 11434439 [PubMed - indexed for MEDLINE]

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Evaluation of the microbicidal efficacy of Steris System I for digestive endoscopes using GERMANDE and ASTM validation protocols.

Duc DL, Ribiollet A, Dode X, Ducel G, Marchetti B, Calop J.

Groupe d'Etude et de Recherche sur les Machines Automatiques de Nettoyage-DŽsinfection des Endoscopes et les Endoscopes (GERMANDE), Marseille, France. luuduc@resopharma.fr

In the light of more and more invasive procedures being carried out in digestive endoscopy using sterile devices, it appears necessary to put in place a process of endoscope reprocessing capable of ensuring the complete elimination of micro-organisms contaminating the device. We undertook a study of the microbial efficacy of STERIS SYSTEM 1 (SS1) which purports to achieve this objective. The channels of a gastroscope and a colonoscope were contaminated with suspensions of Pseudomonas aeruginosa, Aspergillus niger and Bacillus subtilis spores. Two procedures were then followed: (1) manual washing only, and (2) treatment in SS1 without prewashing. Recoveries of organisms were made from each channel according to a standard methodology to discover any survivors. Contamination controls we re assessed to measure the logarithmic reduction between the initial contamination and that recovered from the channels. Six cycles per micro-organisms, per type of endoscope, and per type of procedure were carried out. From an initial contamination leve l of 10(6) micro-organisms per endoscope, no micro-organisms were recovered in 35 of the 36 cycles with the SS1. In one cycle with the colonoscope, three B. subtilis organisms were recovered from the channels. Washing only gave microbial reductions which varied according to the micro-organism tested. The maximum reduction with washing alone was by a factor of 10(3 +/- 0.1)for B. subtilis and the minimum reduction factor was 10(3 +/- 0.3)for P. aeruginosa. Considering the results obtained with SS1 without prewashing and the efficacy obtained from washing only, the washing step offers an additional antimicrobial assurance reduction factor of between 10 and 103.1. This study shows that SS1, integrated into an overall reprocessing procedure for digestive endoscopes, is capable of delivering the complete elimination of contaminating micro-organisms in a reduced time and eliminates the toxic risk of reprocessing associated with aldehyde based disinfectants. Copyright 2001 The Hospital Infection Society.

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PMID: 11428881 [PubMed - indexed for MEDLINE]

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Salvage chemotherapy with mitoxantrone, fludarabine, cytarabine, and cisplatin (MIFAP) in relapsing and refractory lymphoma.

HŠnel M, Kršger N, Kroschinsky F, Birkmann J, HŠnel A, Herbst R, Naumann R, Friedrichsen K, Ehninger G, Zander AR, Fiedler F.

Medizinische Klinik und Poliklinik I, UniversitŠtsklinikum Carl Gustav Carus an der Technischen UniversitŠt Dresden, Fetscherstrasse 74, 01307 Dresden, Germany. haenel@oncocenter.de

PURPOSE: The aim of the study was to evaluate the feasibility and efficacy of the combination of mitoxantrone, fludarabine, cytarabine, and cisplatin (MIFAP) in patients with prognostically unfavorable recurrent and refractory Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). METHODS: Forty-six patients (median age 43 years, range 18-63) with relapsed (n = 15) or refractory (n = 31) malignant lymphoma were enrolled (HD, n = 13; low-grade/transformed NHL, n = 4; high-grade NHL, n = 29). A total of 39 patients (85%) showed multiply relapsed diseases with a duration of prior remission of < 12 months (n = 8) or had lymphoma being resistant to prior chemotherapy (n = 31). The MIFAP therapy consisted of fludarabine (15 mg/m2, q. 12 h, day 1-4), cytarabine (50 mg/m2 by continuous infusion (CI) over 22 h, day 1-4), cisplatin (25 or 30 mg/m2 by CI over 24 h, day 1-4), and mitoxantrone (4 mg/m2, day 2-5). RESULTS: Thirteen patients (28%) achieved complete remission (CR) and 15 patients (33%) partial remission (PR), for an overall response (OR) rate of 61%. Twenty-two patients responding to MIFAP (10 CR, 12 PR) have been consolidated by high-dose therapy (HDT) with hematopoietic stem cell transplantation (SCT). After a median follow-up of 12 months, 16 patients are in continuous CR (CCR) (n = 14) or CCRu (unconfirmed) (n = 2). The median duration of event-free survival (EFS) and overall survival (OS) were 6.5 and 19.3 months, respectively. Probabilities of EFS and OS after 3 years were 19% and 40%. Responders consolidated by subsequent HDT showed rates for 3-year EFS and OS of 40% and 66%, respectively. Unfavorable prognostic factors for EFS by univariate analysis were refractory lymphoma and the presence of B-symptoms. Significant prognostic factors for OS were NHL, refractory lymphoma, B-symptoms, and bone marrow involvement. The major toxicities were leukocytopenia and thrombocytopenia of the World Health Organization (WHO) grade IV in nearly all courses (median duration 10 and 11 days). In contrast, non-hematological side effects were moderate, predominantly of WHO grades I and II. Treatment-related mortality with MIFAP was 4% (two patients with septicemia by Aspergillus fumigatus). CONCLUSIONS: MIFAP is an effective salvage protocol for patients with poor-risk recurrent or refractory HD and NHL. The observed toxicity seems to be acceptable considering the unfavorable prognosis and intensive pretreatment. The results in patients responding to MIFAP and afterwards undergoing HDT with autologous stem cell support are even comparable to those published in patients with prognostically more favorable diseases.

Publication Types:
PMID: 11414199 [PubMed - indexed for MEDLINE]

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Allergy test results of a rural and small-city population compared with those of an urban population.

Taksey J, Craig TJ.

Pennsylvania State University, College of Medicine, Hershey, Pa., USA.

The frequency of sensitization to environmental antigens changes in different regions. As such, the pattern of sensitivity to common allergens was studied at multiple sites across central Pennsylvania, an area composed of small cities and rural communities, to determine uniqueness of allergies in populations from this area in contrast to allergies as determined by skin testing in large urban centers. The study reported was undertaken to determine allergen variation from an urban population compared with a rural population of a Northeastern state so that environmental avoidance and immunotherapy can be more precisely prescribed. Patient charts were retrospectively reviewed to determine sensitivity to house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae), cockroach, Penicillium, Aspergillus spp, dog, cat, timothy grass, ragweed, oak, and Alternaria tenuis at five sites in Pennsylvania. All of these sites were classified as "small city" or "rural" for the study. One hundred patient records were examined at each site for the results of allergy testing by the prick puncture, radioallergosorbent test (RAST), or intradermal methods. These small-city and rural data were pooled and compared with that of the National Cooperative Inner-City Asthma Study (NCI-CAS), which included 1286 patients from urban environments. The prevalence of allergy to both species of dust mites, dog, timothy grass, and ragweed was significantly greater in the pooled rural group than in the NCICAS inner-city patients (P < .05). In contrast, sensitivity to cockroach antigens and Alternaria was significantly greater in the NCICAS urban population than in the pooled rural group (P < .05). No statistically significant difference was found between the NCICAS and the pooled rural patients in reference to Penicillium, cat, and oak (P > .05).

Publication Types:
PMID: 11409261 [PubMed - indexed for MEDLINE]

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Deterioration and spoilage of peanuts and desiccated coconuts from two sub-Saharan tropical East African countries due to the associated mycobiota and their degradative enzymes.

Ismail MA.

Department of Botany, Faculty of Science, Assiut University, Egypt. botany@swiftuganda.com

A broad variety of fungi (84 species belonging to 36 genera) were identified with more taxa infesting peanut seed samples from two tropical countries (29 genera and 61 species) compared to those found in desiccated coconuts (20 genera and 55 species) on both DRBC and DG18 media. This may be due to the higher moisture levels in peanuts (5.07-7.97%) compared with coconuts (1.5-4.17%). More taxa and propagules were recovered on DG18 in both cases. The dominant fungi from both substrates on both isolation media were Aspergillus and Penicillium, with other fungi from only one substrate/medium. The aflatoxigenic species (A. flavus) dominated Kenyan samples more so than Ugandan samples on both substrates. However only 71.5% and 87.5% of the peanut kernels, on DRBC and DG18, respectively, were found to be infested with fungi. The aflatoxigenic species (A. flavus/parasiticus) were found in 75% of the samples, however only 15.75% and 13% of the kernels analyzed were infested. The most frequently isolated species from peanuts were A. niger followed by A. flavus and M. phaseolina. E. repens, E. amstelodami, E. rubrum and E. chevalieri dominated peanut seeds on DG18, and R. stolonifer, A. parasiticus, F. solani, L. theobromae and P. chrysogenum on DRBC. The mean count of fungal propagules in coconut samples were approximately 0.7 x 10(3) and 0.8 x 10(3) on DRBC and DG18, respectively, with a high proportion of those propagules recorded for the aflatoxigenic species (about 0. 17 x 10(3) and 0.25 x 10(3) colonies/g). The mycobiota of desiccated coconut was dominated by A. niger, A. flavus and P. chrysogenum. Also A. ochraceus, P. waksmanii, Paecilomyces variotii, P. islandicum and R. mucilaginosa were more frequent on DRBC, while, species of Cladosporium. Chrysosporium and Eurotium were more frequent on DG18. Enzyme indices (or the activities) for each specific strain, when determined after 5 and 8 days of incubation, proved to be similar. A recommendation is given. The proteolytic and lipolytic potentialities of the most commonly encountered species from both peanuts and coconuts were studied. The most interesting observation is that most of the positive isolates, in both commodities had high enzymic activity compared to those reported earlier for isolates of the same species. Such capabilities suggest that these commodities are expected to deteriorate, since climatic conditions in tropical areas favour fungal proliferation. Emphasis on the proper harvesting, drying, handling, transportation and/or storage; and also education of the populace, especially those are dealing with these foods, should be taken into consideration by the relevant authorities. The contaminated foods constitute a health hazard for human consumption.

PMID: 11407493 [PubMed - indexed for MEDLINE]

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Current importance of ochratoxin A-producing Aspergillus spp.

Abarca ML, Accensi F, Bragulat MR, Caba–es FJ.

Departament de Sanitat i d'Anatomia Animals (Microbiologia), Facultat de Veterinˆria, Universitat Aut˜noma de Barcelona, Bellaterra, Spain. Lourdes.Abarca@uab.es

Ochratoxin A (OA) is receiving attention worldwide because of the hazard it poses to human and animal health. OA contamination of commodities, such as cereals or pork and poultry meat, is well recognized. Nevertheless, there is an increasing number of articles reporting OA contamination in other food commodities, such as coffee, beer, wine, grape juice, and milk, in the last few years. This continuous and increasing exposure to OA that humans experience is reflected in the high incidence of OA in both human blood and milk in several countries. OA was believed to be produced only by Aspergillus ochraceus and closely related species of section Circumdati and by Penicillium verrucosum; however, in the genus Aspergillus, the production of OA has been recently reported by species outside the section Circumdati. Thus, it has been clearly established as a metabolite of different species of the section Nigri, such as Aspergillus niger and Aspergillus carbonarius. OA production ability by Aspergillus spp. is more widespread than previously thought; therefore, there is the possibility that unexpected species can be new sources of this mycotoxin in their natural substrates.

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PMID: 11403149 [PubMed - indexed for MEDLINE]

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Onychomycosis and other superficial fungal infections of the foot in the elderly: a pan-European survey.

PiŽrard G.

Department of Dermatopathology, University of Lige, Belgium. Gerald.Pierard@ulg.ac.be

BACKGROUND: The escalating ageing population in the western world has led to an increased incidence of superficial fungal infections. The most common infections include onychomycosis, tinea pedis and tinea cruris. With the increasing life expectancy, the prevalence of onychomycosis and other superficial fungal infections is likely to increase further without adequate prevention and treatment. Objective: To study the prevalence of foot mycoses in Europe. METHOD: The Achilles project represents a survey of 90,085 subjects from 16 European countries. RESULTS: Approximately half of the total screened population had evidence of fungal foot infection, with tinea pedis and onychomycosis affecting one quarter of these individuals. Advancing age showed an unfavourable effect on the prevalence of these infections. CONCLUSION: As the number of aged people in developed countries continues to increase, skin diseases will constitute a greater pharmaco-economic concern of worldwide healthcare. Better recognition by clinicians and patients of mycotic foot disease will help prevent direct morbidity and further complications. Copyright 2001 S. Karger AG, Basel

PMID: 11385227 [PubMed - indexed for MEDLINE]

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Allergic respiratory disease and fungal remediation in a building in a subtropical climate.

Jarvis JQ, Morey PR.

University of Nevada School of Medicine, Reno, USA.

An outbreak of allergic respiratory disease occurred in a new building that was characterized from initial occupancy by the presence of extensive visible mold (especially Aspergillus versicolor) on interior surfaces. Epidemiological study of the occupants of both the affected building and a comparison neighboring structure indicated high rates of respiratory and other symptoms among persons working in the affected building. Subsequent clinical evaluations of some persons occupying the building for up to five years identified several cases of building-related allergic respiratory disease, including asthma and hypersensitivity pneumonitis. Based on these findings, the building was evacuated before remediation began. The mycological goal of the three-year building restoration project was to reduce concentration of non-phylloplane fungi such as A. versicolor to the lowest feasible level. All visibly colonized materials in the building were discarded and all fine dust on interior surfaces was removed by vacuuming and/or damp wiping. A medical surveillance program utilizing serial self-reported questionnaires and readily available clinical evaluations was designed to monitor the health of building occupants after re-entry. Symptom rates just prior to building reentry were substantially lower than those found before evacuation and have remained unchanged after re-occupancy was completed. No new or recrudescent cases of illness are known to have occurred after building re-entry.

PMID: 11297052 [PubMed - indexed for MEDLINE]

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[Exposure status of East and West German households with house dust mites and fungi]

[Article in German]

Oppermann H, Doering C, Sobottka A, KrŠmer U, Thriene B.

Hygieneinstitut Sachsen-Anhalt, Magdeburg.

The interrelation between biological pollution of indoor spaces and health disorders, allergic symptoms and health issues in general is well known. Besides animal epithelia, the exposure to house dust mites and mould fungi is considered a serious risk factor. In the scope of a comparative study involving school beginners in East and West Germany (launched in 1991), dust was vacuumed from a total of 218 mattresses of children's beds and checked for their content of house dust mites and mould fungi. This investigation aimed at assessing the degree of exposure, to determine regional differences, if any, and to uncover the correlation between exposure and symptoms. Dust mite infestation was highest in the small town of Borken in Westphalia (in 86% of the specimens > 2 micrograms mite allergens/g of dust) and lowest in Magdeburg in Saxony-Anhalt (55.3%). Total concentrations of mould fungi varied from 1.4 x 10(3) CFU/g of dust and 300 x 10(3) CFU/g of dust with a geometric mean of 26.5 x 10(3) CFU/g of dust. A total of 41 different genera/species were identified. Most frequent were the following genera: Penicillium, Eurotium, Aspergillus, Alternaria, Epicoccum and Cladosporium. The importance of individual factors influencing was confirmed. Humidity decreases the higher the flat is situated in a building. This partly explains the differences in concentrations between Borken where children live mainly on the ground floor, and the other cities with taller buildings. Spores of mould fungi were discovered more frequently in mattresses from humid flats. An association between biological indoor space factors and some allergological parameters seemed obvious, however, due to the small size of the test group most of them were not significant.

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PMID: 11285754 [PubMed - indexed for MEDLINE]

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Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care?

Bulpa PA, Dive AM, Garrino MG, Delos MA, Gonzalez MR, Evrard PA, Glupczynski Y, InstallŽ EJ.

Department of Intensive Care, Mont-Godinne University Hospital, UniversitŽ Catholique de Louvain, Yvoir, Belgium. pierre.bulpa@rean.ucl.ac.be

OBJECTIVES: Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a cause of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD) treated with corticosteroids. For these patients admission in intensive care unit (ICU) is often required for life-support and mechanical ventilation. Whether this approach improves outcome is unknown. DESIGN AND SETTING: Retrospective study in a university hospital intensive care unit. PATIENTS: Between November 1993 and December 1997, 23 COPD patients were admitted in our ICU and received antifungal agents for possible IPA. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The clinical features and the outcome were reviewed. Diagnosis of IPA was classified as confirmed (positive lung tissue biopsy and/or autopsy) or probable (repeated isolation of Aspergillus from the airways with consistent clinical and radiological findings). Among the 23 patients treated for Aspergillus, 16 fulfilling these criteria for IPA were studied. Steroids had been administered at home to all patients but one and were increased during hospitalization in all. Twelve patients suffered a worsening of their bronchospasm precipitating acute respiratory failure. During ICU stay all patients required mechanical ventilation for acute respiratory failure. Although amphotericin B deoxycholate was started when IPA was suspected (0.5-1.5 mg/kg per day), all patients died in septic shock (n = 5) or in multiple-organ failure. CONCLUSIONS: The poor prognosis of intubated COPD patients with IPA, in spite of antifungal treatment suggests that further studies are required to define the limits and indications for ICU management of these patients.

PMID: 11280674 [PubMed - indexed for MEDLINE]

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The phylogenetics of mycotoxin and sclerotium production in Aspergillus flavus and Aspergillus oryzae.

Geiser DM, Dorner JW, Horn BW, Taylor JW.

Department of Plant Pathology, The Pennsylvania State University, 204 Buckhout Laboratory, University Park, Pennsylvania 16802-4507, USA. dgeiser@psu.edu

Aspergillus flavus is a common filamentous fungus that produces aflatoxins and presents a major threat to agriculture and human health. Previous phylogenetic studies of A. flavus have shown that it consists of two subgroups, called groups I and II, and morphological studies indicated that it consists of two morphological groups based on sclerotium size, called "S" and "L." The industrially important non-aflatoxin-producing fungus A. oryzae is nested within group I. Three different gene regions, including part of a gene involved in aflatoxin biosynthesis (omt12), were sequenced in 33 S and L strains of A. flavus collected from various regions around the world, along with three isolates of A. oryzae and two isolates of A. parasiticus that were used as outgroups. The production of B and G aflatoxins and cyclopiazonic acid was analyzed in the A. flavus isolates, and each isolate was identified as "S" or "L" based on sclerotium size. Phylogenetic analysis of all three genes confirmed the inference that group I and group II represent a deep divergence within A. flavus. Most group I strains produced B aflatoxins to some degree, and none produced G aflatoxins. Four of six group II strains produced both B and G aflatoxins. All group II isolates were of the "S" sclerotium phenotype, whereas group I strains consisted of both "S" and "L" isolates. Based on the omt12 gene region, phylogenetic structure in sclerotium phenotype and aflatoxin production was evident within group I. Some non-aflatoxin-producing isolates of group I had an omt12 allele that was identical to that found in isolates of A. oryzae. Copyright 2000 Academic Press.

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PMID: 11273679 [PubMed - indexed for MEDLINE]

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Evaluation of health aspects of kojic acid in food.

Burdock GA, Soni MG, Carabin IG.

Burdock and Associates, Inc., 622 Beachland Boulevard, Vero Beach, Florida 32963, USA. gburdock@salvitas.com

Kojic acid is a fungal metabolite commonly produced by many species of Aspergillus, Acetobacter, and Penicillium. The Aspergillus flavus group has traditionally been used in the production of a number of foods, including miso (soybean paste), shoyu (soy sauce), and sake. Kojic acid is widely used as a food additive for preventing enzymatic browning, and in cosmetic preparations as a skin-lightening or bleaching agent. Because kojic acid is often produced during the fermentation of historically used dietary staples, it has a long history of consumption. Various types of compounds, such as glucose, sucrose, acetate, ethanol, arabinose, and xylose, have been used as carbon sources for kojic acid production. Different Aspergillus species are known to produce variable amounts of kojic acid. The mechanism of action of kojic acid is well defined and it has been shown to act as a competitive and reversible inhibitor of animal and plant polyphenol oxidases, xanthine oxidase, and D- and some L-amino acid oxidases. The structure of kojic acid indicates a relatively simple route of metabolism much like dietary hexoses. Acute or subchronic toxicity resulting from an oral dose has not been reported, but convulsions may occur if kojic acid is injected. Results of mutagenicity studies are mixed, but in the in vivo mammalian dominant lethal assay, kojic acid was proven negative. Continuous administration of high doses of kojic acid in mice resulted in induction of thyroid adenomas in both sexes. Kojic acid reversibly affects thyroid function primarily by inhibiting iodine uptake, leading to decreases in T3 and T4 and increase in TSH. Increased TSH from pituitary gland in turn stimulates thyroid hyperplasia. Several lines of evidence indicate that the proliferative effects of kojic acid on thyroid are not related to a genotoxic pathway. The risk of functional inhibition of iodine uptake and its metabolism (organification) and thyroid tumor induction by kojic acid in humans appears to be extremely low. Based on the literature reviewed and discussed here, consumption of kojic acid at levels normally found in food does not present a concern for safety. Copyright 2001 Academic Press.

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PMID: 11259181 [PubMed - indexed for MEDLINE]

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Toxigenic fungi: which are important?

Pitt JI.

Food Science Australia, North Ryde, NSW, Australia. John.Pitt@foodscience.afisc.csiro.au

Growth of commonly occurring filamentous fungi in foods may result in production of mycotoxins, which can cause a variety of ill effects in humans, from allergic responses to immunosuppression and cancer. According to experts, five kinds of mycotoxins are important in human health around the world: aflatoxins, ochratoxin A, fumonisins, certain trichothecenes, and zearalenone. These toxins are produced by only a few species of fungi, in a limited range of commodities. Aflatoxins are potent carcinogens, produced by Aspergillus flavus and A. parasiticus in peanuts, maize and some other nuts and oilseeds. Ochratoxin A is a kidney toxin and probable carcinogen. It is produced by Penicillium verrucosum in cereal grains in cold climates, by A. carbonarius in grapes, wines and vine fruits, and by A. ochraceus sometimes in coffee beans. Fumonisins, which may cause oesophageal cancer, are formed by Fusarium moniliforme and F. proliferatum, but only in maize. Trichothecenes are highly immunosuppressive and zearalenone causes oestrogenic effects; both are produced by F. graminearum and related species. Current reporting probably underestimates the effect of mycotoxins as a cause of human mortality.

Publication Types:
PMID: 11204142 [PubMed - indexed for MEDLINE]

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Species-specific profiles of mycotoxins produced in cultures and associated with conidia of airborne fungi derived from biowaste.

Fischer G, MŸller T, Schwalbe R, Ostrowski R, Dott W.

Institute of Hygiene and Environmental Medicine, University Hospital, RWTH Aachen, Germany. Guido.Fischer@post.rwth-aachen.de

The potential to produce mycotoxins and non-volatile secondary metabolites was investigated for approximately 250 freshly isolated fungal strains. Among the eleven most relevant species, viz. Aspergillus flavus, A. fumigatus, A. niger, A. parasiticus, A. versicolor, Emericella nidulans, Paecilomyces variotii, Penicillium brevicompactum, P. clavigerum, P. crustosum, and P. polonicum, a wide range of metabolites partly of toxicological relevance was identified. Several unknown metabolites were found for the less frequent species, which were primarily investigated for chemotaxonomic delimitation from closely related species. The spectra of metabolites in conidial extracts and culture extracts (containing also mycelium and medium) were compared for a limited number of relevant fungi. Some mycotoxins, such as sterigmatocystin in Emericella nidulans, were not present in the conidial extracts, though produced by most strains. Fumigaclavine C, tryptoquivaline, and trypacidin, characteristic for A. fumigatus, were found in conidial extracts, but highly toxic compounds such as gliotoxin and fumitremorgens were not present. Finally, compounds such as cyclopenol, cyclopenin, and penitrem A being characteristic for certain penicillia, were found in conidial extracts and are therefore assumed to occur in native bioaerosols.

Publication Types:
PMID: 11109562 [PubMed - indexed for MEDLINE]

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[Microbiological threat from buildings and rooms and its influence on human health (sick building syndrome)]

[Article in Polish]

OchmaÄski W, Barabasz W.

I Katedra i Klinika Chor—b Wewnetrznych Collegium Medicum, Uniwersytetu JagielloÄskiego w Krakowie.

In buildings we can observe many different strains of bacteria, over 400 species of mould fungi, many strains of fungus causing the rotting of wood and wood like materials, many species of algae, aphids, and other types of growths and seed plants and also over 30 types of mites especially those seen in house dust. Buildings, especially their interiors have a very specific microclimate. Within it areas of so called ecological lows are formed in which conditions for settlement, growth and reproduction of these organisms take place. A building, which is a hazard to the health of its residents, is called a "sick building" from the term "sick building syndrome". The incidence and development of some types of mould fungus is associated with the production of very toxic metabolites which are called secondary metabolites i.e. mycotoxins. Long term human, especially in relation to children, contact with the species producing the most potent mycotoxins like aflatoxin--Apergillus flavus, ochratoxins--Aspergillus ochraceus, rubratoxins--Penicillium rubrum or strachybotrytoxins--Strachybotrys chartarum may even be the cause of death. Mould fungus or just mould is a saprophytic fungus derived from many different systemic groups (Mucor, Aspergillus, Penicillium, Fusarinum). Fungi can produce lethal mycotoxins such as: alternariol, aflatoxins, gliotoxins, ochratoxins, nivalenol, cytinine, dicumarol, rugulosine, trichoviridine and about 200 more which considering their mutagenicity are potentially dangerous to humans, animals, flora and microorganisms. Research which was begun by Prof. Julian Aleksandrowicz and Prof. Boles¸aw Smyk in 1970 and 1971 showed that the so called "leukaemia houses" of leukaemia victims had an abundance of toxinogenic fungus in them, particularly the most potent fungus which turned out to be Aspergillus flavus. Toxinogenic funguses are abundant in many living spaces and cellars in older and also in new housing. Mycotoxins have been shown to be very toxic and harmful and it is no wonder that many inhabitants of these living spaces are constantly ill, mainly upper respiratory tract infections, lethargy, constant headaches, nausea and a general ill feeling. Inhabiting these living spaces for a considerable period may lead to cancer.

Publication Types:
PMID: 11109318 [PubMed - indexed for MEDLINE]

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Occurrence of itraconazole-tolerant micromycetes in the soil and food products.

Pieckov‡ E, Jesensk‡ Z.

Institute of Preventive and Clinical Medicine, Bratislava, Slovakia.

Unexpected pathogens from the environment represent considerable risk for humans with impaired health. We examined the occurrence of itraconazole tolerant micromycetes in soil and in maize products. Five concentrations of itraconazole (2.5-12.5 micrograms/mL) selected according to known treatment schedules for human patients were incorporated into Sabouraud agar with chloramphenicol and Rose Bengal and diluted samples were inoculated onto the agar surface. After 7-d growth at 22 degrees C colonies of Alternaria sp., Aspergillus clavatus, A. glaucus group, A. flavus, A. fumigatus, A. niger group, A. ochraceus group, A. ochraceus, Chaetomium sp., Cladosporium cladosporioides, Cylindrocarpon sp., Doratomyces sp., Fusarium sp., F. moniliforme, F. oxysporum, F. solani, F. subglutinans, Marianaea elegans, Mortierella sp., Mucor sp., Myrothecium sp., Penicillium sp., Rhizopus sp., Scopulariopsis brevicaulis, Sepedonium sp., Stachybotrys chartarum, Stemphylium sp., Torula humicola and Trichoderma viride were isolated.

PMID: 11097027 [PubMed - indexed for MEDLINE]

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Indoor air quality in a middle school, Part II: Development of emission factors for particulate matter and bioaerosols.

Scheff PA, Paulius VK, Curtis L, Conroy LM.

School of Public Health, University of Illinois at Chicago, USA.

A middle school (grades 6 to 8) in a residential section of Springfield, Illinois, with no known air quality problems, was selected for a baseline indoor air quality survey. The study was designed to measure and evaluate air quality at the middle school with the objective of providing a benchmark for comparisons with measurements in schools with potential air quality problems. The focus of this article is on the development of emission factors for particulate matter and bioaerosols. The school was characterized as having no health complaints and good maintenance schedules. Four indoor locations including the cafeteria, a science classroom, an art classroom, the lobby outside the main office, and one outdoor location were sampled for various environmental comfort and pollutant parameters for one week in February 1997. Integrated samples (eight-hour sampling time) for respirable and total particulate matter, and short-term measurements (two-minute samples, three times per day) for bioaerosols were collected on three consecutive days at each of the sampling sites. Continuous measurements of carbon dioxide were logged at all locations for five days. Continuous measurements of respirable particulate matter were also collected in the lobby area. A linear relationship between occupancy and corresponding carbon dioxide and particle concentrations was seen. A completely mixed space, one compartment mass balance model with estimated CO2 generation rates and actual CO2 and particulate matter concentrations was used to model ventilation and pollutant emission rates. Emission factors for occupancy were represented by the slope of emission rate versus occupancy scatter plots. The following particle and bioaerosol emission factors were derived from the indoor measurements: total particles: 1.28 mg/hr/person-hr; respirable particles: 0.154 g/hr/person-hr; total fungi: 167 CFU/hr/person-min; thermophilic fungi: 35.8 CFU/hr/person-min; mesophilic fungi: 119 CFU/hr/person-min; total bacteria: 227 CFU/hr/person-min; gram-negative bacteria: 69.5 CFU/hr/person-min; gram-positive bacteria: 191 CFU/hr/person-min; Aspergillus: 17.0 CFU/hr/person-min; Penicillium: 161 CFU/hr/person-min; and yeasts: 16.4 CFU/hr/person-min.

Publication Types:
PMID: 11062928 [PubMed - indexed for MEDLINE]

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[Microflora of the farming work environment as an occupational risk factor]

[Article in Polish]

KrysiÄska-Traczyk E.

Zak¸adu Biologicznych Szkodliwoæci Zawodowych, Instytutu Medycyny Wsi im. W. Chodki w Lublinie.

The paper presents the results of the studies concerning the air mould fungi concentration in the work environment during grain threshing, flax breaking and thyme cleaning. A high level of fungi was observed in the air at all workplaces with the highest concentrations during grain threshing. Of the total number of 12 farms, in 8 the air mould fungi concentration exceeded the proposed standard of 50,000 CFU/m3. Among the species containing cereals, flax and thyme, mould fungi of Alternaria alternata sp.--an etiologic factor of allergic respiratory diseases--occurred most frequently. During flax breaking, the presence of fungi of Fusarium poae sp., which affect grain husks and cause a great economic loss in agriculture, was observed. Mould fungi of Aspergillus candidus sp. were found during thyme cleaning. These fungi have been reported to be an etiologic factor of organic dust toxic syndrome among secondary school students employed in the grain dust environment polluted with the spores of Aspergillus candidus. The results obtained show that the agricultural work environment is considerably polluted with the spores of mould fungi of allergenic and immunotoxic properties, which cause a high degree of health risk to people employed in agriculture.

Publication Types:
PMID: 11059408 [PubMed - indexed for MEDLINE]

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The use of transgenic yeasts expressing a gene encoding a glycosyl-hydrolase as a tool to increase resveratrol content in wine.

Gonz‡lez-Candelas L, Gil JV, Lamuela-Ravent—s RM, Ram—n D.

Departamento de Ciencia de los Alimentos, Consejo Superior de Investigaciones Cientificas, Buriassot, Valencia, Spain.

Resveratrol, a phenolic compound produced in grapes, exhibits properties that may contribute to the reduction of the incidence of coronary heart disease and other human health related processes. Recombinant yeast strains expressing the Aspergillus niger abfB gene encoding an alpha-L-arabinofuranosidase or the Candida molischiana bgIN gene encoding a beta-glucosidase have been used in vinifications as tools to increase the resveratrol content of white wine. Glycosylated resveratrol isomers (trans- and cis-piceid) and free resveratrol isomers (trans- and cis-resveratrol) were detected and quantified in white wines. Wines fermented with the strain expressing BgiN showed an increased amount of total resveratrol derivatives, particularly the non-glycosylated forms.

Publication Types:
PMID: 11020039 [PubMed - indexed for MEDLINE]

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Use of a repetitive DNA probe to type clinical and environmental isolates of Aspergillus flavus from a cluster of cutaneous infections in a neonatal intensive care unit.

James MJ, Lasker BA, McNeil MM, Shelton M, Warnock DW, Reiss E.

Mycotic Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Aspergillus flavus is second to A. fumigatus as a cause of invasive aspergillosis, but no standard method exists for molecular typing of strains from human sources. A repetitive DNA sequence cloned from A. flavus and subcloned into a pUC19 vector, pAF28, was used to type 18 isolates from diverse clinical, environmental, and geographic sources. The restriction fragment length polymorphisms generated with EcoRI- or PstI-digested genomic DNA and probed with digoxigenin-labeled pAF28 revealed complete concordance between patterns. Eighteen distinct fingerprints were observed. The probe was used to investigate two cases of cutaneous A. flavus infection in low-birth-weight infants in a neonatal intensive care unit (NICU). Both infants were transported by the same ambulance and crew to the NICU on the same day. A. flavus strains of the same genotype were isolated from both infants, from a roll of tape used to fasten their umbilical catheters, from a canvas bag used to store the tape in the ambulance, and from the tape tray in the ambulance isolette. These cases highlight the need to consider exposures in critically ill neonates that might occur during their transport to the NICU and for stringent infection control practices. The hybridization profiles of strains from a second cluster of invasive A. flavus infections in two pediatric hematology-oncology patients revealed a genotype common to strains from a definite case patient and a health care worker. A probable case patient was infected with a strain with a genotype different from that of the strain from the definite case patient but highly related to that of an environmental isolate. The high degree of discrimination and reproducibility obtained with the pAF28 probe underscores its utility for typing clinical and environmental isolates of A. flavus.

Publication Types:
PMID: 11015372 [PubMed - indexed for MEDLINE]

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Exposure to microbes, endotoxins and total dust in cigarette and cigar manufacturing: an evaluation of health hazards.

Reiman M, Uitti J.

Kuopio Regional Institute of Occupational Health, Kuopio, Finland.

The concentrations of airborne microbes, endotoxins and total dust were measured in one cigar and two cigarette factories in order to evaluate the risk of respiratory symptoms. The role of humidifiers as a source of microbes was investigated. Air samples for the analyses were collected near workers' breathing zones during different phases of production. Gram-negative bacteria, mesophilic fungi, thermotolerant fungi and thermophilic actinomycetes, but not Aspergillus glaucus fungi, were found in higher concentrations in the cigar factory than in the cigarette factories. High microbe concentrations (10(4)-10(5)cfu m(-3)) occurred throughout the production line in the cigar factory. The highest dust and endotoxin concentrations were found in the wick-making department in the cigar factory (3.3mg dust per m(3) and 38ng endotoxin per m(3)) and during the weighing or handling of raw tobacco in the cigarette factories (4.5 mg dust per m(3) and 106ng endotoxin per m(3)). The spray humidifiers in the cigar factory were a more important source of microbes than was raw tobacco. In the cigarette factories, steam humidifiers were used; the humidified air was free of microbes. The microbe concentrations in the tobacco factories were lower than in environments known to have caused allergic alveolitis.

Publication Types:
PMID: 10963711 [PubMed - indexed for MEDLINE]

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Resolution of sick building syndrome in a high-security facility.

Hiipakka DW, Buffington JR.

U.S. Naval Hospital, Rota, Spain.

The main objective of this article is to serve as a case study for other industrial hygiene (IH) professionals' review as a "real world" effort in responding to a facility perceived as "sick" by its occupants. As many industrial hygienists do not have extensive backgrounds in evaluating microbial air contaminants or the mechanical function of building HVAC units, the overall intent is to provide "lessons learned" to IH generalists who may be asked to participate in indoor environmental quality (IEQ) surveys. In September 1994, a suspected case of "sick building syndrome" was investigated (with significant airborne fungal loads confirmed) at a communications center after numerous occupants reported upper respiratory disease and/or allergy-type symptoms. The setting was a two-story structure approximately 30 years old, with a normal occupancy load of 350 to 400 persons. In addition to continual structural modifications, the central HVAC air conditioning systems had poor maintenance histories. Inspection of HVAC components revealed visible fungal growth on air filters and air ducts and in cooling fan condensate drip pans. Fungal air samples were collected with an Anderson N6 air sampler and Sabouraund dextrose agar media. Over a study period of 23 months, three rounds of 26 air samples were collected for 5 minutes each at 28.3 liters/minute airflow. Cultures exhibited fungi such as Aspergillus, Penicillium, Alternaria, and Cladosporium. Certain strains of these fungi produce mycotoxins that may cause a variety of deleterious health effects such as those described by occupants. Initial 1994 airborne fungal concentrations ranged from 85 to 6157 colony forming units (CFUs) per cubic meter of sampled air (CFU/m3). Some investigators have reported fungal concentrations as low as 245 CFU/m3 associated with complaint sites in other buildings. Remediation efforts involved hiring a dedicated mechanic to implement a HVAC preventive maintenance program (including regular replacement of all HVAC air filters and cleaning of accessible components with water/bleach solution). Post-abatement January 1996 re-sampling revealed a significant drop in airborne fungal colonies up to 97 percent (range = 21 to 1092 CFUs/m3)--which also coincided with physicians at the local hospital sensing a qualitative reduction in patient visits from facility workers. To address seasonal bias, a final August 1996 air sample round revealed a range of 14 to 500 CFUs/m3. Of the 21 workspaces sampled in all three rounds, nine continued to show a decline in CFUs/m3 from September 1994 baseline counts. These results demonstrate the critical role of an ongoing HVAC maintenance program for reducing potential reservoirs of fungal organisms in indoor work environments. Building renovations (especially those involving major changes to building layout and usage) can adversely affect IEQ if plans do not include coordinated updates and regular preventive maintenance of HVAC systems. Eventual negative outcomes can be reduced occupant productivity and deleterious health effects.

PMID: 10957819 [PubMed - indexed for MEDLINE]

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Allergic bronchopulmonary aspergillosis as presenting sign of cystic fibrosis in an elderly man.

Vilar ME, Najib NM, Chowdhry I, Bassett CW, Silverman BA, Giusti RJ, Rosa UW, Schneider AT.

Department of Allergy and Immunology, Long Island College Hospital, Brooklyn, New York, USA.

BACKGROUND: Although cystic fibrosis is the most common genetic disorder of children, its heterogeneous spectrum of severity lends itself to underdiagnosis in the older adult patient population where the index of suspicion is not high. METHODS: We report a 60-year-old Hispanic man with asthma who presented with progressive dyspnea and wheezing unresponsive to inhaled corticosteroid treatment. Additionally, he had clinical findings and a past history suggestive of cystic fibrosis. Skin testing, radiography and laboratory studies were completed to evaluate for allergic bronchopulmonary aspergillosis (ABPA) and cystic fibrosis. RESULTS: Test results revealed peripheral eosinophilia and hyper IgE. Skin testing to Aspergillus fumigatus (Af) was positive. IgG, IgM, and Af specific antibodies were present. High resolution CT scan showed central bronchiectasis. Sweat tests were positive on two separate occasions and gene analysis showed our patient to have a positive gene mutation at D127ON/D127ON. CONCLUSION: Cystic fibrosis should be suspected in the older adult patient with a compatible clinical presentation.

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PMID: 10923608 [PubMed - indexed for MEDLINE]

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Induction of the soybean phytoalexins coumestrol and glyceollin by Aspergillus.

BouŽ SM, Carter CH, Ehrlich KC, Cleveland TE.

Southern Regional Research Center, Agricultural Research Center, U.S. Department of Agriculture, New Orleans, LA 70179-0687, USA. sboue@nola.srrc.usda.gov

Several isoflavonoid phytoalexins produced by soybeans are known to be estrogenic, with potential beneficial health effects in humans. Increased production of phytoalexins by the soybean plant will facilitate research efforts in this area. In this study, phytoalexin induction and accumulation in soybean cotyledon tissue was observed using four species of Aspergillus: A. sojae, A. oryzae, A. niger, and A. flavus. All four Aspergillus species tested elicited phytoalexin accumulation in living soybean cotyledons. Results from a time course study indicated that maximum concentrations of the phytoalexin glyceollin, 955 microg/g fresh weight (fw), occurred at day 3 in soybean cotyledon tissue inoculated with A. sojae. Other Aspergillus species caused an accumulation of glyceollin at significantly lower levels. A maximum concentration of coumestrol of 27.2 microg/g fw was obtained from soybean cotyledons inoculated with A. niger. Soybean phytoalexins induced by food-grade A. sojae and A. oryzae allowed the collection of higher concentrations of phytoalexins for further examination in several in vitro and in vivo biological studies conducted to determine potential estrogenic activities.

PMID: 10888516 [PubMed - indexed for MEDLINE]

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Antimicrobial effects of Finnish plant extracts containing flavonoids and other phenolic compounds.

Rauha JP, Remes S, Heinonen M, Hopia A, KŠhkšnen M, Kujala T, Pihlaja K, Vuorela H, Vuorela P.

Department of Pharmacy, University of Helsinki, Finland.

Plant phenolics, especially dietary flavonoids, are currently of growing interest owing to their supposed functional properties in promoting human health. Antimicrobial screening of 13 phenolic substances and 29 extracts prepared from Finnish plant materials against selected microbes was conducted in this study. The tests were carried out using diffusion methods with four to nine microbial species (Aspergillus niger, Bacillus subtilis, Candida albicans, Escherichia coli, Micrococcus luteus, Pseudomonas aeruginosa, Saccharomyces cerevisiae, Staphylococcus aureus and Staphylococcus epidermidis). Flavone, quercetin and naringenin were effective in inhibiting the growth of the organisms. The most active plant extracts were purple loosestrife (Lythrum salicaria L.) against Candida albicans, meadowsweet (Filipendula ulmaria (L.) Maxim.), willow herb (Epilobium angustifolium L.), cloudberry (Rubus chamaemorus L.) and raspberry (Rubus idaeus L.) against bacteria, and white birch (Betula pubescens Ehrh.), pine (Pinus sylvestris L.) and potato (Solanum tuberosum. L.) against gram-positive Staphylococcus aureus.

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PMID: 10857921 [PubMed - indexed for MEDLINE]

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Pulmonary infection in human immunodeficiency virus-infected patients in Taiwan.

Fang CT, Hung CC, Chang SC, Hsueh PR, Chang YL, Chen MY, Luh KT.

Department of Internal Medicine, National Taiwan University Hospital, Taipei.

BACKGROUND: Pulmonary infection is a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. METHODS: We conducted a retrospective analysis of the pathogens causing pulmonary infection in 272 HIV-infected patients admitted to a university hospital from January 1993 through December 1998. RESULTS: A total of 158 (58%) patients had pulmonary complications, all but two of whom had acquired immunodeficiency syndrome (AIDS). There were 156 episodes of pulmonary infection, involving 124 patients. The most common pulmonary infection was Pneumocystis carinii pneumonia (PCP): 66 patients had 77 episodes of PCP, all of which occurred in patients with CD4+ lymphocyte counts below 0.2 x 10(9)/L (200/microL). Pulmonary tuberculosis (TB), diagnosed in 47 patients, was the second most common pulmonary infection. Twenty TB patients had open TB. HIV-infected patients who were immigrants from Southeast Asia (9/23, 39%) had a higher risk of developing pulmonary TB than nonimmigrants (38/249, 15%) (p = 0.004). Only one of 17 episodes of community-acquired bacterial pneumonia was caused by Streptococcus pneumoniae. Less common opportunistic pulmonary pathogens included cytomegalovirus (5 cases), Aspergillus species (3), Cryptococcus neoformans (3), Mycobacterium avium complex (2), Penicillium marneffei (1), Nocardia species (1), and Rhodococcus equi (1). CONCLUSIONS: PCP and pulmonary TB are the two leading pulmonary infections in Taiwanese HIV/AIDS patients. These findings should be taken into consideration when developing management strategies and public health policies.

PMID: 10770026 [PubMed - indexed for MEDLINE]

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[Nosocomial infections due to opportunistic fungi: analysis of a news outbreak in the Spanish press]

[Article in Spanish]

Adell C, Trilla A, Bruguera M, Giol M, SallŽs M, Bayas JM, TerŽs J, Asenjo MA.

Servicio de Medicina Preventiva, Hospital Cl’nic de Barcelona, Universidad de Barcelona, IDIBAPS.

BACKGROUND: To study an outbreak of media news related to nosocomial infections due to opportunistic fungi in Spanish hospitals. METHOD: Case definition: any news related to possible nosocomial infection due to opportunistic fungi in Spanish hospitals, published in national or local daily newspapers, over the pre-epidemic (July-December, 1998) and epidemic periods (January-June, 1999). All news were reviewed and identified using global press reports summaries, prepared by two independent sources, and were analyzed by three different observers. RESULTS: Over the pre-epidemic period there were not any news related to nosocomial infections due to opportunistic fungi. Over the epidemic period, a total of 218 news were identified, 154 (71%) published in national newspapers and 64 (29%) in local ones. We analyzed separately 18 editorials or opinion articles related to this subject. The epidemic curve (distribution of news by week) showed an incidence news peak at week 5 (102 news, 46.7% of all news published). The media mentioned up to 19 different hospitals as institutions with possible cases of nosocomial fungal infections. After week 8, news incidence drop, and remain thereafter at minimum levels. CONCLUSIONS: The example provided by the analysis of this outbreak of media news, related to nosocomial infections by Aspergillus an other opportunistic fungi, is useful to allow us understand how some medical news arise, develop and were transmitted. The public alert situation created in Spain was remarkable, and it is likely that there was a transient loss of confidence in the safety of public health institutions. Today's medicine requires a great and better openness to the media, and a better cooperation between both parts.

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PMID: 10758599 [PubMed - indexed for MEDLINE]

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Indoor viable mold spores--a comparison between two cities, Erfurt (eastern Germany) and Hamburg (western Germany).

Koch A, Heilemann KJ, Bischof W, Heinrich J, Wichmann HE.

Friedrich-Schiller-University Jena, Institute of Occupational, Social and Environmental Medicine, Department of Indoor Climatology, Erfurt, Germany.

BACKGROUND: In eastern Germany, the prevalence of allergies is lower than in western Germany for both children and adults. Several reasons for this fact have been discussed, although it is still not completely understood. One purpose of the epidemiologic study "Indoor and genetic factors in asthma and allergy" (INGA) is to compare exposure to mold spores in two German cities. Therefore, 405 homes in Erfurt (east) and Hamburg (west) were visited twice by trained investigators between June 1995 and May 1997. METHODS: Samples of settled dust were taken by vacuuming from the carpet in the living room. Sieved house dust was diluted and plated on DG18 agar. The analyses were carried out in duplicate in the same laboratory. RESULTS: No significant difference could be shown for the total and for single genera (Alternaria, Aspergillus, Cladosporium, and Penicillium) in concentration of spores of viable fungi in settled house dust between Erfurt and Hamburg. Seasonal variation of the mold picture, with highest values in August, could be identified both indoors and outdoors. CONCLUSIONS: Because outdoor concentration is the main influence on indoor concentration of mold spores from June to October, we recommend sampling from November to May to evaluate exposure to indoor mold spores.

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PMID: 10726733 [PubMed - indexed for MEDLINE]

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Indoor air pollutants in schools: nasal patency and biomarkers in nasal lavage.

NorbŠck D, WŒlinder R, Wieslander G, Smedje G, Erwall C, Venge P.

Department of Medical Sciences/Occupational and Environmental Medicine, University of Uppsala, University Hospital, Sweden.

BACKGROUND: There is growing concern about the respiratory health aspects of the indoor air quality in schools. METHODS: A standardized investigation, including nasal lavage (NAL), measurement of the nasal cavity by acoustic rhinometry, and hygienic measurements of airborne pollutants, was performed in classrooms, outside the pollen season. All 279 school personnel working in the main buildings of 12 randomly selected primary schools in an urban community in central Sweden (Uppsala) were invited to enroll in the study; 234 (84%) participated. Eosinophil cationic protein (ECP), myeloperoxidase (MPO), lysozyme, and albumin were analyzed in NAL fluid. Crude statistical analysis, as well as multiple regression analysis, was performed, controlling for room temperature, age, sex, current smoking, and a history of atopy. RESULTS: Most classrooms (83%) did not meet the Swedish ventilation standards. A lower degree of nasal patency was found at higher concentrations of respirable dust, nitrogen dioxide (NO2), formaldehyde, and total molds, and in the presence of Aspergillus spp. in the classroom air. The most consistent findings were observed for formaldehyde, NO2, and Aspergillus spp., related to both decreased nasal patency and increase of ECP and lysozyme in NAL. The presence of yeast was associated with an increase of ECP and lysozyme in NAL, but was not related to nasal patency. CONCLUSIONS: Ventilation flow was below current hygienic standards in the classrooms. Air pollutants in the classroom air may influence nasal patency and inflammatory response in the nasal mucosa.

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PMID: 10726731 [PubMed - indexed for MEDLINE]

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Two year follow-up of a garbage collector with allergic bronchopulmonary aspergillosis (ABPA).

Allmers H, Huber H, Baur X.

Berufsgenossenschaftliches Forschungsinstitut fŸr Arbeitsmedizin (BGFA), Institut an der Ruhr-UniversitŠt Bochum, Germany. allmers@bigfoot.de

BACKGROUND: Separate collection of biodegradable garbage and recyclable waste is expected to become mandatory in some western countries. A growing number of persons engaged in garbage collection and separation might become endangered by high loads of bacteria and fungi. Case history and examination A 29 year old garbage collector involved in emptying so-called biological garbage complained of dyspnea, fever, and flu-like symptoms during work beginning in the summer of 1992. Chest x-ray showed streaky shadows near both hili reaching into the upper regions. IgE- and IgG-antibodies (CAP, Pharmacia, Sweden) were strongly positive for Aspergillus fumigatus with 90.5 kU/L and 186%, respectively. Total-IgE was also strongly elevated with 5430 kU/L. Bronchial challenge testing with commercially available Aspergillus fumigatus extract resulted in an immediate-type asthmatic reaction. Two years later he was still symptomatic and antibodies persisted at lower levels. CONCLUSIONS: Our diagnosis was allergic bronchopulmonary aspergillosis (ABPA) including asthmatic responses as well as hypersensitivity pneumonitis (extrinsic allergic alveolitis) due to exposure to moldy household waste. A growing number of persons engaged in garbage collection and handling are exposed and at risk to develop sensitization to fungi due to exposure to dust of biodegradable waste. Further studies are necessary to show if separate collection of biodegradable waste increases the health risks due to exposure to bacteria and fungi in comparison to waste collection without separation. Copyright 2000 Wiley-Liss, Inc.

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PMID: 10706756 [PubMed - indexed for MEDLINE]

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A comparison of sampling media for environmental viable fungi collected in a hospital environment.

Wu PC, Su HJ, Ho HM.

Department of Environmental and Occupational Health, National Cheng Kung University Medical College, Tainan, Taiwan, Republic of China.

Quantitative evaluation of fungal exposure is often conducted by analysis of the composition of microbes in air samples and calculation of the concentrations afterward. The collecting medium that favors the growth for most saprophytic fungi is considered to be the ideal choice in most circumstances. Currently, the culture medium most frequently adopted in environmental sampling for airborne fungi is MEA (malt extract agar) recommended by the ACGIH for its suitability for most fungal growth. DG18 (dichloran glycerol-18), developed in 1980, is suggested for growth at lower water activity (a(w)=0.95) specifically and is not as commonly used in general studies. This investigation collected airborne viable fungi using a single stage/N6 Andersen impactor with MEA and DG18 agar plates attached simultaneously to the same set of samplers. The sampling locations were at 17 sites within a central air-conditioned hospital. After incubation and morphological identification, concentrations of airborne fungi and bacteria were expressed as CFU/m(3) (colony forming units/m(3)). There are 405 DG18 plates and 378 plates available for statistical analysis. Results show that the airborne fungal concentrations, shown by geometric mean (GM), are higher from the DG18 plates than from the MEA plates. The total fungal concentrations is 68.6 vs 12.94 CFU/m(3), and for Aspergillus spp., the concentration is 1.58 vs 0.72 CFU/m(3); for Penicillium spp., 3.37 vs 0.71; and for yeast, 5.09 vs 0.49 CFU/m(3). In addition, the number of different genera present is greater on the DG18 plates than on the MEA plates, on average, 2.85 types vs 1.72. This study suggests that in a hospital environment with 24-h, central air conditioning, DG18 plates appear to be more effective in collecting more fungal colonies in terms of both quantity and types of genera. Such a finding is presumed to be attributed to the characteristic of DG18 in slowing colony growth so that the dominating genus will not over occupy the culture plate surface before the less competitive genus can fully develop. Future studies on related biological mechanisms are essential to conclude whether the above results sustain when sampling is conducted in other environments. Copyright 2000 Academic Press.

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PMID: 10702333 [PubMed - indexed for MEDLINE]

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Immunochemical detection of molds: a review.

Li S, Marquardt RR, Abramson D.

Department of Animal Science, University of Manitoba, Winnipeg, Canada.

Molds are widely distributed in nature and cause deterioration of foods and feeds. Their mycotoxins can adversely affect human and animal health. Suitable assays for molds, therefore, are required to implement control and regulatory strategies and to develop appropriate feeding regimens for mold-infested feeds. Many different types of mold assays have been used, most of which are not reproducible or accurate. However, the immunoassays, particularly enzyme-linked immunosorbent assays (ELISAs), can be especially useful. Among these, assays that detect the water-soluble extracellular secretions of fungi, the exoantigens, are generally able to detect fungi at the genus or species level, whereas the heat-stable polysaccharides tend to be specific for one or more genus of fungi. Several species and genus (genera)-specific ELISAs have been developed using monoclonal or polyclonal antibodies against exoantigens and heat-stable polysaccharides from a wide range of fungi, including Aspergillus, Penicillium, and Fusarium species. Other assays have been developed that nonspecifically detect mold in food or feed, some using antibodies against a mixture of antigens from different fungi. These assays are highly sensitive, are easy to perform, and provide an index of the amount of mold present in the sample. Further refinement of these assays should facilitate their widespread use by food and feed processors, regulatory agencies, taxonomists, and research scientists.

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PMID: 10678438 [PubMed - indexed for MEDLINE]

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Comparisons of seasonal fungal prevalence in indoor and outdoor air and in house dusts of dwellings in one Northeast American county.

Ren P, Jankun TM, Leaderer BP.

Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA. airquality1@yale.edu

Fungi cause allergies and many other adverse health effects. In this study, we characterized the nature and seasonal variation of fungi inside and outside homes in the Greater New Haven, Connecticut area. Three indoor air samples (in the living room, bedroom, and basement) and one outdoor sample were collected by the Burkard portable air sampler. House dust samples were collected in the living room by a vacuum cleaner. The mold concentrations varied widely from house to house in both indoor and outdoor air. No significant difference (p>0.05) in concentration and type of fungi between living room and bedroom or by season was observed. Both concentration and type of fungi were significantly higher (p<0.05) in the basement than other indoor areas and outdoor air in winter. The type of fungi in living room, bedroom, and outdoor air were found to have significant changes among seasons, but there was no significant difference for the basement among seasons. Cladosporium spp. was dominant in both indoor and outdoor air in summer. Penicillium and Aspergillus were dominant in indoor air in winter, but neither was dominant in any season in outdoor air. The type of fungi and their concentrations in house dust samples were not representative of those isolated in indoor air. In dust samples, more Mucor, Wallemia, and Alternaria species, but less Aspergillus, Cladosporium, and Penicillium species were found in all seasons. Air sampling in spring or fall in every suspected house is suggested for year-round fungal exposure assessment.

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PMID: 10638841 [PubMed - indexed for MEDLINE]

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Study of the first contact management profile of cases of infectious keratitis: a hospital-based study.

Vajpayee RB, Dada T, Saxena R, Vajpayee M, Taylor HR, Venkatesh P, Sharma N.

Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. rbvajpay@medinst.ernet.in

PURPOSE: To study the management pattern and examine the role of cultures and antibiotic sensitivity testing in infectious keratitis. METHODS: A retrospective analysis of the demographic, clinical, and microbiological data was performed in 100 consecutive patients with infectious keratitis. The main parameters evaluated were nature of first contact with the health care services, investigations undertaken, treatment initiated, and the time interval between presentation to the first medical contact and to our center. Finally, the reports of culture and antibiotic sensitivity testing undertaken at our center were evaluated. RESULTS: In 70% of cases, ophthalmologists in independent practice were the first medical contact. Direct microscopy of the corneal scraping was undertaken in only 6% of cases, whereas culture and sensitivity studies had not been performed in any of the patients. Forty-six percent of the patients were prescribed 0.3% ciprofloxacin eyedrops in an inadequate dosage. Broad-spectrum fortified antibiotics eye drops had not been prescribed in any of the cases. At our center, positive cultures were obtained in 73.86% of cases and the most common organism isolated was coagulase-negative Staphylococcus (33.84%), followed by Pseudomonas aeruginosa (15.38%). A large number of the isolates demonstrated resistance to the recommended antibiotic therapy. CONCLUSIONS: Failure to implement standard management protocol for infectious keratitis at first contact is a major factor contributing to ocular morbidity in India.

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PMID: 10632009 [PubMed - indexed for MEDLINE]

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Infant pulmonary hemorrhage in a suburban home with water damage and mold (Stachybotrys atra).

Flappan SM, Portnoy J, Jones P, Barnes C.

Department of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Missouri, USA. Sflappan@cmh.edu

The American Academy of Pediatrics recently issued guidelines regarding the potential toxic effect of indoor molds. We now report another case of an infant with pulmonary hemorrhage whose residential environmental assessment revealed the presence of the toxigenic mold Stachybotrys atra. We used a questionnaire to identify environmental factors that could predispose the home to fungal contamination. We collected air samples from multiple locations in the home that we felt would reflect areas of relevant exposure. Surface samples were collected with a piece of transparent tape for semiquantitative measurement of spores present. We classified spores into their respective genera based on shape, size, and color. We also measured mycotoxin levels. Air sampling revealed significantly elevated total spore counts in the patient's bedroom and in the attic. Aspergillus/Penicillium species were predominant. Stachybotrys spores were found in the air sampled in the patient's bedroom, as well as from surfaces sampled in the patient's closet and the attic ceiling. Additionally, a small patch of Stachybotrys-contaminated area in the closet ceiling was sent for mycotoxin analysis. This material proved to be highly toxigenic. As the link between the presence of Stachybotrys in the home and pulmonary hemorrhage in infants increases, further efforts should be made to educate physicians, health care providers, and new parents about the potential toxic effects of this mold.

Publication Types:
PMID: 10544162 [PubMed - indexed for MEDLINE]

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Endotoxins and IgG antibodies as indicators of occupational exposure to the microbial contaminants of metal-working fluids.

Laitinen S, Linnainmaa M, Laitinen J, Kiviranta H, Reiman M, Liesivuori J.

Kuopio Regional Institute of Occupational Health, P.O. Box 93, FIN-70701 Kuopio, Finland. sirpa.laitinen@occuphealth.fi

OBJECTIVES: The aim of this study was to evaluate workers' exposure to microbes and bacterial endotoxins during the use of metal-working fluids (MWF). METHODS: Air and bulk sampling with biomonitoring of workers' serum IgG antibodies were used to estimate the exposure to biological agents at 18 workplaces. The types of emulsified MWF used were synthetic fluid, mineral oil or rape seed oil, in grinding, turning and drilling work. RESULTS: The endotoxin concentrations in the air ranged from 0.04 to 600 ng/m(3) when the endotoxin levels in MWF were 0.03-25,000 ng/ml. A high correlation was found between the endotoxin levels and the bacterial counts from MWF, as well as between the total culturable bacteria and the gram-negative bacteria concentrations in the air. Comamonas testosteroni and C. acidovorans were the most common strains in the samples but also colonies of Ochrobactrum anthropi, Pantoea agglomerans and Stenotrophomonas maltophilia were isolated from the workplaces. Fungi like Aspergillus, Cladosporium and Penicillium species were identified in the air but only rarely in the MWF. Positive IgG antibodies were found in the sera of 22 of the 25 MWF workers examined. Antibodies against S. maltophilia, P. agglomerans and C. acidovorans were the most common, appearing in 72%, 64% and 64%, respectively, of the cases. The MWF workers showed significantly higher IgG antibody responses to bacterial antigens than did the controls. CONCLUSIONS: The results clearly proved that in occupational hygiene measurements, endotoxins serve as excellent indicators of exposure to the microbial contaminants of MWF. IgG antibodies against antigens identified from workplace samples could be a practical tool for occupational health physicians.

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PMID: 10541909 [PubMed - indexed for MEDLINE]

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Exposure-response relations of alpha-amylase sensitisation in British bakeries and flour mills.

Nieuwenhuijsen MJ, Heederik D, Doekes G, Venables KM, Newman Taylor AJ.

T H Huxley School of Environment, Earth Sciences and Engineering, Centre for Environmental Technology, Imperial College of Science, Technology and Medicine, London, UK. m.nieuwenhuijsen@ic.ac.uk

OBJECTIVES: To describe the levels of exposure to fungal alpha-amylase in British bakeries and flour mills, and to describe the relation between exposure to alpha-amylase and sensitisation to fungal alpha-amylase. METHODS: 495 personal flour dust samples were taken in seven British bakeries and flour mills and analysed for alpha-amylase with an immunoassay. Workers at the sites were asked to fill out questionnaires on work related symptoms, smoking history, and work history, and they were skin prick tested with common allergens and fungal alpha-amylase to assess sensitisation. RESULTS: Exposure to high concentrations of alpha-amylase occur in a few areas of British bakeries and flour mills, and there can be considerable differences in exposures to alpha-amylase between sites and between exposure groups, and even within similar exposure groups from different sites. Exposure to the highest concentrations of alpha-amylase was found in the dispensing and mixing areas of the bakeries (geometric mean (GM) 39.7 ng/m3). Exposure to alpha-amylase showed only a moderate correlation with concentrations of dust (r = 0.42) and flour aeroallergen (r = 0.46). The results also showed a relation between exposure to alpha-amylase and sensitisation to fungal alpha-amylase (prevalence ratio (PR) for medium exposure 3.9, 95% confidence interval (95% CI) 0.8 to 20.2, PR for high exposure 9.9, 95% CI 2.8 to 34.6) compared with the low exposure category). Atopic subjects had an increased risk of sensitisation, but this was not significant. CONCLUSION: This study suggests that exposure to alpha-amylase is a considerable health risk in British bakeries and flour mills. A small proportion of workers are exposed to alpha-amylase at concentrations that result in high rates of sensitisation. A reduction in exposure to alpha-amylase is likely to reduce this risk.

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PMID: 10448329 [PubMed - indexed for MEDLINE]

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Species-specific production of microbial volatile organic compounds (MVOC) by airborne fungi from a compost facility.

Fischer G, Schwalbe R, Mšller M, Ostrowski R, Dott W.

Institute for Hygiene and Environmental Medicine, University Hospital, Technical University of Aachen, Germany.

Thirteen airborne fungal species frequently isolated in composting plants were screened for microbial volatile organic compounds (MVOC), i.e., Aspergillus candidus, A. fumigatus, A. versicolor, Emericella nidulans, Paecilomyces variotii, Penicillium brevicompactum, Penicillium clavigerum, Penicillium crustosum, Penicillium cyclopium, Penicillium expansum, Penicillium glabrum, Penicillium verruculosum, and Tritirachium oryzae. Air samples from pure cultures were sorbed on Tenax GR and analyzed by thermal desorption in combination with GC/MS. Various hydrocarbons of different chemical groups and a large number of terpenes were identified. Some compounds such as 3-methyl-1-butanol and 1-octen-3-ol were produced by a number of species, whereas some volatiles were specific for single species. An inventory of microbial metabolites will allow identification of potential health hazards due to an exposure to fungal propagules and metabolites in the workplace. Moreover, species-specific volatiles may serve as marker compounds for the selective detection of fungal species in indoor domestic and working environments.

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PMID: 10448558 [PubMed - indexed for MEDLINE]

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An approach to management of critical indoor air problems in school buildings.

Haverinen U, Husman T, Toivola M, Suonketo J, Pentti M, Lindberg R, Leinonen J, HyvŠrinen A, Meklin T, Nevalainen A.

National Public Health Institute, Laboratory of Environmental Microbiology and Unit of Epidemiology, Kuopio, Finland. ulla.haverinen@ktl.fi

This study was conducted in a school center that had been the focus of intense public concern over 2 years because of suspected mold and health problems. Because several attempts to find solutions to the problem within the community were not satisfactory, outside specialists were needed for support in solving the problem. The study group consisted of experts in civil engineering, indoor mycology, and epidemiology. The studies were conducted in close cooperation with the city administration. Structures at risk were opened, moisture and temperature were measured, and the causes of damage were analyzed. Microbial samples were taken from the air, surfaces, and materials. Health questionnaires were sent to the schoolchildren and personnel. Information on the measurements and their results was released regularly to school employees, students and their parents, and to the media. Repairs were designed on the basis of this information. Moisture damage was caused mainly by difficult moisture conditions at the building site, poor ventilation, and water leaks. Fungal genera (concentrations <200 colony-forming units (cfu)/m(3), <3000 cfu/cm(2)) typical to buildings with mold problems (e.g., Aspergillus versicolor, Eurotium) were collected from the indoor air and surfaces of the school buildings. Where moisture-prone structures were identified and visible signs of damage or elevated moisture content were recorded, the numbers of microbes also were high; thus microbial results from material samples supported the conclusions made in the structural studies. Several irritative and recurrent symptoms were common among the upper secondary and high school students. The prevalence of asthma was high (13%) among the upper secondary school students. During the last 4 years, the incidence of asthma was 3-fold that of the previous 4-year period.

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PMID: 10423392 [PubMed - indexed for MEDLINE]

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Microscopic fungi in dwellings and their health implications in humans.

Pieckov‡ E, Jesensk‡ Z.

Institute of Preventive and Clinical Medicine, Limbova 14, 833 01 Bratislava, Slovak Republic. pieckova@upkm.sk

The article reviews the quantitative and qualitative incidence of microscopic filamentous fungi in dwellings, methods for their detection, mycotoxins, glucans and volatile organic compounds produced by microscopic fungi in the indoor air of homes. Characteristics and properties of the most important species of fungi in dwellings (Alternaria spp., Aspergillus spp., Cladosporium spp., Fusarium spp., Penicillium spp., Stachybotrys spp., and Wallemia spp.) and the health problems of occupants of the "moldy homes are also discussed.

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PMID: 10384209 [PubMed - indexed for MEDLINE]

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Isolated renal Aspergillus abscess in an AIDS patient with a normal CD4+ cell count on highly active antiretroviral therapy.

Rey D, de Mautort E, Saussine C, Hansmann Y, Waller J, Herbrecht R, Christmann D, Lindner V, Letscher-Bru V, Koenig H, Lang JM.

Centre d'Informations et de Soins de l'ImmunodŽficience Humaine, Clinique MŽdicale A, H™pitaux Universitaires, Strasbourg, France. david.rey@chru-strasbourg.fr

Isolated renal Aspergillus abscess is a very rare complication of HIV infection. It usually occurs in patients with severe immune deficiency. The case of a 29-year-old HIV-infected homosexual male, a nonintravenous drug abuser, who developed a right renal Aspergillus abscess despite normalization of the CD4+ cell count after highly active antiretroviral treatment is described. When antimicrobial treatment failed (amphotericin B followed by itraconazole), he was cured by right nephrectomy and remains in good health 3 months later with no recurrence. In cases of Aspergillus renal abscess in HIV-infected patients, surgery is the treatment of choice, especially in the current era of highly active antiretroviral therapy.

Publication Types:
PMID: 10219579 [PubMed - indexed for MEDLINE]

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[outbreak of invasive pulmonary mycosis in neutropenic hematologic patients in relation to remodelling construction work]

[Article in Spanish]

Gaspar C, Mariano A, Cuesta J, Rodr’guez G, D’az J, Picazo J, Fereres J.

Servicio de Medicina Preventiva, Hospital Cl’nico San Carlos, Madrid.

BACKGROUND: An increase was observed in the number of cases of invasive pulmonary mycosis in neutropenic hematologic patients coinciding with construction work being carried out in the Hospital Cl’nico San Carlos (Madrid, Spain). The aim of this study was to confirm the existence of an outbreak, identify the factors related and adopt adequate control measures. METHODS: A descriptive, epidemiologic, environmental microbiologic study was performed. The incidence of cases in the study period and a control period was compared. Air samples were collected in the affected area and other areas of hospitalization not related to the construction work. The ventilation system of the Hemalotogy Isolation Unit (HIU) was also sampled. The control measures undertaken included: hermetic sealing of the construction work adjacent to hematology followed by transfer of the patients to another floor of the hospital. RESULTS: The existence of an outbreak was confirmed (significant increase in the incidence, p = 0.017). Eleven cases and one death by massive hemoptisis were reported. The mean total fungal count and to Aspergillus spp were 120 and 35 UFC/m3, respectively in the hematologic hospitalization area adjacent to the construction work and 37 and 5 UFC/m3 in other areas (p < 0.001). Contamination was detected in the ventilation system of the HIU by A. fumigatus (125 UFC/m3 of air from the interior of the conduct). CONCLUSIONS: An elevated number of fungal spores found in samples from the hematologic hospitalization area as well as no further new cases being reported following the transfer of the patients suggest that the outbreak was related to the adjacent construction work being carried out.

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PMID: 10217845 [PubMed - indexed for MEDLINE]

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Mycotoxins of Aspergillus fumigatus in pure culture and in native bioaerosols from compost facilities.

Fischer G, MŸller T, Ostrowski R, Dott W.

Institute for Hygiene and Environmental Medicine, University Hospital, RWTH Aachen, Germany.

Exposure to secondary metabolites of airborne fungi in waste handling facilities is discussed in regard to potential toxic impacts on human health. The relevance of mycotoxins has been intensely studied in connection with contamination of food and feed. Toxic secondary metabolites are expected to be present in airborne spores, but exposure to mycotoxins in bioaerosols has not been studied sufficiently. Aspergillus fumigatus is one of the most frequent species in the air of compost plants. A wide range of secondary metabolites was found in pure cultures of freshly isolated strains of A. fumigatus. Tryptoquivaline, a compound with tremorgenic properties, and trypacidin, for which no toxic properties are described, were found in native bioaerosols in a compost facility. The highly toxic metabolites gliotoxin and verruculogen were not found in the bioaerosols.

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PMID: 10101846 [PubMed - indexed for MEDLINE]

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Correlation between the prevalence of certain fungi and sick building syndrome.

Cooley JD, Wong WC, Jumper CA, Straus DC.

Department of Microbiology and Immunology, Texas Tech University Health Sciences Center, Lubbock 79430, USA.

OBJECTIVE: To examine the role of fungi in the production of sick building syndrome. METHODS: A 22 month study in the United States of 48 schools (in which there had been concerns about health and indoor air quality (IAQ). Building indoor air and surface samples, as well as outdoor air samples were taken at all sites to look for the presence of fungi or their viable propagules. RESULTS: Five fungal genera were consistently found in the outdoor air and comprised over 95% of the outdoor fungi. These genera were Cladosporium (81.5%), Penicillium (5.2%), Chrysosporium (4.9%), Alternaria (2.8%), and Aspergillus (1.1%). At 20 schools, there were significantly more colony forming units per cubic metre (CFU/m3) (p < 0.0001) of propagules of Penicillium species in the air samples from complaint areas when compared with the outdoor air samples and the indoor air samples from noncomplaint areas. At five schools, there were more, although not significant (p = 0.10), Penicillium propagules in the air samples from complaint areas when compared with the outdoor air samples and the indoor air samples from noncomplaint areas. In 11 schools, the indoor air (complaint areas) fungal ratios were similar to that in the outdoor air. In these 11 schools Stachybotrys atra was isolated from swab samples of visible growth under wetted carpets, on wetted walls, or behind vinyl wall coverings. In the remaining 11 schools, the fungal ratios and CFU/m3 of air were not significantly different in different areas. Many of the schools took remedial action that resulted in an indoor air fungal profile that was similar to that outdoors. CONCLUSIONS: Propagules of Penicillium and Stachybotrys species may be associated with sick building syndrome.

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PMID: 9861178 [PubMed - indexed for MEDLINE]

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Cerebral fungal infections in the immunocompromised host: a literature review and a new pathogen--Chaetomium atrobrunneum: case report.

Guppy KH, Thomas C, Thomas K, Anderson D.

Department of Neurosurgery, Loyola University Medical Center, Marywood, Illinois 60153, USA.

OBJECTIVE AND IMPORTANCE: A case of a cerebral abscess, occurring in a patient who had undergone bone marrow transplant, caused by a new pathogen, Chaetomium atrobrunneum, and a review of the literature are presented. Although Aspergillus species are by far the most common fungi found in cerebral abscesses in immunocompromised patients, an increasing number of fungi commonly found in nature but not usually associated with infections in humans have been isolated from cerebral abscesses in these patients. CLINICAL PRESENTATION: A 31-year-old male patient, who had undergone a recent bone marrow transplantation for multiple myeloma, presented 3 months after transplantation with right-sided hemiplegia caused by a left parietal hemorrhagic lesion. INTERVENTION: A biopsy guided by computed tomography showed that the abscess contained the fungus C. atrobrunneum. The final identification of the organism was based on cultures, scanning electron microscopic studies, and consultation with the Fungus Testing Laboratory at the University of Texas Health Science Center, San Antonio, TX. The patient was treated with several antifungal medications but developed uncontrolled cerebral edema, which led to further neurological deterioration and eventual death. CONCLUSION: Cerebral abscesses in the immunocompromised patient may no longer be assumed to be caused solely by Aspergillus species. The literature reveals several rare cases of uncommon fungi found in these abscesses. Only four cases of cerebral infections caused by the genus Chaetomium have been reported. The case presented represents the first time a patient who had undergone a bone marrow transplant with a cerebral abscess was found to be caused by the pathogen C. atrobrunneum.

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PMID: 9848862 [PubMed - indexed for MEDLINE]

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Concentrations of airborne Aspergillus compared to the incidence of invasive aspergillosis: lack of correlation.

Hospenthal DR, Kwon-Chung KJ, Bennett JE.

Laboratory of Clinical Investigation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA. dhospenthal@atlas.niaid.nih.gov

Air sampling of the rooms and corridors of the oncology wards of the hospital was carried out over a 54-week period to assess the concentration of viable Aspergillus conidia. A. fumigatus and A. flavus were recovered at a mean of 1.83 cfu m-3 air sampled. Individual samplings yielded concentrations of up to 11.6 cfu m-3. Other Aspergillus spp. were recovered at a mean of 2.38 cfu m-3 (maximum 32.6 cfu m-3). Concentration was not correlated with season or hospital ward. Review of autopsy results showed an average of 6.6 cases of aspergillosis annually over a 22-year period. No seasonal variation in case incidence was found. Six cases of invasive aspergillosis were diagnosed on the three cancer wards during the air-sampling period, but no association was seen linking these cases with changes in recovery of airborne Aspergillus. A seasonal pattern was not observed in the overall incidence of aspergillosis cases nor concentrations of airborne conidia.

PMID: 9776829 [PubMed - indexed for MEDLINE]

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Aspergillus nidulans infection in chronic granulomatous disease.

Segal BH, DeCarlo ES, Kwon-Chung KJ, Malech HL, Gallin JI, Holland SM.

Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-1886, USA.

Chronic granulomatous disease (CGD) is a rare inherited disorder of the NADPH oxidase complex in which phagocytes are defective in generating reactive oxidants. As a result, patients with CGD suffer from recurrent bacterial and fungal infections. The most common fungal infections are caused by Aspergillus species. Aspergillus nidulans is a rare pathogen in most patient populations with quantitative or qualitative neutrophil defects. We have reviewed all cases in which A. nidulans was isolated from patients at the National Institutes of Health (Bethesda, MD) between 1976 and 1997. A. nidulans infection occurred in 6 patients with CGD, but was not a pathogen in any other patient group. Aspergillus fumigatus was a more common pathogen in CGD compared with A. nidulans, but A. nidulans was more virulent. A. nidulans was significantly more likely to result in death compared with A. fumigatus, to involve adjacent bone, and to cause disseminated disease. Patients with A. nidulans received longer courses of amphotericin B therapy than patients with A. fumigatus, and were treated with surgery more often. In contrast to A. fumigatus, A. nidulans was generally refractory to intensive antifungal therapy, suggesting that early surgery may be important. These data show that A. nidulans is a distinct pathogen in CGD and its isolation carries more severe implications than that of A. fumigatus.

Publication Types:
PMID: 9772923 [PubMed - indexed for MEDLINE]