[Non allergic disorders associated with domestic moulds]

Positive associations between respiratory outcomes and fungal index in rural inhabitants of a representative sample of French dwellings

Our study aims at estimating exposure to molds at home, based on microbial Volatile Organic Compounds (MVOCs) assessment, and evaluating its effect on respiratory diseases in a representative sample of dwellings. In the framework of a national campaign, indoor pollution was monitored in a sample of the 24 million dwellings of metropolitan France (n=567). 727 subjects answered to a standardized questionnaire on respiratory diseases and had MVOCs sampled in their bedrooms and a fungal index (FI) defined. Among the 431 dwellings with complete data, one out of three was contaminated by molds as assessed by a positive FI: 27.0% in urban, 38.2% in periurban and 34.9% in rural dwellings respectively. Positive associations were observed between fungal index and current asthma (8.6%) and chronic bronchitis-like symptoms (8.4%), especially in rural areas (OR=2.95, 95%CI (1.10; 7.95) and 3.35, 95%CI (1.33; 8.48) respectively). Our study, based on objective assessments of fungal contamination, is in agreement with previous results suggesting mold-related respiratory effects. Moreover associations found among rural population could indicate specific pollution and impact in this environment.

[Interstitial lung disease due to domestic moulds]

Identifying the role of fungi present in the domestic environment in the development of interstitial pneumonia can be a difficult clinical problem. We report a case of interstitial lung disease case occurring in a 53-year-old patient. He presented with profound hypoxemia (PaO(2) 54mmHg). Chest CT showed diffuse ground glass opacities. Initial blood tests for allergy and autoimmune disease were negative. Faced with a worsening of his clinical status after returning home he was hospitalized several times. At fibreoptic bronchoscopy, multiple white deposits were observed. Bronchoalveolar lavage with differential cell count was performed, revealing a 23% lymphocytosis. Serology for specific household molds showed moderate reaction to various molds found in homes, especially Stachybotrys chartarum. Pulmonary function tests revealed a moderate restrictive pattern with impaired diffusion of carbon monoxide and a bronchiolocentric interstitial pneumonia was found at lung biopsy. After a permanent move to a new residence, clinical parameters, radiological, biological and functional normalized. The final diagnosis was interstitial lung disease related to mycotoxins of S. Chartarum. The diagnosis of hypersensitivity pneumonitis to domestic mold or interstitial lung disease secondary to mycotoxins should be considered in patients presenting with interstitial pneumonia and requires specific investigations to ensure that an environmental cause with an allergic or toxic role is not missed.