Establishing site specific reference levels for fungi in outdoor air for building evaluation

Application of the Environmental Relative Moldiness Index in Indoor Marijuana Grow Operations

OBJECTIVES

Indoor marijuana grow operations (IMGOs) are increasing due to legalization of recreational and medicinal cannabis at the state level. However, the potential exposures of IMGO workers have not been well studied. Mold exposure has been identified as a major occupational health concern. Mold-specific quantitative polymerase chain reaction (MSQPCR) can provide quantitative exposure data for fungi at the species level. The purpose of this study was to characterize the airborne fungal burden using MSQPCR and to evaluate the applicability of an airborne Environmental Relative Moldiness Index (ERMI) in IMGOs.

METHODS

Air and dust samples were collected inside and outside the IMGOs and then analyzed via MSQPCR. These data were then used to calculate IMGO-specific ERMI scores. Culturable air samples were collected on agar plates and analyzed via microscopy. Differences were evaluated between indoor and outdoor concentrations, as well as between air and dust samples. The agreement between MSQPCR and culture-based methods was also evaluated.

RESULTS

Based on the geometric means for non-zero values of each fungal species across all IMGOs, the total airborne concentration was approximately 9100 spore equivalent (SE) m-3 with an interquartile range (IQR) of 222 SE m-3. The indoor/outdoor ratio of geometric means across all 36 species per IMGO ranged from 0.4 to 6.2. Significantly higher indoor concentrations of fungal species, including Aspergillus spp., were observed. An average airborne ERMI score of 7 (IQR = 7.6) indicated a relatively high burden of mold across a majority of operations. The ERMI scores were driven by the high concentrations of Group 1 species with a mean of 15.8 and an IQR of 13. There were 63 additional species identified in the culturable air samples not included in the ERMI.

CONCLUSIONS

High concentrations of airborne fungi were identified in IMGOs. Our evaluation of the ERMI based on MSQPCR as a rapid diagnostic and risk assessment tool for industrial hygienists in the IMGO setting is equivocal. ERMI did not identify all relevant fungal species associated with this specific occupational environment. We identified several issues with using the ERMI calculation. At this time, the catalog of fungal species needs to optimized for the occupational setting to ensure adequate coverage, especially for those species expected to be found in this burgeoning industry. Further research is necessary to elucidate the link between the ERMI score of airborne samples, worker exposure and health effects in grows to generate an acceptable index score for use in occupational exposure assessments.

Normal background levels of air and surface mould reserve in English residential building stock: a preliminary study towards benchmarks based on NAHA measurements

This paper reports results obtained from a surface (both visually clean and dirty/dusty surfaces) and active (aggressive or activated) air testing scheme on 140 residential rooms in England, without visible water damage or mould growth, along with a few rooms with visible mould growth/water damage tested for comparison purposes. The aim was to establish normal background levels of mould in non-water-damaged interiors to benchmark a 'normal' indoor environment, and in turn when there is a need for further investigation, and, possibly, remediation. Air and surface mould was quantified based on the activity of β-N-acetylhexosaminidase (EC 3.2.1.52; NAHA). The obtained readings showed a log-normal distribution. Ninety-eight percent of the samples obtained from visually clean surfaces were equal to or less than 25 relative fluorescence units (RFU), which is suggested to be the higher bound for the range which can be used as a success criterion for surface cleaning/remediation. Of samples obtained from visually dirty/dusty surfaces, around 98% were below 450 RFU, which is suggested to define the lower-bound for abnormally high levels of mould, rare even on dirty/dusty surfaces. Similarly, around 98% of the air samples were found to have 1700 RFU or below. Values above 1700 RFU are therefore deemed unlikely in a non-problem indoor environment and can be indicative of a possible problem inducing mould growth. The samples with values below 1700 were further divided into three proposed sub-categories. Finally, the obtained RFU values and the suggested benchmarks were compared to those obtained from 17 non-residential indoor environments tested previously in Copenhagen, and the benchmarks that are currently used in Danish national standards, and they were both found to be highly congruent, suggesting that local climate regimes and room functions might not be as influential on indoor mould levels as commonly thought, or that the nuances between England and Denmark in terms of these factors are not strong enough to lead to sizable changes in the typical indoor mould levels in these countries' building stocks.

Mold and Human Health: a Reality Check

There are possibly millions of mold species on earth. The vast majority of these mold spores live in harmony with humans, rarely causing disease. The rare species that does cause disease does so by triggering allergies or asthma, or may be involved in hypersensitivity diseases such as allergic bronchopulmonary aspergillosis or allergic fungal sinusitis. Other hypersensitivity diseases include those related to occupational or domiciliary exposures to certain mold species, as in the case of Pigeon Breeder's disease, Farmer's lung, or humidifier fever. The final proven category of fungal diseases is through infection, as in the case of onchomycosis or coccidiomycosis. These diseases can be treated using anti-fungal agents. Molds and fungi can also be particularly important in infections that occur in immunocompromised patients. Systemic candidiasis does not occur unless the individual is immunodeficient. Previous reports of "toxic mold syndrome" or "toxic black mold" have been shown to be no more than media hype and mass hysteria, partly stemming from the misinterpreted concept of the "sick building syndrome." There is no scientific evidence that exposure to visible black mold in apartments and buildings can lead to the vague and subjective symptoms of memory loss, inability to focus, fatigue, and headaches that were reported by people who erroneously believed that they were suffering from "mycotoxicosis." Similarly, a causal relationship between cases of infant pulmonary hemorrhage and exposure to "black mold" has never been proven. Finally, there is no evidence of a link between autoimmune disease and mold exposure.

Aureobasidium melanogenum: a native of dark biofinishes on oil treated wood

The genus Aureobasidium, which is known as a wood staining mould, has been detected on oil treated woods in the specific stain formation called biofinish. This biofinish is used to develop a new protective, self-healing and decorative biotreatment for wood. In order to understand and control biofinish formation on oil treated wood, the occurrence of different Aureobasidium species on various wood surfaces was studied. Phenotypic variability within Aureobasidium strains presented limitations of morphological identification of Aureobasidium species. PCR amplification and Sanger sequencing of ITS and RPB2 were used to identify the culturable Aureobasidium species composition in mould stained wood surfaces with and without a biofinish. The analysed isolates showed that several Aureobasidium species were present and that Aureobasidium melanogenum was predominantly detected, regardless of the presence of a biofinish and the type of substrate. A.melanogenum was detected on wood samples exposed in the Netherlands, Cameroon, South Africa, Australia and Norway. ITS-specific PCR amplification, cloning and sequencing of DNA extracted from biofinish samples confirmed results of the culturing based method: A. melanogenum is predominant within the Aureobasidium population of biofinishes on pine sapwood treated with raw linseed oil and the outdoor placement in the Netherlands.

Geographic distribution of Environmental Relative Moldiness Index molds in USA homes

OBJECTIVE

The objective of this study was to quantify and describe the distribution of the 36 molds that make up the Environmental Relative Moldiness Index (ERMI).

MATERIALS AND METHODS

As part of the 2006 American Healthy Homes Survey, settled dust samples were analyzed by mold-specific quantitative PCR (MSQPCR) for the 36 ERMI molds. Each species' geographical distribution pattern was examined individually, followed by partitioning analysis in order to identify spatially meaningful patterns. For mapping, the 36 mold populations were divided into disjoint clusters on the basis of their standardized concentrations, and First Principal Component (FPC) scores were computed.

RESULTS AND CONCLUSIONS

The partitioning analyses failed to uncover a valid partitioning that yielded compact, well-separated partitions with systematic spatial distributions, either on global or local criteria. Disjoint variable clustering resulted in seven mold clusters. The 36 molds and ERMI values themselves were found to be heterogeneously distributed across the United States of America (USA).

Detection of Aspergillus fumigatus by quantitative polymerase chain reaction in air samples impacted on low-melt agar

BACKGROUND

The standard procedure for routine environmental sampling for the prevention of invasive aspergillosis outbreaks is culturing of Aspergillus fumigatus after impaction of air. Time to results is usually 7 days. A preliminary study was carried out to compare the time to results and sensitivity of culturing and quantitative polymerase chain reaction (QPCR) in the detection of airborne A fumigatus.

METHODS

Fungal DNA was extracted from 43 samples of impacted low-melt agar by a 3-step extraction method and amplified by QPCR. Identification was made using a specific A fumigatus probe.

RESULTS

With QPCR, 19 of the 43 samples were positive for A fumigatus; with culturing, 7 of these 19 samples were positive, and 12 were negative. The cycle threshold (Ct) values for the 12 culture-negative samples were between 39 and 43 cycles, and the Ct values for 6 of the 7 culture-positive samples were <38 cycles, suggesting that the amount of DNA detected by QPCR was higher in the presence of viable conidia.

CONCLUSION

QPCR detection of airborne A fumigatus in impacted low-melt agar significantly reduces the period of time between sample collection and results (48 hours), suggesting that this new approach can be beneficial for routine environmental sampling.

Fungal spores: a critical review of the toxicological and epidemiological evidence as a basis for occupational exposure limit setting

Fungal spores are ubiquitous in the environment. However, exposure levels in workplaces where mouldy materials are handled are much higher than in common indoor and outdoor environments. Spores of all tested species induced inflammation in experimental studies. The response to mycotoxin-producing and pathogenic species was much stronger. In animal studies, nonallergic responses dominated after a single dose. Allergic responses also occurred, especially to mycotoxin-producing and pathogenic species, and after repeated exposures. Inhalation of a single spore dose by subjects with sick building syndrome indicated no observed effect levels of 4 x 10(3) Trichoderma harzianum spores/m(3) and 8 x 10(3) Penicillium chrysogenum spores/m(3) for lung function, respiratory symptoms, and inflammatory cells in the blood. In asthmatic patients allergic to Penicillium sp. or Alternaria alternata, lowest observed effect levels (LOELs) for reduced airway conductance were 1 x 10(4) and 2 x 10(4) spores/m(3), respectively. In epidemiological studies of highly exposed working populations lung function decline, respiratory symptoms and airway inflammation began to appear at exposure levels of 10(5) spores/m(3). Thus, human challenge and epidemiological studies support fairly consistent LOELs of approximately 10(5) spores/m(3) for diverse fungal species in nonsensitised populations. Mycotoxin-producing and pathogenic species have to be detected specifically, however, because of their higher toxicity.

Development of an Environmental Relative Moldiness index for US homes

OBJECTIVE

The objective of this study was to establish a national relative moldiness index for homes in the United States.

METHODS

As part of the Housing and Urban Development's American Healthy Homes Survey, dust samples were collected by vacuuming 2 m in the bedrooms plus 2 m in the living rooms from a nationally representative 1096 homes in the United States using the Mitest sampler. Five milligrams of sieved (300 mum pore, nylon mesh) dust was analyzed by mold-specific quantitative polymerase chain reaction for the 36 indicator species in 1096 samples.

RESULTS

On the basis of this standardized national sampling and analysis, an "Environmental Relative Moldiness Index" was created with values ranging from about -10 to 20 or above (lowest to highest).

CONCLUSIONS

The Environmental Relative Moldiness Index scale may be useful for home mold-burden estimates in epidemiological studies.

Verifying interpretive criteria for bioaerosol data using (bootstrap) Monte Carlo techniques

A number of interpretive descriptors have been proposed for bioaerosol data due to the lack of health-based numerical standards, but very few have been verified as to their ability to describe a suspect indoor environment. Culturable and nonculturable (spore trap) sampling using the bootstrap version of Monte Carlo simulation (BMC) at several sites during 2003-2006 served as a source of indoor and outdoor data to test various criteria with regard to their variability in characterizing an indoor or outdoor environment. The purpose was to gain some insight for the reliability of some of the interpretive criteria in use as well as to demonstrate the utility of BMC methods as a generalized technique for validation of various interpretive criteria for bioaerosols. The ratio of nonphylloplane (NP) fungi (total of Aspergillus and Penicillium) to phylloplane (P) fungi (total of Cladosporium, Alternaria, and Epicoccum), or NP/P, is a descriptor that has been used to identify "dominance" of nonphylloplane fungi (NP/P > 1.0), assumed to be indicative of a problematic indoor environment. However, BMC analysis of spore trap and culturable bioaerosol data using the NP/P ratio identified frequent dominance by nonphylloplane fungi in outdoor air. Similarly, the NP/P descriptor indicated dominance of nonphylloplane fungi in buildings with visible mold growth and/or known water intrusion with a frequency often in the range of 0.5 Fixed numerical criteria for spore trap data of 900 and 1300 spores/m(3) for total spores and 750 Aspergillus/Penicillium spores/m(3) exhibited similar variability, as did ratios of nonphylloplane to total fungi, phylloplane to total fungi, and indoor/outdoor ratios for total fungal spores. Analysis of bioaerosol data by BMC indicates that numerical levels or descriptors based on dominance of certain fungi are unreliable as criteria for characterizing a given environment. The utility of BMC analysis lies in its generalized application to test mathematically the validity of any given descriptor or criterion for bioaerosols, which can be an important tool in quantifying the uncertainty in interpreting bioaerosol data.

Occupational risk assessment of aspergillosis after renal transplantation

Returning to work after transplantation is a much-discussed topic today, especially as a measure to avoid permanent work disability. Many transplant patients regain their ability to work 2-6 months after transplantation. However, returning to work should not endanger their health. This means that occupational risks such as occupational exposure to Aspergillus spores must be evaluated. We evaluated the community-acquired aspergillosis risk and in particularly the occupational aspergillosis risk, using the example of a 39-year-old construction worker immunosuppressed after renal transplantation. On one hand the risk is linked to the exposure to microorganisms that the individual is likely to be subjected to, and on the other hand to the factors that modify his state of susceptibility or resistance to these infectious agents. The necessity of immunosuppressive therapy after transplantation elevates the aspergillosis risk, especially 1-6 months after transplantation. There are many professions in which exposure to Aspergillus spores can occur. The risk of acquiring aspergillosis at work exists, but is not quantifiable today. Nevertheless, the risk should be minimized during the period of vulnerability by preventive measures such as restriction of certain activities, changing work methods and reorganizing the work day to adapt to the risk, and wearing personal protective equipment, as well as attention to information about aspergillosis risk and about the likelihood of exposure in the patient's professional and leisure activities.