Acute Pulmonary Hemorrhage in Infants Associated With Exposure to Stachybotrys atra and Other Fungi

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Abstract
Background A geographic cluster of 10 cases of pulmonary hemorrhage and hemosiderosis in infants occurred in Cleveland, Ohio, between January 1993 and December 1994. Study Design This community-based case-control study tested the hypothesis that the 10 infants with pulmonary hemorrhage and hemosiderosis were more likely to live in homes whereStachybotrys atrawas present than were 30 age- and ZIP code–matched control infants. We investigated the infants' home environments using bioaerosol sampling methods, with specific attention toS atra. Air and surface samples were collected from the room where the infant was reported to have spent the most time. Results Mean colony counts for all fungi averaged 29227 colony-forming units (CFU)/m3in homes of patients and 707 CFU/m3in homes of controls. The mean concentration ofS atrain the air was 43 CFU/m3in homes of patients and 4 CFU/m3in homes of controls. ViableS atrawas detected in filter cassette samples of the air in the homes of 5 of 9 patients and 4 of 27 controls. The matched odds ratio for a change of 10 units in the mean concentration ofS atrain the air was 9.83 (95% confidence interval, 1.08-3×106). The mean concentration ofS atraon surfaces was 20×106CFU/g and 0.007×106CFU/g in homes of patients and controls, respectively. Conclusion Infants with pulmonary hemorrhage and hemosiderosis were more likely than controls to live in homes with toxigenicS atraand other fungi in the indoor air.