Potential Association Between Indoor Mold Growth and Pulmonary Hemorrhage in Infants


             Indoor Environments Division Partner Alert              Page
                   U.S. Environmental Protection Agency
                           January 1997
     Potential Association Between Indoor Mold Growth
           and Pulmonary Hemorrhage in Infants

     The Centers for Disease Control and Prevention (CDC) of the Public
Health Service has recently asked for our help to publicize the apparent
association between mold contamination of the indoor environment and a
number of cases of infant pulmonary hemorrhage that CDC has investigated.
During the last 4 years several infants have experienced pulmonary
hemorrhage or bleeding from the lungs - some of them died. CDC investigators
believe that an association may exist between infant pulmonary hemorrhage
and the indoor mold Stachybotrys atra.
     The Environmental Protection Agency and CDC believe it is important to
recognize the symptoms of pulmonary hemorrhage and to avoid exposing
infants to indoor molds. CDC would also like to continue the investigation and
identify other possible cases.  While we do not want to create undue alarm or
misstate the possible relationship between infant pulmonary hemorrhage and
Stachybotrys atra, public awareness of the symptoms and causes of pulmonary
hemorrhage could save lives.
     The following key points are adapted from the CDC brochure "Important
Facts about Pulmonary Hemorrhage" and the January 17,1997 issue of CDC's
Morbidity and Mortality Weekly Report.
     Please help us disseminate this information to the public health
community, encourage people to report any case of pulmonary hemorrhage
with an unknown cause in an infant (under 1 year of age) to the CDC, and let us
know how your efforts progress.
     Thanks for your help.
Symptoms of Pulmonary Hemorrhage
Pulmonary hemorrhage is bleeding in the lungs.  Symptoms include coughing up
blood and nosebleed. If you notice these symptoms in your infant, get medical
attention immediately. It can be fatal in infants under 1 year of age.

Causes of Pulmonary Hemorrhage
While research is ongoing about this rare but deadly disease, CDC's
investigation suggests that one of the causes of infant pulmonary hemorrhage
may be toxins from the indoor mold in the infants' environment. These toxins
may irritate the lining of the infants lungs and weaken developing blood vessels,
eventually leading to pulmonary bleeding.  In addition, CDC indicates that
exposure to tobacco smoke in addition to this indoor mold may increase an
infant's risk of pulmonary hemorrhage. Pulmonary hemorrhage has also been
linked with allergy to cow's milk, pneumonia, heart/ lung/ spleen/ pancreas
problems, and other infections/ allergies/ immunological diseases.

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Stachybotrys atra
The mold suspected to be associated with pulmonary hemorrhage is
Stachybotrys atra. Stachybotrys is black or green-black and has a slimy
appearance. This mold grows primarily on materials such as wood and wood
based products, paper, or other cellulose products which have become and
remain wet. It is not typically found in dry or simply humid locations or on
bread, shower tiles, plastic, vinyl, concrete, or ceramics.

Cleanup of Mold Growth
Fix all leaks and eliminate water sources associated with the mold growth.
Clean hard surfaces with a solution of bleach and water (11/2 cups of bleach per
gallon of water); make sure to ventilate the area when using chlorine bleach
(note: do not add detergents which contain ammonia to the solution of bleach
and water - toxic fumes could result). Some experts suggest that persons
performing the cleanup wear filter masks and gloves to avoid contact with the
mold. Let the bleach and water mixture sit for 15 minutes and then dry the area
thoroughly. Porous materials that are wet and cannot be thoroughly cleaned
and dried should be discarded, as they can remain a source of mold growth.
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To report a case of pulmonary hemorrhage with an unknown cause in
an infant (under 1 year of age) or to obtain the publications marked with an
asterisk below, please contact the Centers for Disease Control and
Prevention at (770) 488-7320.

For Additional Information:

*Centers for Disease Control and Prevention. Important Facts about: Pulmonary
Hemorrhage. Pamphlet September 1996.

*Centers for Disease Control and Prevention. Update on Pulmonary Hemorrhage/
Hemosiderosls Among Infants - Cleveland, Ohio, 1993-1996. Morbidity and Mortality
Weekly Report, Vol. 46,  No. 2, January 17,1997. (Internet http://www.cdc.gov/cdc.htm)

*Centersfor Disease Control and Prevention. Acute Pulmonary Hemorrhage/
Hemoslderosis Among Infants - Cleveland, January 1993-November 1994. Morbidity
and Mortality Weekly Report, Vol. 43, No. 48, December 9,1994.
(Internet http://www.cdc.gov/cdc.htm)

      Several fact sheets and other indoor air quality related publications including
      "Biological Pollutants in Your Home" and "Flood Cleanup: Avoiding Indoor Air
      Quality Problems" are available from:

Indoor Air Quality Information Clearinghouse
P.O. Box 37133
Washington, DC 20013-7133
(800)-438-4318  or  (202)-484-1307

 *Montana, E., Etzel, R., Allan, T., Horgan, T., and Dearborn, D.  Environmental Risk
Factors Associated with Pediatric Idiopathic Pulmonary Hemorrhage and Hemosiderosis
in a Cleveland Community. Pediatrics, Vol. 99, No. 1,  January1997. (Internet
http://www.pediatrtcs.orglcg\lcontenilful\IQ9nie5)

U.S. Environmental Protection Agency, Indoor Environments Division web site
http://www.epa.gov/iaq/

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