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MOULDY HOUSE PROBLEM. Tartu 10.3.-11.3.2004. DEFINITIONS. mould = microbes and their (toxic) products in moisture and water damaged building materials mouldy house = a building partly damaged by moisture and microbial growth damages can be visible or within building structures.
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MOULDY HOUSE PROBLEM Tartu 10.3.-11.3.2004 Markku Seuri, FIOH, 2004
DEFINITIONS • mould = microbes and their (toxic) products in moisture and water damaged building materials • mouldy house = a building partly damaged by moisture and microbial growth • damages can be visible or within building structures Markku Seuri, FIOH, 2004
THE MAIN DIFFICULTY • the exposure is not known • several candidates: • spores • toxins • microbial volatile organic compounds • microbes themselves • structures of microbes • allergens Markku Seuri, FIOH, 2004
LIVING EXPOSURE • the exposure changes over time • the microbes change: • material • type of damage • degree of moisture • temperature • nutrition • selection of species in time • the health effects change Markku Seuri, FIOH, 2004
SPORES • commonly measured and expressed as colony forming units (cfu) per cubic meter of air, gram of material • poor relation to the health effects • one has to consider to microbial species, no only the amount • measure of the damage, not of the health effects or the risk Markku Seuri, FIOH, 2004
MICROBIAL ALLERGENS • mould allergens exist, but most of the health effects are not IgE related allergies • fungal allergens are commonly essential enzymes in the fungus • similarities between the allergens of different species Markku Seuri, FIOH, 2004
STRUCTURES OF MICROBIAL WALL • beeta-glucans of fungi • endotoxin of gram negative bacteria • rarely seen in the air of mouldy houses • can be a problem in renovation • can cause irritation of respiratory tract • not a probable cause of health effects Markku Seuri, FIOH, 2004
MICROBIAL VOLATILE ORGANIC COMPOUNDS • do MVOCs exist? • MVOCs are released also from moistened materials without microbial growth • a measure of moisture damage on materials • not capable of producing irritation in the concentrations seen in mouldy houses Markku Seuri, FIOH, 2004
MICROBIAL TOXINS • their role in causing health effects in mouldy houses controversial • good potential cause: • various health effects - many toxins • potential (ng/g -level) • most difficult health effects are seen in old damages - selection of species in time • no way to measure small quantities (at the moment) Markku Seuri, FIOH, 2004
MICROBES THEMSELVES • not fungi commonly found in mould damages • only less than 10% of the microbial growth of any environmental sample can be named • interest in two groups: • slowly growing mycobacteria • microbes living with in amoeba Markku Seuri, FIOH, 2004
AMOEBA AND LEGIONELLOSIS • Legionella is intracellular bacteria • found in natural and man-made water systems • multiplies in 20-50 degrees of C (32-40 ideal) • survives in the environment within amoeba • can be an occupational diseases, for instance in work place showers • an epidemic in a Finnish hospital has been found Markku Seuri, FIOH, 2004
AMOEBA SHELTER OTHER BACTERIA • over 40 bacteria have been found within amoebae • including Chlamydia pneumoniae • we have found amoebae in damaged building material samples (in about one fifth of samples sent to our laboratories in Kuopio) Markku Seuri, FIOH, 2004
MOULD DAMAGES AND IMMUNOCOMPROMISED PATIENTS • Aspergillus spp have caused infections in hospitals, even fatal case • at the moment there is no evidence that the fungi in the mouldy buildings could cause diseases to health inhabitants Markku Seuri, FIOH, 2004
SYMPTOMS AND DISEASES FOUND IN MOULDY BUILDINGS • irritation • “toxic” or “general” symptoms • increased number of respiratory infections • diseases Markku Seuri, FIOH, 2004
IRRITATION SYMPTOMS • respiratory tract: • commonly the higher, rarely the lower • irritation of the eyes • irritation of the skin • the most common symptoms • transient • usually relieves in a few days Markku Seuri, FIOH, 2004
“TOXIC” OR “GENERAL” SYMPTOMS • symptoms like: • headache • tiredness • aching muscles and joints • fever and chills • transient • may need a week or two to be relieved Markku Seuri, FIOH, 2004
RESPIRATORY INFECTIONS • normal flues • sinusitis • the incidence is higher in mouldy houses • some toxins restrain the cilial movement in the respiratory tract in vitro Markku Seuri, FIOH, 2004
DISEASES 1 • asthma is the most common • mechanism is not known • most asthma cases seen in mouldy houses are not allergic • the risk of asthma is about two in the mouldy houses, but the risk is not divided evenly among them Markku Seuri, FIOH, 2004
DISEASES 2 • allergic rhinitis have been shown • some clusters of inflammatory rheumatic diseases have been published • the causal link not established • the risk of these diseases seen rarely Markku Seuri, FIOH, 2004