Stachybotrys Chartarum

Known as the nefarious “black mold,” Stachybotrys Chartarum is a toxigenic type of mold that can also cause allergic reactions. Stachybotrys mold is usually black or brownish white in color, and has a dry texture. Stachybotrys thrives in damp, wet areas with humidity levels that maintain these environmental conditions for weeks. It is known for growing on cellulose material such as wood, cardboard, paper, hay or wicker, also any type of metals. Black mold knows no environmental limitations or temperature – it eats everything!

Stachybotrys is sometimes call “toxic mold” because it produces mycotoxins called Trichcochenes that cause severe health problems to those who have been exposed to it. Stachybotrys exposure symptoms include difficulty brain fog, neurological problems, anxiety, sleeplessness and confusion. Dull aches and pains in the mucous membranes of the sinuses is common among sufferers of black mold exposure.

If you’ve been exposed to Stachybotrys you may also experience burning sensations and sores on your skin. Stachybotrys is linked to neurological problems and pulmonary bleeding in infants, children and adults. If you have black mold in a home with children, it is important to remove children, pets and plants from the home and prevent their exposure.

Contact a mold remediation professional immediately to help you assess the damage that has been done by black mold in your home, and to start the remediation process as soon as possible. Black mold is very sneaky, so it’s important to follow its trail to all areas of the house.

Recognizing Stachybotrys

Stachybotrys grows on material with a high cellulose content, such as hay, straw, wicker, and wood chips, as well as building materials such as ceiling tile, drywall, paper vapor barriers, wallpaper, insulation backing, cardboard boxes, paper files, fiberboard, the paper covering of gypsum wallboard, particleboard, jute, dust, and wood when these items become water damaged.

Stachybotrys also loves metal, where it turns into rust. This mold can grow in the Arctic and in temperatures beyond. Black mold knows no temperature and can grow on anything.

Symptoms Reported with Exposure

Individuals with chronic exposure to toxins produced by this mold reported memory loss, muscle aches, sore throats, headaches, fatigue, dermatitis, cancer, and generalized malaise. Animals injected with the toxin from the toxin from this mold exhibit the following symptoms: necrosis and hemorrhage within the brain, thymus, spleen, intestine, lung, heart, lymph node, liver, and kidneys. Effects by absorption of the toxin in the human lung are known as mycosis. The toxins may also suppress the immune system.

Images of Stachybotrys Chartarum
Note: These are highly extreme cases

Toxin Production

Toxicologically, stachybotrys can produce extremely potent trichothecene poisons.  Some of these difficulties derive from the nature of the organisms and the toxic products they produce and varying susceptibilities among those exposed.  Statistically significant differences for more exposed people have increased lower respiratory symptoms, dermatological, eye and constitutional neurological symptoms, chronic fatigue, and allergy history. Symptoms were also associated with upper respiratory, skin and central nervous system disorders. A trend for frequent upper respiratory infections, and urinary tract infections (dysuria of the bladder) were also observed. Higher and longer indoor exposure to S. chartarum results in immune modulation and major immune suppression..

Stachybotrys mycotoxins and other biologically active compounds are the reasons why this mold is of such great concern to human health. Stachybotrys chartarum is one of many molds that are capable of producing one or more mycotoxins (chemicals produced by molds that may be able to cause symptoms or illness and death in people).

Stachybotrys chartarum produces the following types of macrocyclic trichothecenes, which are highly toxic compounds.

Much of what is currently known about exposure to mycotoxins has emerged from veterinary science. The toxic effects from mycotoxins produced by stachybotrys chartarum were first reported in the 1920s in Russia, when researchers reported severe morbidity and mortality in cattle and horses that ingested hay contaminated with this mold. Clinical observations included severe skin and mucous membrane inflammation, bleeding disorders, diarrhea, and upper and lower respiratory tract disorders.

Of particular concern is the threat that humans will inhale and ingest these toxic spores. One vague example are Yellow Rain attacks in Southeast Asia during the 1970s that were associated with the use of aerosolized trichothecenes. The toxins are often present on the fungal spores. Recent experimental animal studies have reported severe intra-alveolar, bronchiolar, and interstitial inflammation in mice that were exposed via an intranasal route with trichothecenes.

In contrast to toxicity from direct inhalation of stachybotrys spores, simulated environmental conditions with extensive surface growth of toxigenic stachybotrys and high air flow have not produced significant pulmonary toxicity in exposed mice. This observation may be related to the physical properties of stachybotrys; it produces spores in a slimy mass that are unlikely to become airborne without dry conditions. In addition, the production of mycotoxin by stachybotrys is dependent upon the environmental conditions of its growth. On some building materials and growth substrates, stachybotrys has not demonstrated biologic toxicity or mycotoxin production.

In laboratory animals, acute exposure to large amounts of trichothecene toxins resulting in a rapid release of stored white blood cells into circulation, while repeated or chronic exposure destroys granulocytic precursor cells in bone marrow leading to white cell depletion. Among the reported cellular effects are: mitogen B/T lymphocyte blastogenesis suppression, decrease of IgM, IgG, IgA; impaired macrophage activity and migration-chemotaxis; broad immunosuppressive effects on the cellular and humoral-mediated immune response leading to secondary infections; immunomodulation leading to spontaneous antibody increase and immunosuppressive effects in human peripheral blood lymphocytes.

Characteristics

Stachybotrys chartarum (SC), as mentioned above, is a greenish black mold that is found throughout the world and is typically wet and slimy to the touch. It can look also appear sooty, or even like grayish white strands depending on the amount of moisture available and the length of time it has been growing. Stachybotrys mycelial mats are generally pigmented dark olive-gray and appear to be a slimy mass, with smooth margins and may have either a smooth or ridged surface. The spores are more brownish in color. When the growth sporulates, the colony may appear to have a powdery surface. (Note: fungi cannot be identified by their visual appearance of the mycelial mat. Identification requires examination of the fungal spores under a microscope.)

It is important to remember that many other common indoor molds can look similar to stachybotrys (including cladosporium, aspergillus, alternaria, and drechslera), so testing is critical to conclusively identify stachybotrys in a building.

Stachybotrys mold needs the proper conditions in order to grow, including moisture, a nutrient source, temperature, and time. However, once the stachybotrys begins to grow it can continue to propagate even if the surface water source dries up. The nutrient sources that best support stachybotrys are those with a high cellulose content. Stachybotrys survives a wide variation in temperature and grows most proficiently in temperatures that humans consider warm to moderately hot. It tends to develop more slowly than many other molds-one to two weeks after moisture intrusion as compared to one to two days for molds like aspergillus, penicillium, or cladosporium. Despite its slow start, stachybotrys usually develops into the dominant mold if the conditions are favorable, eventually crowding out other mold types that may have colonized the material first.

Like many other molds, stachybotrys can spread both through the generation of spores and the growth of root-like structures called mycelia. Stachybotrys spores grow in clusters at the end of stem-like structures known as hyphae. The spores do not easily disperse into the air if the colonized material is wet, as the spores are held together by a sticky/slimy coating. Distribution through the air is possible when the mold dries out or is disturbed. Because of this danger of the airborne dispersion of spores, all cleaning and removal of stachybotrys mold should be done using appropriate controls.

Stachybotrys has a high moisture requirement, so it grows vigorously where moisture has accumulated from roof or wall leaks, or chronically wet areas from plumbing leaks. It is often hidden within the building envelope. When S. chartarum is found in an air sample, it should be searched out in walls or other hidden spaces, where it is likely to be growing in abundance. S. chartarum has a well-known history in Russia and the Ukraine, where it has killed thousands of horses, which seem to be especially susceptible to its toxins.

Persons handling material heavily contaminated with this mold describe symptoms of cough, rhinitis, burning sensations of the mouth and nasal passages and cutaneous irritation at the point of contact, especially in areas of heavy perspiration, such as the armpits or the scrotum (Andrassy et al., 1979). One case study of toxicosis associated with macrocyclic trichothecenes produced by S. chartarum in an indoor exposure, has been published (Croft et al., 1986), and has proven seminal in further investigations for toxic effects from molds found indoors. In this exposure of a family in a home with water damage from a leaky roof, complaints included (variably among family members and a maid) headaches, sore throats, hair loss, flu symptoms, diarrhea, fatigue, dermatitis, general malaise, psychological depression. (Croft et al, 1986; Jarvis, 1995).

This is a slow-growing fungus on media. It does not compete well with other rapidly growing fungi. The dark-colored fungi grows on building material with a high cellulose content and a low nitrogen content. Areas with relative humidity above 55% and are subject to temperature fluctuations are ideal for toxin production. Appropriate media for the growth of this organism will have a high cellulose content and a low nitrogen content. With current construction materials, this could be almost anything in a new building.

It is usually difficult to see in indoor samples unless it is on the outside of a wall or physically disturbed. The spores are in a gelatinous mass. The spores die readily after release. Dead spores can be quite dangerous, as they often set off mycotoxins. As stachybotrys produces these toxigenic spores that are potentially dangerous to humans, they can enter an air-conveyance system and damage the lungs and create trauma to the small passage airways. The dead spores are still allergenic and especially toxigenic. If one tries to disturb these masses, they set off many mycotoxins which can be even more toxic. Percutaneous absorption has caused mild symptoms.

The EPA nor the CDC have purposefully set any regulations or guidelines for determining the health risks associated with stachybotrys atra. Collected mold cultures of stachybotrys atra can be tricky due to the existence of other types of fungi in the same area. Removing cultures of stachybotrys atra must be undertaken with great care to contain the spread of dangerous spores.

First Reports

In 1837 stachybotrys was first described by Corda from wallpaper collected in a home in Prague. In the 1920’s toxic effects of stachybotrys was reported in Russia. In the 1940’s, there were initial reports of stachybotryotoxicosis in humans reported in Russia.

Finally, in 1986 Atmospheric Environment – W.A. Croft – Airborne Outbreak of Trichothecene Toxicosis. Potential problem with stachybotrys chartarum. Family in Chicago home with complaints of medical problems, traced to stachybotrys and trichothecene toxicosis. Accumulation of data over past 60 years tells us that we should not handle materials contaminated with stachybotrys. Commonly found in homes with water damage. Can grow behind walls undiscovered, and cultivate profusely on sheetrock.

As mentioned, stachybotrys has been linked by the Center for Disease Control to 10 cases of lung disorder in infants and 100 other cases. In 1993, there were a number of cases of acute pulmonary hemorrhage in nearly 30 infants after homes were flooded. The CDC will not acknowledge the specific cause of these deaths. However, they eventually concluded that significant exposure to stachybotrys, in addition to other hydrophilic molds, played a significant role in the development of this severe and fatal lung disease.

Historical Health Effects

Health problems associated with Stachybotrys chartarum were first noted in Russian and Eastern European farm animals that ate moldy hay in the 1930’s and 1940’s.

In the Ukraine and other parts of eastern Europe during the 1930’s, there were unusual outbreaks of a new disease in animals that was characterized by symptoms such as shock, dermal necrosis, leukopenia, hemorrhage, nervous disorders and death. Horses eating heavily stachybotrys contaminated fodder experienced immune system suppression, infection and bleeding that was fatal with high doses. In 1938, Russian scientists determined the disease was associated with stachybotrys (then known as S. alternans) growing on the straw and grain fed to the animals.

Intensive studies were then conducted resulting in the first demonstrated toxicity of stachybotrys in animals. Horses were actually fed cultures of the fungus. The contents of one petri plate resulted in sickness and the contents of 30 petri plates resulted in death.

As horses seem to be especially susceptible to these toxins; 1 mg of pure toxin is reported to cause death. The Russians coined the term stachybotryotoxicosis for this new disease. Since then, stachybotryotoxicosis has been reported on numerous farm animals from various parts of the world, especially in eastern Europe, but is apparently rare (if even reported) in North America.

The first reported human health effects were seen in agricultural workers who handled the moldy straw or hay. In the early 1940’s reports of stachybotryotoxicosis in humans appeared in Russia. People affected where those who handled or were in close contact with hay or feed grain infested with stachybotrys. Some of these individuals had burned the straw or slept on straw-filled mattresses. Common symptoms in humans were dermatitis, pain and inflammation of the mucous membranes of the mouth and throat, a burning sensation of the nasal passages, tightness of the chest, cough, bloody rhinitis, fever, headache and fatigue. Some members (possibly volunteers) of the teams investigating this disease rubbed samples of the fungus onto their skin to determine its direct toxicity. The fungus induced local and systemic toxic symptoms similar to those observed in naturally occurring cases.

Individuals who ate grain from the contaminated hay experienced symptoms such as burning sensations in the mouth, nausea, vomiting, diarrhea and abdominal pain. These high level exposures were associated with coughing, runny nose, burning sensations in the mouth or nose, nose bleeds, headache, fatigue and skin irritation (rashes and itching) at the site of moldy hay contact. This seems to be a re-occurring problem today with toxigenic molds and agriculture; especially corn, coffee, soy, and grains.

Between the 1950’s and the 1980’s there were continued publications on stachybotryotoxicosis but few that indicated a potential problem with stachybotrys in homes and buildings. In 1986, Croft et al. reported an outbreak of trichothecene toxicosis in a Chicago home. Over a 5-year period, the family complained of headaches, sore throats, flu-like symptoms, recurring colds, diarrhea, fatigue, dermatitis and general malaise. Air sampling of this home revealed spores of stachybotrys. The fungus was found growing on moist organic debris in an uninsulated cold air duct and on some wood fiber ceiling material. The home had a chronic moisture problem that favored mold growth. Extracts from the duct debris and contaminated building materials were toxic to test animals and several macrocyclic trichothecenes were identified in the extracts. When the mold problem was corrected, these symptoms associated with trichothecene toxicosis disappeared.

Since the paper by Croft et al (1986), there have been numerous reports of stachybotrys in homes/buildings in North America, but few definitive studies implicating the fungus as the cause of mycotoxicosis. One important paper by Johanning et al. (1996), reported on the health of office workers in a flooded New York office building with high concentrations of stachybotrys on sheetrock. The study concluded “… self-reported health status indicator changes and lower T-lymphocyte proportions and dysfunction as well as some other immunochemistry alterations were associated with onset, intensity and duration of occupational exposure to toxigenic stachybotrys combined with other atypical fungi.”

Since the collapse of the Twin Towers, many surrounding buildings have been discovered in NYC contaminated with “heavy amounts of stachybotrys.” Most of these buildings were old and water damaged. With more public awareness, there will be more and more reports of stachybotrys appearances. What many news stories have down played, however, is the fact that there were high amounts of asbestos residue intermingled with the building debris, thus making the aftermath much more toxic than what may have been expected. Any aerosol tests that may have been performed would have picked up several types of evidence of sick-building syndrome. A small portion of that would have been, at best, stachybotrys of the ruined muddle of destruction, but it is important to remember everything has been quite stirred up due to unnatural occurrences to Ground Zero.

There has been more documentation that stachybotrys occurs more frequently in animals than in humans, but more articles are backing up testimony that it is almost equivocal. However, if spores are released into the air, humans certainly can come into contact with them and develop symptoms that include coughing, wheezing, runny nose, irritation to the eyes or throat, skin rash, and diarrhea. Many of these symptoms are commonly and often mistakenly associated with allergies. In fact, some theories hold that the symptoms are an allergic reaction to the mold or from toxic byproducts from the mold. There also seems to be an association between contact with trichothecenes and a variety of autoimmune human diseases.

There have been cases of DNA testing where stachybotrys was still detected in the body 9 years after exposure. As with other toxigenic fungi, stachybotrys alters human DNA and has been known to cause permanent neurological, pathological, psychological, and immunological effects on the human body

Prevention and Help

The most important consideration to keep in mind is that mold needs a moist, wet, or damp environment in order to thrive. By maintaining a clean, dry home or workplace, dangerous mold species cannot begin to grow. Sources in and around homes that can create a dangerous environment include leaky or broken pipes, windows or older doors that lack good seals, roofs that leak, and any cracks or holes in the building. If flooding has occurred, it is extremely important to make sure that the water is thoroughly dried up to avoid festering water or dampness within 24 to 48 hours. Cosmetic ventures will do absolutely nothing but cover up the dilemma and complicate problems with liability and health issues later.

Good preventive maintenance can reduce the risk of a problem with molds growing inside the home and other buildings. Homes and buildings with water damage should be repaired and all moldy material should be removed. Avoiding or diminishing other contributors of humidity may help. Some causes and contributors of high humidity may include leaking pipes, water damaged dry walls and ceiling tile (due to leaking pipes, leaking roof or flooding), faulty or obstructed dryer vent connections, use of steaming hot water in washing machines, many showers, faulty or obstructed bathroom/kitchen ventilation fans, boiling water for long periods of time, canning or pressure cooking, hand washing and rack drying knit and delicate laundry, use of humidifiers and excessive sealing of the home so that there is inadequate air exchange.

Some molds can be killed by cleaning the moldy surface with chlorine, (few) however, stachybotrys often has a germ mycelium that is buried inside the water damaged surface that is often inaccessible to chlorine. In fact, bleach often does not kill Stachybotrys entirely when directly applied to it. Changing the humidity may lead to limited death of the stachybotrys colony. However, changing the humidity may also induce heavy sporulation. Burning the building that has undergone stachybotrys contamination has been an idea of many people but some experts state that not even a fire of 500 degrees could destroy the spores of this deadly enemy. If anything, it could spread it and worsen the condition. The ground around these buildings can also become heavily contaminated with stachybotrys from a sick building. It is recommended that the ground (dirt) be removed at least one meter prior to rebuilding any new foundation.

To avoid such problems before a potential catastrophe, all buildings should undergo scheduled maintenance that includes inspection for water leaks, problem seals around windows and doors, as well as checks for visible mold in moist or damp parts of the building.

There are air sample, tape, swab, and DNA tests that can be done on any premises to determine if stachybotrys is present, the three latter being the easier to detect. Because stachybotrys doesn’t spore the same way other toxigenic molds do, it does not show up in a standard blood antibody test very often, therefore, serum tests are not very accurate. There are some other tests to determine stachybotrys exposure.

Important Findings

Once a building has been contaminated with stachybotrys, some experts agree that there is no way to remediate it.

Even fire is not hot enough to destroy this mold. Additionally, if even one spore is found in an air sample, it is the equivalent of finding thousands, as it is very hard to find stachybotrys airborne; and it means that this fungus has started to colonize in very high numbers, and as one might say; a lost cause. Unlike any data you may have read, stachybotrys is becoming increasingly more and more common in homes and buildings within the United States and Canada that are not only water damaged, but are in a situation affected by high humidity.

Despite fundamental epidemiologic questions that remain unanswered regarding stachybotrys, the past several years have seen a remarkable public health response to this issue. The detection of stachybotrys in the indoor environment has led to the closure of office buildings and schools, and has prompted highly publicized class-action litigation against building owners. An industry of industrial hygienists specializing in the assessment and remediation of indoor molds has emerged, and their services are recommended by expert panels.

Conclusions and Recommendations

Prudent public health practice then indicates removal from exposure through clean up or remediation, and public education about the potential for harm. Stachybotrys should be treated as though they are toxin producing if in abundant quantities. It is not always cost effective to measure toxicity, so cautious practice regards the potential for toxicity as serious, aside from other health effects associated with excessive exposure to molds and their products. It is unwise to wait to take action until toxicity is determined after laboratory culture, especially since molds that are toxic in their normal environment may lose their toxicity in laboratory monoculture over time (Jarvis, 1995) be identified as toxic. While testing for toxins is useful for establishing etiology of disease, and therefore may not and adds to knowledge about mold toxicity in the indoor environment, prudent public health practice might advise speedy clean-up, or removal of a heavily exposed populations from exposure as a first resort.

Health effects from exposures to molds in indoor environments can result from allergy, infection, mucous membrane and sensory irritation and toxicity alone, or in combination. Mold growth in buildings (in contrast to mold contamination from the outside) always occurs because of unaddressed moisture problems. When excess mold growth occurs, exposure of individuals, and remediation of the moisture problem must be addressed.

ADDITIONAL READING ON STACHYBOTRYS

1. For symptoms, associated illnesses, treatment options, articles, etc., see: http://www.mold-survivor.com/
2. American Academy of Pediatrics, Committee on Environmental Health. 1998. Toxic effects of indoor molds. Pediatrics. 1998 101:712-714
3. Andersen, B., Nielsen, K. F., Jarvis, B. B. (2002). Characterization of Stachybotrys from water-damaged buildings based on morphology, growth, and metabolite production. Mycologia 94: 392-403 [Abstract][Full Text]
4. Andrassy K, Horvath I, Lakos T, Toke Z. “Mass incidence of mucotoxicoses in Hajdu-Bihar County”. Mykosen 1979;23:130-133
5. Ammann, Harriet, Is indoor mold contamination a threat to health?
6. Andersen B, Nissen N., 2000 Evaluation of media for detection of Stachybotrys and Chaetomium species associated with water-damaged buildings Int Biodet Biodegr 46:111-116
7. Auger PL, Gourdeau P, Miller D, “Clinical experience with patients suffering from a chronic fatigue-like syndrome and repeated upper respiratory infections in relation to airborne molds”. Am. J. of Indust. Medicine 1994; 25:41-42
8. Barron GL., 1961 Studies on species of Oidiodendron, Helicodendron and Stachybotrys from soil Can J Microbiol 39:1563-1571
9. Bennett, J. W., Klich, M. (2003). Mycotoxins. Clin. Microbiol. Rev. 16: 497-516 [Abstract][Full Text]
10. Bisby GR., 1943 Stachybotrys Trans Brit Mycol Soc 26:133-143
11. Bitnum A, Nosal R. 1999. Stachybotrys chartarum (atra) contamination of the indoor environment: health implications. Paediatr Child Health. 4(2):125-129.
12. Blazes, LCDR David L. MC, USNR; LT James V. Lawler, MC, USNR; CAPT Angeline A. Lazarus, MC, USN VOL 112 / NO 2 / AUGUST 2002 When biotoxins are tools of terror
13. Bhat RV, Beedu SR, Ramakrishna Y, Munshi KL. Outbreak of trichothecene mycotoxicosis associated with consumption of mould-damaged wheat products in Kashmir Valley, India. Lancet. 1989;1:35-37.
    [Medline]
14. Butler EE, Mann MP., 1959 Use of cellophane tape for mounting and photographing phytopathogenic fungi Phytopathology 49:231-232
15. Brautbar, Nachman 2002 Toxic molds – The killer within us: Indoor molds and their symptoms
16. Centers for Disease Control and Prevention. Outbreaks of gastrointestinal illness of unknown etiology associated with eating burritos, United States, October 1997October 1998. MMWR Morb Mortal Wkly Rep. 1999;48:210-213. [Medline]
17. Corrier DE. “Mycotoxicosis: mechanism of immunosuppression”. Vet Immunol Immunopathol 1991; 30:73-87
18. Croft WA, Jarvis BB, Yatawara CS., 1986 Airborne outbreak of trichothecene mycotoxicosis Atmos Env 1986;20:549-552
19. Cruse, M., Telerant, R., Gallagher, T., Lee, T., Taylor, J. W. (2002). Cryptic species in Stachybotrys chartarum. Mycologia 94: 814-822 [Abstract][Full Text]
20. Davies R, Summerbell RC, Haldane D, et al. 1995. Fungal contamination in public buildings: a guide to recognition and management. Ottawa: Environmental Health Directorate
21. Dearborn, D. G., Smith, P. G., Dahms, B. B., Allan, T. M., Sorenson, W.G., Montana, E., Etzel, R. A. (2002). Clinical Profile of 30 Infants With Acute Pulmonary Hemorrhage in Cleveland. Pediatrics 110: 627-637 [Abstract][Full Text]
22. Dearborn DG, Yike I, Sorenson WG, Miller MJ, Etzel RA., 1999 Overview of investigations into pulmonary hemorrhage among infants in Cleveland, Ohio Env Health Persp 107:S495-S499
23. Dearborn DG, et al. Update: pulmonary hemorrhage/hemosiderosis among infants–Cleveland, Ohio, 1993-6. MMWR Morb Mortal Wkly Rep. 1997;46:33-35
24. DIFCO Manual of dehydrated culture media and reagents for microbiological and clinical laboratory procedures 1969 Detroit: DIFCO Laboratories Inc
25. Domsch KH, Gams W, Anderson T-H., 1980 Compendium of soil fungi London: Academic Press
26. Dorai M, Vittal BPR., 1986 A new Stachybotrys from eucalyptus litter Trans Brit Myc Soc 87:642-644
27. Ed McMahon’s Killer Mold Problem, Press release Fri Apr 12, 2002 2:14 PM ET
28. Elidemir O, et al. 1999. Isolation of Stachybotrys from the lung of a child with pulmonary hemosiderosis. Pediatrics. 104: 964-966
29. El-Maghraby OMO, Bean GA, Jarvis BB, Aboul-Nasr MB., 1991 Macrocyclic trichothecenes produced by Stachybotrys isolated from Egypt and Eastern Europe Mycopath 113:109-115
30. Ellis MB., 1971 Dematiaceous Hyphomycetes CAB Commonwealth Mycological Institute, Surrey
31. Ellis MB., 1976 More Dematiaceous Hyphomycetes CAB Commonwealth Mycological Institute, Surrey
32. Etzel, Ruth, J.A.M.A.; mycotoxins – linking evidence and experience
33. Etzel RA, Sorenson WG, Miller JD, et al. Mycotoxins and pulmonary hemorrhage [letter]. Arch Pediatr Adolesc Med. 1999;153:205-206
34. Etzel RA, Montana E, Sorenson WG, Kullman GJ, Allan M, Dearborn DG. Acute pulmonary hemorrhage in infants associated with exposure to Stachybotrys atra and other fungi. Arch Pediatr Adolesc Med. 1998;152:757-762.
35. Filtenborg O, Frisvad JC, Thrane U., 1990 The significance of yeast extract composition on metabolite production in Penicillium In: Samson RA, Pitt JI, eds. Modern concepts in Penicillium and Aspergillus Classification, New York: Plenum Press
36. Flannigan B, Miller JD., 1994 Health implications of fungi in indoor environments-An overview In: Samson RA, Flannigan B, Flannigan ME, Verhoeff AP, Adan OCG, eds. Health implications of fungi in indoor air environment. 1th ed. Elsevier, Amsterdam. p 3-26
37. Flannigan B, McCabe EM, McGarry F. “Allergenic and toxigenic micro-organisms in houses”. J Appl Bact Symp (Suppl) 1991; 70:61S-73S
38. Forgacs J, Carll WT., 1962 Mycotoxicosis Adv Vet Sci 7:273-293
39. Fung F, Clark R, Williams S., 1998 Stachybotrys, a mycotoxin-producing fungus of increasing toxicologic importance Clinical Toxicology 36:79-86
40. Gravesen S, Frisvad JC, Samson RA., 1994 Microfungi Copenhagen: Munksgaard
41. Gravesen S, Nielsen PA, Iversen R, Nielsen KF., 1999 Microfungal contamination of damp buildings-examples of risk constructions and risk materials Env Health Persp 107:Supplement 3. p 505-508
42. Gray, Dr. Michael 2001 Mold, Mycotoxins and Human Health
43. Hinkley SF, Jarvis BB., 2000 Chromatographic method for Stachybotrys toxins In: Pohland A, Trucksess MW, eds. Methods Molecular Biology 157. Mycotoxin Protocols. Totowa: Humana Press. p 173-194
44. Hinkley SF, Mazzola EP, Fettinger JC, Lam YKT, Jarvis BB., 2000 Atranones A-G, from the toxigenic mold Stachybotrys chartarum Phytochem 55:663-673
45. Hintikka EL. Stachybotryotoxicosis as a veterinary problem. In: Rodricks JV, Hesseltine CW, Mehlman MA (eds). Mycotoxins in Human and Animal Health. Park Forest South, Ill: Pathotox Publishers, 1977:277-284
46. Hirvonen, Maija-Riitta, Mechanisms of Adverse Health Effects of Moldy House Microbes: In Vitro and In Vivo Studies on Toxic Effects and Inflammatory Responses, National Public Health Institute, Division of Environmental Health, Kuopio, Finland
47. Hodgson MG, Morey P, Leung WY. Building-associated pulmonary disease from exposure to Stachybotrys chartarum and Aspergillus versicolor. J Occup Enivron Med. 1998;40:241-249
48. Horner WE, Helbling A, Salvaggio JE, Lehrer SB. Fungal allergens. Clin Microbiol Rev. 1995;8(2):161-179
49. Hughes SJ., 1958 Revisiones hyphomycetum aliquot cum appendice de nominibus rejiciendis Can J Bot 36:727-836
50. Human health effects of indoor mycotoxin exposure in fungi-contaminated indoor environments
51. Jarvis BB., 1992 Macrocyclic trichothecenes from Brazilian Baccharis species: from microanalysis to large-scale isolation Phytochem Anal 3:241-249
52. Jarvis BB, Lee Y-W, Comezoglu SN, Yatawara CS., 1986 Trichothecenes produced by Stachybotrys atra from Eastern Europe Appl Env Microb 51:915-918
53. Jarvis BB, Salemme J, Morais A., 1995 Stachybotrys toxins 1 Nat Toxins 3:10.
54. Jarvis BB. Mycotoxins–an overview. In: Ownby CA, Odell GV (eds). Natural Toxins. New York, NY: Pergamon Press, 1988:17-29.
55. Jarvis BB, Sorenson WG, Hintikka E-L, Nikulin M, Zhou Y, Jiang J, Wang S, Hinkley SF, Etzel RA, Dearborn DG., 1998 Study of toxin production by isolates of Stachybotrys chartarum and Memnoniella echinata isolated during a study of pulmonary hemosiderosis in infants Appl Env Microb 64:3620-3625
56. Jarvis BB. “Mycotoxins and Indoor Air Quality”. In: Biological Contaminants in Indoor Environments (ASTM STP 1071). Phillip R. Morey, James C. Feeley, James A. Otten (eds.). Philadelphia: American Society for Testing and Materials, 1990: 201-213
57. Jesenska Z, Pieckova E, Bernat D., 1992 Heat-resistant fungi in the soil Int J Food Microbiol 16:209-214.
58. Johanning E, Biagini RE, Hull D, Morey PR, Jarvis BB, Landsbergis P., 1996 Health and immunology study following exposure to toxigenic fungi (Stachybotrys chartarum) in a water-damaged office environment Int Arch Occup Health 68:207-218
59. Johanning E, Landsbergis P, Gareis M, Yang CS, Olmsted E. Clinical experience and results of a sentinel health investigation related to indoor fungal exposure. Environ Health Perspect. 1999;107(3):489-494
60. Johanning E, Morey PR, Jarvis BB. “Clinical Epidemiological Investigation of Health Effects caused by Stachybotrys Atra Building Contamination”, Proceedings of Indoor Air, 1993; Vol. 1: 225-230
61. Jong SC, Davis EE., 1976 Contribution to the knowledge of Stachybotrys and Memnoniella in culture Mycotaxon 3:409-485
62. Kaneto R, Dobashi K, Kojima I, Sakai K, Shibamoto N, Yoshioka T, Nishid AH, Okamoto R, Akagawa H, Mizuno S., 1994 Mer-nf5003b, mer-nf5003e and mer-nf5003f, novel sesquiterpenoids as avian-myeloblastosis virus protease inhibitors produced by Stachybotrys sp J Antib 47:727-730
63. Kibsey, P., Case Presentation: Stachybotrys Chartarum – A Mold Found in Water Damaged Buildings, Capital Health Region, Victoria, B.C.
64. Kozak PP, Gallup J, Cummins LH, Gillman SA. Endogenous mold exposure: environmental risk to atopic and nonatopic patients. In: Gammage RB, Kay SV (eds). Indoor Air and Human Health. Chelsea, Mich: Lewis Publishers; 1985:149-170
65. Kozak PP, Garvins J, Cummins L H, Gillman SA. “Currently available methods for home mold surveys”. Ann Allergy 1979; 45:167-176
66. Kuhn, D. M., Ghannoum, M. A. (2003). Indoor Mold, Toxigenic Fungi, and Stachybotrys chartarum: Infectious Disease Perspective. Clin. Microbiol. Rev. 16: 144-172.
67. Lillard-Roberts, Susan 2002, Associated illnesses from fungal exposure
68. Lillard-Roberts, Susan, 2001 Confirming fungal exposure
69. Lillard-Roberts, Susan 2002 Potential signs and contributing factors of mold in possible sick buildings
70. Lillard-Roberts, Susan, 2003 Treatments
71. Lillard-Roberts, Susan 2001, Symptoms of fungal exposure
72. Lowry R, Buick B, Riley M. Idiopathic pulmonary hemosiderosis and smoking. Ulster Med J. 1993;63:1160-1168
73. Marinkovich, Vincent, Sorenson, S.G., Gordon, Wayne A.,Johanning, Eckardt,Haddad, Lisa, Khaboshany, A, Omidi, A, Morsali,S.M., Craner, J.,Stetzenbach, Linda, D., Berek L, Petri IB, Mesterhazy A A, Teren J, Molnar J., Withanage GS, Murata H, Koyama T, Ishiwata I., Pitt JI., Wild CP, Turner PC., Massey TE, Smith GB, Tam AS, Georggiett OC, Muino JC, Montrull H, Brizuela N, Avalos S, Gomez RM., S. Bernardini, G. Falck, A. Hirvonen, H. J?rventaus, J. Tuimala, Samson, Robert, A., Kari Reijula, Nolard, nicole, Anna-Liisa Pasanen, Johanning, Eckardt, Landsbergis, Paul, Etzel, Ruth A, Dearborn, Dorr, Ammann, Harriet, B?nger, J., M?ller, M., Stalder, K., Hallier E., Medical abstracts on fungal exposure from around the world
74. Mason CD, Rand TG, Oulton M, MacDonald J, Anthes M., 2001 Effects of Stachybotrys chartarum on surfactant convertase activity in juvenile mice Toxicol Appl Pharmacol 172:21-28[Medline]
75. Mayo Clinic on mold exposure, The
76. McKenzie EHC, 1991 Dematiaceous hyphomycetes on Freycinetia (Pandanaceae) 1 Stachybotrys Mycotaxon 41:179-188
77. Mealey Publications, The Case of the Toxic SUV, General Motors Faces North Carolina Mold Suit, Monday April 22, 2002
78. MMWR 1997. Update: pulmonary hemorrhage/hemosiderosis among infants-Cleveland, Ohio 1993-1996. 46:33-35.
79. Mharram AM, El-Hissy FT, El-Zayat SA., 1990 Studies on the mycoflora of Aswan High Dam Lake, Egypt: vertical fluctuations J Basic Microbiol 30:197-208
80. Millar C. Peel board wants province to pay cleanup. $5 million needed to fix mouldy classrooms. Toronto Star. August 5, 1998
81. Montana E, Etzel RA, Allan T, Horgan TE, Dearborn DG. Environmental risk factors associated with pulmonary hemorrhage and hemosiderosis in a Cleveland community. Pediatrics. 1997;99(1):E5
82. Montnaro, Anthony, The Impact of Environmental Molds in the Home Disclosures
83. Moubasher AH, Abdel-Hafez SII, Bagy MMK, Abdel-Satar MA., 1990 Halophilic and halotolerant fungi in cultivated desert and salt marsh soils from Egypt Acta Mycologica 26:65-81
84. Nevalainen, A., Haverinen U., Husman T., Toivola M., Suonketo J., Pentti M., Lindberg R., Leinonen J., Hyv?rinen A., Meklin T. 1999 Schools, mould, and Health; an Intervention Study; An approach to management of critical indoor air problems in school buildings. Environmental Health Perspectives 107, 509-514
85. Nielsen KF, Hansen M?, Larsen TO, Thrane U., 1998a Production of trichothecene mycotoxins on water damaged gypsum boards in Danish buildings Int Biodet Biodegr 42:1-7
86. Nielsen KF, Thrane U., 2001 Fast method for screening of trichothecenes in fungal cultures using gas chromatography-tandem mass spectrometry J Chrom A 929:75-87
87. Nielsen KF, Thrane U, Larsen TO, Nielsen PA, Gravesen S., 1998b Production of mycotoxins on artificially inoculated building materials Int Biodet Biodegr 42:8-17
88. Nikulin M, Reijula K, Jarvis BB, Hintikka EL. Experimental lung mycotoxicosis in mice induced by Stachybotrys chartarum. Int J Exp Path. 1996;77(5):213-218
89. Nikulin M, Pasanen A, Berg S, Hintikka E. Stachybotrys chartarum growth and toxin production in some building materials and fodder under different relative humidities. Appl Environ Microbiol. 1994;60(9):3421-3424
90. Pang VF, Lambert RJ, Felsburg PJ, Beasley VR, Buck WB, Hascheck WM. Experimental T-2 toxicosis in swine following inhalation exposure: clinical signs and effects on hematology, serum biochemistry, and immune response. Fundam Appl Toxicol. 1988;11:100-109
91. Peltola J, Anderson MA, Raimo M, Mussalo-Rauhamaa H, Salkinoja-Salonen M., 1999 Membrane toxic substances in water-damaged construction materials and fungal pure cultures In: Johanning E. Bioaerosols, Fungi, Mycotoxins: Health effects, Assessment, Prevention and Control 1. New York: Eastern New York Occupational & Environmental Health Center. p 432-443
92. Peraica, M.; Radic, B.; Lucic, A.; Pavlovic, M. , September 1, 1999, Diseases Caused by Molds in Humans, Bulletin of the World Health Organization
93. Personal Mold Stories, www.mold-help.org
94. Pitt JI.,Toxigenic fungi and mycotoxins. Br Med Bull. 2000;56:184-192. [Medline]
95. Removal, testing, directory of services, http://www.mold-help.com/
96. Reshetilova TA, Soloveva TF, Baskunov BP, Kozlovskii AG., 1992 Investigation of alkaloid formation by certain species of fungi of the Penicillium genus Mikrobiologiya 61:873-879
97. Ruotsalainen M, Hirvonen M-R, Nevalainen A, Meklin T, Savolainen K., 1998 Cytotoxicity, production of reactive oxygen species and cytokines induced by different strains of Stachybotrys sp. from mouldy buildings in RAW2647 macrophages Env Tox Pharm 6:193-199
98. Samson RA, Hoekstra ES, Frisvad JC, Filtenborg O, eds 2000 Introduction to Food- and Air Borne Fungi 6th Ed. Utrecht: Centraalbureau voor Schimmelcultures
99. Samson, RA. “Occurrence of molds in modern living and working environments”. Eur J Epidemiol 1985 March; 1: 54-61
100. Schiefer HB and Beasley VR. Effects on the digestive system and energy metabolism. in Trichothecene Mycotoxicosis: Pathophysiologic Effects, Vol. 1. Ed:VR Beasley. CRC Press, Boca Raton, FL, 1994 pp.61-89
101. Seeley TD, Nowicke JW, Meselson M, Guillemein J, Akratanakul P. Yellow Rain. Scientific American. 1985;253:128-137
102. “Selected mycotoxins, other toxins, trichothecenes, ergot”. Environmental Health Criteria 105. WHO, Geneva,. 1990: 71-163
103. Simmons EG, 1992 Alternaria taxonomy: current status, viewpoint, challenge In: Chelkowski J, Visconti A, eds. Alternaria: biology, plant diseases and metabolites. Amsterdam: Elsevier. p 1-35
104. Smedsgaard J., 1997 Micro-scale extraction procedure for standardized screening of fungal metabolite production in cultures J Chrom A 760:264-270
105. Smith JE, Solomons G, Lewis C, Anderson JG. Role of mycotoxins in human and animal nutrition and health. Nat Toxins. 1995;3:187-192. [Medline]
106. Sorenson WG. Fungal spores: hazardous to health? Environ Health Perspect. 1999;107:469-472
107. Sorenson B, Kullman G, Hintz P. Health Hazard Evaluation Report No. 95-0150. National Institute of Occupational Safety and Health, CDC, National Center for Environmental Health; April 1996 HETA 95-0160-2571
108. Suarez L, Hendricks KA, Cooper SP, et al. Neural tube defects among Mexican Americans living on the US-Mexico border. Am J Epidemiol. 2000;152:1017-1023.
     [Medline]
109. Subramanian CV., 1957 Hyphomycetes-IV Proceedings of the Indian Academy of Sciences 46:324-335
110. Sudakin DL. Toxigenic fungi in a water-damaged building: an intervention study. Am J Ind Med. 1998;34:183-190
111. Summerbell RC, Stabi F, Dales R. et.al. “Ecology of fungi in human dwellings”. J Med Vet Mycol. 1992 (Suppl 1); 30: 279-285
112. Udagawa S., 1984 Taxonomy of mycotoxin-producing Chaetomium In: Kurata H, Ueno Y, eds. Toxigenic Fungi-Their toxins and health hazards. Amsterdam: Elsevier. p 139-147
113. Ueno Y. Trichothecene mycotoxins–mycology, chemistry and toxicology. Adv Nutr Res. 1980:3:301-353
114. Ueno Y. In “Trichothecenes – Chemical, Biological and Toxicological Aspects”. Ueno (editor) Elsevier Science Publishing Co., Inc. New York, NY. 1983. 135-146
115. Vesper SJ, Magnuson ML, Dearborn DG, Yike I, Haugland RA., 2001 Initial characterization of the hemolysin Stachylysin from Stachybotrys chartarum Infect Immun 69:912-916
116. Vesper SJ, Dearborn DG, Elidermir O, Haugland RA., 2000a Quantification of siderophore and hemolysin from Stachybotrys chartarum strains, including a strain isolated from the lung of a child with pulmonary hemorrhage and hemosiderosis Appl Env Microb 66:2678-2681
117. Vesper SJ, Dearborn DG, Yike I, Allen T, Sobolewski J, Hinkley SF, Jarvis BB, Haugland RA., 2000b Evaluation of Stachybotrys chartarum in the house of an infant with pulmonary hemmorrhage: Quantitative Assessment before, during, and after remediation J Urb Health 77:68-85
118. Vesper SJ, Dearborn DG, Yike I, Sorenson WG, Haugland RA., 1999 Hemolysis, toxicity, and randomly amplified polymorphic DNA analysis of Stachybotrys chartarum strains Appl Env Microb 65:3175-3181
119. Viana, M. E., Coates, N. H., Gavett, S. H., Selgrade, M. K., Vesper, S. J., Ward, M. D. W. (2002). An Extract of Stachybotrys chartarum Causes Allergic Asthma-like Responses in a BALB/c Mouse Model. Toxicol. Sci. 70: 98-109
120. Wilkins CK, Larsen ST, Hammer M, Poulsen OM, Wolkoff P, Nielsen G. Respiratory effects in mice exposed to airborne emissions from Stachybotrys chartarum and implications for risk assessment. Pharmacol Toxicol. 1998;83:112-119
121. Yao, T-C, Hung, I-J, Jaing, T-H, Yang, C-P (2002). Pitfalls in the diagnosis of idiopathic pulmonary haemosiderosis. Arch. Dis. Child. 86: 436-438