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Ruth A. Etzel, MD, PhD; Eduardo Montaña, MD, MPH; W. G. Sorenson, PhD; Greg J. Kullman, CIH, PhD; Terrance M. Allan, MPH; Dorr G. Dearborn, PhD, MD

Arch Pediatr Adolesc Med. 1998;152:757-762.

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 where Stachybotrys atra was present than were 30 age- and ZIP code–matched control infants. We investigated the infants' home environments using bioaerosol sampling methods, with specific attention to S 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)/m³ in homes of patients and 707 CFU/m³ in homes of controls. The mean concentration of S atra in the air was 43 CFU/m³ in homes of patients and 4 CFU/m³ in homes of controls. Viable S atra was 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 of S atra in the air was 9.83 (95% confidence interval, 1.08-3x10⁶). The mean concentration of S atra on surfaces was 20x10⁶ CFU/g and 0.007x10⁶ CFU/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 toxigenic S atra and other fungi in the indoor air.

From the Centers for Disease Control and Prevention, Atlanta, Ga (Drs Etzel, Montaña, Sorenson, Kullman, and Olson); the Cuyahoga County Board of Health, Cleveland, Ohio (Mr Allan); the Department of Chemistry and Biochemistry, University of Maryland, College Park (Dr Jarvis); Agri-Canada, Ottawa, Ontario (Dr Miller); and the Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve School of Medicine, Cleveland (Dr Dearborn).

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