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Mold toxicity
From WikEM
Contents
Background
- Molds are multicellular fungi that decompose organic matter
Common Household Molds
- Penicillium
- Cladosporium
- Aspergillus
- Alternaria
Mechanism of Toxicity
- Allergy
- More commonly outdoor molds cause allergy but they can be found indoors in cases of excessive water damage
- Infection
- Only a few fungi can infect immunocompetent people: Coccidioides, Blastomyces, Histoplasma, Cryptococcus
- Immunocompromised people are at significant risk even from Candida and Aspergillus
- Toxicity
- Glucans, a component of the cell wall, can produce Organic Dust Toxic Syndrome when inhaled
Clinical Features
Mold Allergy
- IgE antibodies against molds can lead to asthma or allergic rhinitis
- Hypersensitivity pneumonitis is a rare immune response to high concentrations of fungal proteins
Organic Dust Toxic Syndrome
- flu-like illness between 4-8 hours after heavy exposure to mold
- Symptoms are self-limited and resolve in 24 hours
Sick Building Syndrome
- Vague constellation of neurologic, dermatologic, gastrointestinal, and respiratory complaints attributed to a building's environment
Differential Diagnosis
- Acute allergic reaction
- Pneumonia
- Asthma
- Allergic rhinitis
Influenza-Like Illness
Evaluation
- Generally, no specific workup in the ED
- May workup specific symptoms, if deemed appropriate
Outpatient
Consider:
- RAST (Radioallergosorbent) testing can detect IgE mediated allergy
- Air samples and "bulk, wipe, and wall" samples can detect presence of molds
Management
- No Specific drugs or antidotes
- Decontamination and avoidance of environment
Disposition
- Outpatient management
