| Dr. Hodgson summarizes what is known about human symptoms and discomfort in the built environment, and formulates several critical hypotheses that show striking parallels to the questions arising from discussions of the IEI/MCS syndrome. ( info) |
2/11. An outbreak of respiratory diseases among workers at a water-damaged building--a case report. We describe a military hospital building with severe, repeated and enduring water and mold damage, and the symptoms and diseases found among 14 persons who were employed at the building. The exposure of the employees was evaluated by measuring the serum immunoglobulin g (IgG)-antibodies against eight spieces of mold and yeast common in Finnish water and mold damaged buildings and by sampling airborne viable microbes within the hospital. The most abundant spieces was Sporobolomyces salmonicolor. All but one of the employees reported some building-related symptoms, the most common being a cough which was reported by nine subjects. Four new cases of asthma, confirmed by S. salmonicolor inhalation provocation tests, one of whom was also found to have alveolitis, were found among the hospital personnel. In addition, seven other workers with newly diagnosed rhinitis reacted positively in nasal S. salmonicolor provocation tests. skin prick tests by Sporobolomyces were negative among all 14 workers. Exposure of the workers to mold and yeast in the indoor air caused an outbreak of occupational diseases, including asthma, rhinitis and alveolitis. The diseases were not immunoglobulin e (IgE)-mediated but might have been borne by some other, as yet unexplained, mechanism. ( info) |
3/11. Bioaerosol lung damage in a worker with repeated exposure to fungi in a water-damaged building. There has been increased concern over health effects related to potential exposure of building occupants to bioaerosols. We report the case of a worker with a respiratory illness related to bioaerosol exposure in a water-damaged building with extensive fungal contamination. We performed environmental tests to evaluate potential exposure to fungi, and we used mycotoxin-specific IgG antibody in serologic studies in the attempt to evaluate exposure to mycotoxins. Extensive fungal contamination was documented in many areas of the building. penicillium, aspergillus, and stachybotrys species were the most predominant fungi found in air sampling. Our serologic test was not useful in differentiating workers who were probably occupationally exposed to mycotoxins from those who were not; however, it did yield evidence that individuals may make specific IgG antibodies to macrocyclic tricothecene mycotoxins. Further research is needed concerning health effects related to bioaerosol exposures, particularly regarding markers of exposure to specific fungi that may produce mycotoxins. In the absence of clinical tools specific for evaluation of mycotoxin-related illness, a systematic clinical approach for evaluating persons with suspected building-related respiratory illness is warranted. ( info) |
4/11. Identifying and managing adverse environmental health effects: 1. Taking an exposure history. Public concern and awareness are growing about adverse health effects of exposure to environmental contaminants. Frequently patients present to their physicians with questions or concerns about exposures to such substances as lead, air pollutants and pesticides. Most primary care physicians lack training in and knowledge of the clinical recognition, management and avoidance of such exposures. We have found that it can be helpful to use the CH2OPD2 mnemonic (Community, Home, hobbies, Occupation, Personal habits, diet and Drugs) as a tool to identify a patient's history of exposures to potentially toxic environmental contaminants. In this article we discuss why it is important to take a patient's environmental exposure history, when and how to take the history, and how to interpret the findings. Possible routes of exposure and common sources of potentially toxic biological, physical and chemical substances are identified. A case of sick-building syndrome is used to illustrate the use of the mnemonic. ( info) |
5/11. Brainstem auditory evoked response in adolescents with acoustic mycotic neuroma due to environmental exposure to toxic molds. Indoor air contamination with toxic opportunistic molds is an emerging health risk worldwide. Some of the opportunistic molds include: stachybotrys chartarum, aspergillus species (A. fumigatus, A. flavus, A. niger, A. versicolor etc.), Cadosporium, alternaria, penicillium, trichoderma, fusarium graminearum etc. These molds flourish in homes that are moist and damp. Reports of floods are now evident in many parts of the world. With these global changes in climatic conditions that favor the opportunistic mode of living among these molds, some health authorities are beginning to feel concerned about the diversity and the extent to which opportunistic molds can cause adverse health effects in humans. mycotoxicosis is the collective name for all the diseases caused by toxic molds. Frequently, we have cases of acoustic neuroma due to mycotoxicity in our Center. Mycotic neuroma probably has not been reported before and the application of brainstem auditory evoked response (BAER) techniques in acoustic mycotic neuroma have not been reported either. The aim of this study, therefore, was to report cases and measurements of acoustic mycotic neuroma in adolescents using the brainstem auditory evoked response. The patients' case history, clinical neurological and neurobehavioral questionnaires were assessed. Then, the BAERs were recorded between Cz and Ai, with a second channel, Cz-Ac. The case histories and the questionnaires were analyzed in conjunction with the outcome of the objective brainstem auditory evoked response measurements. The prevalent subjective findings in the patients were headaches, memory loss, hearing loss, lack of concentration, fatigue, sleep disturbance, facial swelling, rashes, nosebleeds, diarrhea, abdominal pains and respiratory difficulties. Objective BAER showed overall abnormalities in all the patients. Although the waveform abnormalities varied, 1-3 interpeak latencies were abnormal in all the patients. overall results showed the presence of acoustic mycotic neuroma and confirmed the sensitivity and usefulness of BAER in screening acoustic mycotic neuroma and sensorineural auditory dysfunction. ( info) |
6/11. Bronchospasm induced by propofol in a patient with sick house syndrome. IMPLICATIONS: propofol is often used in patients with asthma, but it can induce bronchospasm. We report a patient with sick house syndrome (nonspecific complaints of mucosal irritation, headache, nausea, and chest symptoms) who suffered bronchospasm. This case suggests that propofol is not always a safe anesthetic for patients with asthma, especially drug-induced asthma. ( info) |
7/11. A case of sick building syndrome in a Japanese office worker. The adverse health effects caused by indoor air pollution are termed "sick building syndrome". We report such a patient whose symptoms appeared in the workplace. A 36-year-old female office worker developed nausea and headache during working hours in a refurbished office. After eight months of seeking help at other clinics or hospitals without improvement, she was referred to our hospital. At that time she reacted to the smells of various chemicals outside of the office building. Biochemical findings were all within normal ranges. Specific IgE antibody to cedar pollen was positive and the ratio of TH1/TH2 was 4.5. In the eye Tracking Test (ETT), vertical eye movement was saccadic. Her anxiety level was very high according to the State-Trait anxiety Inventory (STAI) questionnaire. Subjective symptoms, ETT findings and anxiety levels on STAI gradually improved during two years of follow-up. One year after the onset of her illness, the formaldehyde concentrations in the building air ranged from 0.017-0.053 ppm. Even though relatively low, chemical exposure from building materials such as formaldehyde induced a range of symptoms. Also, lack of recognition by superiors and doctors that sick building syndrome might have been the source of her illness coupled with her high state of anxiety may have exacerbated her symptoms and led to the onset of multiple chemical sensitivity. Thus psychosocial factors may contribute to sick building syndrome in the workplace. ( info) |
8/11. The sensitive individual and the indoor environment: case study. This case study describes an indoor environment investigation initiated in response to numerous health and comfort complaints suspected of being associated with a two-story office building. Conventional indoor environment investigation techniques were applied in an attempt to identify one or several contributing factors, such as inadequate outdoor air ventilation and the presence of a respiratory irritant. The air quality satisfaction percentage in the building was well above 80%; however, at least one individual was experiencing a fairly severe reaction only upon entering the subject building. Evaluating the building indoor conditions as acceptable without attempting to address all possible building-related causes and communicating findings to interested occupants would likely have resulted in more occupant complaints and increased the potential for hysteria conditions. This investigation necessarily addressed a sensitive individual and involved an occupational physician as a constructive participant in the investigation. ( info) |
9/11. Allergic alveolitis in a school environment. BACKGROUND: A considerable fraction of newly constructed buildings have indoor air problems associated with health effects, usually of the nonspecific sick building syndrome variety. Specific health effects such as asthma, rhinitis, and allergic alveolitis can also occur. CASE: On 1 September 1988 a school teacher showed symptoms of an acute respiratory illness, which was first interpreted as pulmonary embolism and then later as atypical sarcoidosis. The illness slowly progressed over six years, at which time the diagnosis was revised to chronic allergic alveolitis, related to her school environment. The school had had indoor-air quality problems off and on for several years. CONCLUSIONS: The case illustrates the difficulties of diagnosing cases of chronic allergic alveolitis, especially when it appears in environments where it is not generally encountered. It also raises questions regarding a possible relation between environments associated with the sick building syndrome and the occurrence of building-associated illnesses. ( info) |
| sick building syndrome (SBS) is usually defined as an increased occurrence of non-specific symptoms among populations in determined buildings. This definition differs from those of other medical syndromes in that it refers to a system (a building inclusive of its population) rather than to a clinical state in a single individual. Such a definition should make the term SBS impossible to use as a diagnosis applied to individual persons. In spite of this, it is often used in this way, and the aim of the article is to discuss problems with this practice. It is a case study based on an office building with long-standing building-related health problems. Information concerning the building and its inhabitants comes from a large number of separate documentary sources. The study demonstrates that the diagnostic use of SBS suffers from serious weaknesses. It is proposed that such diagnostics could even have a normative force serving to maintain and reinforce building-related, non-specific health problems. It is therefore suggested that the term sick building syndrome should be abandoned. ( info) |