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Black Mold Linked to Infant Deaths in Cleveland

An unusual black mold has been linked to at least 34 cases of pulmonary hemorrhage and hemosiderosis (PH/H) among infants in the Cleveland area since 1993, resulting in at least 10 deaths. The condition, which involves bleeding in the lungs, is believed to be caused by toxins produced by the mold Stachybotrys atra (also known as Stachybotrys chartarum), which grows only on water-soaked cellulose-based materials, such as wood, acoustic ceiling tiles, cardboard, newspaper, cotton, and gypsum wallboard.

The Cleveland outbreak of PH/H was discovered by Dr. Dorr G. Dearborn, Ph.D, M.D., a pulmonary specialist at the Rainbow Babies and Children’s Hospital in Cleveland. Previously, this disease had been primarily diagnosed in livestock that had eaten moldy fodder. Of the 34 cases in Cleveland, 29 of the infants were African Americans, and all were from a contiguous seven-zip-code area of the city. Investigations of several years of coroner records from the same area indicated that six cases of sudden infant death syndrome (SIDS) showed evidence of preexisting pulmonary bleeding, so they too may have died of PH/H. Since the Cleveland outbreak was first reported, at least 70 similar cases have been found from across the country, indicating a more widespread problem.

One current theory, described in the journal Environmental Health Perspectives (January 1998), is that the mold produces the toxin trichothecene satratoxin H, which is carried on the mold spores into the respiratory systems of victims. The toxin is a potent protein synthesis inhibitor and weakens blood vessels in the rapidly developing infants’ lungs. It is possible, the article suggests, that another stressor, such as exposure to environmental tobacco smoke, contributes to the problem, causing full-blown pulmonary hemorrhage.

When growing, S. atra fungus is black and shiny, sometimes with white edges. When dried out, it is a dull black. It is important to note that not all black mold found in these conditions is S. atra; in fact, it is not even the most common black mold. Jim LaRue, of The HouseMender, Inc. in Cleveland, reported on the EBN-hosted Greenbuilding E-mail Discussion Group that investigations of the homes where babies died have turned up large amounts of paper product with mold on it, including drywall installed in leaky basements.

LaRue also reported a unique heating system configuration in the Cleveland area, now referred to as the “Cleveland drop,” that may be contributing to the problem. In large old houses in Cleveland, the cold-air returns are not connected to the furnace, but dump the return air about 6” (150 mm) from the basement floor. Air distributed by the furnace’s air handler is simply pulled from the basement. Thus, if there are toxic airborne mold spores produced from the S. atra in the basement, they can easily be circulated throughout the house—both when the furnace is operating and when it is off during the wetter, summer months. “My guess is that these drops are also little chimneys for stuff from the basement when the furnace is not operating and when ventilation on upper floors is in operation,” said LaRue.

Dealing with mold contamination in a building is a matter of eliminating sources of moisture and removing actual mold growths. Care should always be taken during remediation. During mold removal, workers should wear rubber gloves and use respirators to minimize risk. For large remediation jobs, professionals should be brought in. On a website regarding Stachybotrys atra, Dr. Dearborn and his collaborators suggest treatment with a solution of bleach and water (1:16) mixed with some soap to cut grease deposits and more effectively remove the mold. From his experience with S. atra in Cleveland, LaRue has found that simple cleaning up the mold is not always sufficient. “It is often necessary to completely remove the mold host,” he said. He told EBN that even though the toxicity threat may be removed, the dead mold spores can act as an allergen in children with asthma.

Building scientist and mycology expert Terry Brennan of Camroden Associates in Rome, New York, has worked on many cases of mold decontamination, including that of S. atra. If S. atra mold contamination is suspected, he says to look for water in the building. As for how apparent the mold will be, he suggests that “if fungi are causing a problem in a building, somewhere there is likely to be a fungal mat you can sample with a shovel” he said. Brennan suggests the following five-point strategy for dealing with mold:

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