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Fungal Growth in Buildings: The Aerobiological Perspective
Harriet A. Burge Ph.D. Harvard School of Public Health, Boston,

In the search for inexpensive shelter, we have developed indoor environments that are conducive to fungal contamination. While active fungal growth indoors is usually inappropriate and should be controlled, assessing specific health risks associated with such growth remains a challenge. Epidemiological tools are often used to determine relative risks associated with occupancy by groups of people in environments with or without certain factors, including fungal growth, but do not always make clear the role of the growth in the disease process in indiviudals. Aerobiologists assess relationships along a pathway that includes sources, dispersion and decay of aerosols, exposuree to individuals, doses of agents, and responses. Both approaches yield valuable information, but require the development of testable hypotheses.

As a model, we can apply the epidemiological and aerobiological processes to the Cleveland hemosiderosis outbreak, and consider the following hypotheses:

The Cleveland babies that develop hemosiderosis are more likely to live in moldy homes than those that did not develop the diseease, all other things being equal.

The Cleveland babies that developed hemosiderosis are more likely to live in homes with Stachybotrys than those that did not develop the disease, all other things being equal.

Aerobiology Babies that developed disease were likely to have received a dose of Stachybotrys chartarum toxins sufficient to cause the reported symptoms.

Some evidence exists to support Hypothesis 1.

Hypothesis 2 is suppored by very little evidence

Hypothesis 3 has not been tested.

Until Hypotheses 2 and 3 areadequately tested and verified, assuming a cause/effect relationshipfor Stachybotrys toxins in these cases is premature. Premature establishement of cause/effect relationships may lead to unneccessaary conceern, and prevent discovery of actual caauses of disease. This hypothesis development and testing process is essential if we are to accurately determine the role of indoor fungi in human disease.