The Western Institute of Technology at Taranaki

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The Western Institute of Technology at Taranaki

• A Case Study
• Is Toxic Black Mould the Culprit?
• Carol Ashcroft, RN, ADN, BHSc, MEd.

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Background

• 51 year old office worker, worked in an office
  alone since 2002
• 2004 - multiple visits to GP for general fatigue,
  nausea sleeplessness
• Prescribed anti-depressants (didnt take)
  omeprazole (losec) for gastric reflux
• Near to collapse, breathlessness, dizziness Hb
  48/L (120-160/L) 4 units of blood iron
  tablets 105g/l
• Further tests performed to establish if anaemia
  was due to blood loss 2005-2006
• Gastroscopy mild gastritis, giardia, no blood
  loss
• Colonoscopy no blood loss
• Small bowel capsule endoscopy gastritis
  gastric antral vascular ectasia (water melon
  stomach)

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GAVE-Watermelon Stomach (Pub.Med.gov)
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Before after Tx(MUSL Digestive Disease Centre)
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GAVE

• Bleeding of lining of stomach
• Tx argon plasma coagulator by gastroscopy
• GAVE can be associated with chronic liver disease
• Mild cholestatic abnormality interruptions to
  flow of bile from liver to duodenum
• Early primary biliary cirrhosis also considered
  has been linked to GAVE
• PBC T cell mediated attack on intralobular bile
  ducts - cholestasis?cirrhosis?liver failure
• Cause of PBC unknown. ? related to genetic
  environmental factors including several bacteria
  viruses and their toxins
• Not known what triggers T-cell attack ? auto
  immune

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Ongoing symptoms

• Shortness of breath, chronic fatigue, dizziness,
  headaches, sleep difficulties
• Nausea, acid reflux, jaw soreness, swallowing
  difficulties, sore coated tongue, dry mouth,
  slurred speech, production of oral mucous
  (sometimes blood stained)
• Generalised muscle joint pains, feet ankle
  oedema
• Dry-bloodshot eyes, face flushes skin rashes
  particularly on the face

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Disintegration of Office Wall - 2006

• Investigation laboratory sampling
• Several fungi spores - Aspergillus/penicillium
• Most significant stachybotrys
• Plaster board, carpet, spores in air
• Indicates long term leak sick building syndrome
  toxic mould

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Stachybotrys

• Greenish-black mould
• Thrives in high humidity, moisture cellulose
  materials paper products (building paper), wood
  products (gib board)
• Spores enter buildings through doors, windows,
  ventilation systems where water leakage -
  roofs, pipes, walls, pot plants or sites of
  flooding.
• Flashings in roof were not installed when
  building renovated

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Stachybotrys(Mold Mildew, Harriman, Brundrett
Kittler)
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Mycotoxins

• Mycotoxins fungal metabolites with the
  potential to cause harm to organisms. A commonly
  occurring mycotoxin is trichothecenes which
  inhibit protein synthesis (formation of proteins
  in body)
• Proteins in the body
• Compose 10-30 of bodys cell mass
• Major source of building material muscles,
  blood, skin, hair, nails internal organs
• Necessary for formation of hormones, enzymes
  anti-bodies

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Trichothecenes in Animals

• When given to animals in low concentrations
  (orally/intraperitoneal inj.) can cause acute
  toxicity in varying degrees vomiting,
  diarrhoea, inflammation of gastrointestinal tract
  refusal to feed, skin irritations, abortion,
  anaemia, leukopenia
• Can be acutely toxic or strongly
  immunosuppressive
• Other symptoms in animals - eye mucous membrane
  irritations followed by necrosis, changes in
  blood parameters, haemorrhaging in organs, severe
  disorders of the immune system rapid death when
  exposed to high levels of toxins
• Toxicity from eating contaminated feed

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Trichothecenes in Humans

• Handling contaminated material or inhalation of
  airborne toxins
• Physical - loss of sleep, appetite, chronic
  fatigue, headaches, dizziness, vague aches
  pains (joint ache), respiratory problems
  breathlessness. Rashes, conjunctivitis,
  diarrhoea, nausea vomiting, cold flu
  symptoms, sore throats, haemoptysis, pulmonary
  haemorrhages altered blood parameters
• Psychological/cognitive irritability, panic,
  anxiety, poor concentration confusion
• Not a specific disease, but an excessive number
  of health complaints

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After Exposure of the Wall

• Her condition rapidly deteriorated
• the fatigue bowled me over, it just knocked me
• Symptoms that particularly worsened shortness
  of breath, blood shot, dry, irritated eyes.
• Sore coated tongue dry mouth. Bright red rash
  over face diagnosed with rosacea

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Rosacea(Everybody Health Information for New
Zealanders)
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Employment

• Unable to continue work took 3 months off
• Condition began to improve returned part-time
• Within 2 wks symptoms reappeared dry, itchy
  irritated eyes, dry mouth lips stuck to her
  teeth, rash on her face worsened
• Transferred to another building
• General health continued to be poor
• Unable to perform the role as she once did
  memory losses
• Has since resigned
• Re-entering the original building immediately
  her eyes water rash on face worsens

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Establishing a Mould Claim Case

• Babcock (2006) suggests the following must be
  demonstrated
• The presence of mould
• The cause of the mould (to demonstrate who is
  responsible)
• Actual exposure to the mould
• An exposure dose that was significant enough to
  cause health effects and,
• A medical link between the type of mould and the
  claim injury.

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Summmary

• There are well-defined problems that people can
  get into with mould exposures, however, are mould
  toxins as big a problem as we think they may be?
  The problem is we just dont know. There is not
  enough information and there are also not enough
  good ways of assessing the impact of some of
  these toxins on patients. Specific toxicity due
  to inhaled moulds, including Stachybotrys in
  building-related illness, has not been
  scientifically established by any published
  study. (Dr Richard Weber, cited in Schieszer,
  2005, p. 1)

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Conclusion

• Case study has presented a number of health
  complaints
• Her condition deteriorated rapidly after exposure
  of the wall
• Symptoms are consistent with both animal human
  toxicity as identified in the literature
• In regard to mycotoxins building-related
  illness, case definitions are inconclusive
  further research is required to make a definitive
  link between fungal toxins the outcomes of
  peoples health

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Nursing Showcase