1. Markku Seuri, FIOH, 20041 MOULDY HOUSE PROBLEM Tartu 10.3.-11.3.2004

2. Markku Seuri, FIOH, 20042 DEFINITIONS  mould = microbes and their (toxic) products in moisture and water damaged building materials  mouldy house = a building partly damaged by moisture and microbial growth  damages can be visible or within building structures

3. Markku Seuri, FIOH, 20043 THE MAIN DIFFICULTY  the exposure is not known  several candidates: – spores – toxins – microbial volatile organic compounds – microbes themselves – structures of microbes – allergens

4. Markku Seuri, FIOH, 20044 LIVING EXPOSURE  the exposure changes over time  the microbes change: –material –type of damage –degree of moisture – temperature – nutrition –selection of species in time  the health effects change

5. Markku Seuri, FIOH, 20045 SPORES  commonly measured and expressed as colony forming units (cfu) per cubic meter of air, gram of material  poor relation to the health effects  one has to consider to microbial species, no only the amount  measure of the damage, not of the health effects or the risk

6. Markku Seuri, FIOH, 20046 MICROBIAL ALLERGENS  mould allergens exist, but most of the health effects are not IgE related allergies  fungal allergens are commonly essential enzymes in the fungus  similarities between the allergens of different species

7. Markku Seuri, FIOH, 20047 STRUCTURES OF MICROBIAL WALL  beeta-glucans of fungi  endotoxin of gram negative bacteria  rarely seen in the air of mouldy houses  can be a problem in renovation  can cause irritation of respiratory tract  not a probable cause of health effects

8. Markku Seuri, FIOH, 20048 MICROBIAL VOLATILE ORGANIC COMPOUNDS  do MVOCs exist? –MVOCs are released also from moistened materials without microbial growth –a measure of moisture damage on materials  not capable of producing irritation in the concentrations seen in mouldy houses

9. Markku Seuri, FIOH, 20049 MICROBIAL TOXINS  their role in causing health effects in mouldy houses controversial  good potential cause: –various health effects - many toxins –potential (ng/g -level) –most difficult health effects are seen in old damages - selection of species in time  no way to measure small quantities (at the moment)

10. Markku Seuri, FIOH, 200410 MICROBES THEMSELVES  not fungi commonly found in mould damages  only less than 10% of the microbial growth of any environmental sample can be named  interest in two groups: –slowly growing mycobacteria –microbes living with in amoeba

11. Markku Seuri, FIOH, 200411 AMOEBA AND LEGIONELLOSIS  Legionella is intracellular bacteria  found in natural and man-made water systems  multiplies in 20-50 degrees of C (32-40 ideal)  survives in the environment within amoeba  can be an occupational diseases, for instance in work place showers  an epidemic in a Finnish hospital has been found

12. Markku Seuri, FIOH, 200412 AMOEBA SHELTER OTHER BACTERIA  over 40 bacteria have been found within amoebae  including Chlamydia pneumoniae  we have found amoebae in damaged building material samples (in about one fifth of samples sent to our laboratories in Kuopio)

13. Markku Seuri, FIOH, 200413 MOULD DAMAGES AND IMMUNOCOMPROMISED PATIENTS  Aspergillus spp have caused infections in hospitals, even fatal case  at the moment there is no evidence that the fungi in the mouldy buildings could cause diseases to health inhabitants

14. Markku Seuri, FIOH, 200414 SYMPTOMS AND DISEASES FOUND IN MOULDY BUILDINGS  irritation  “toxic” or “general” symptoms  increased number of respiratory infections  diseases

15. Markku Seuri, FIOH, 200415 IRRITATION SYMPTOMS  respiratory tract: –commonly the higher, rarely the lower  irritation of the eyes  irritation of the skin  the most common symptoms  transient  usually relieves in a few days

16. Markku Seuri, FIOH, 200416 “TOXIC” OR “GENERAL” SYMPTOMS  symptoms like: –headache –tiredness –aching muscles and joints –fever and chills  transient  may need a week or two to be relieved

17. Markku Seuri, FIOH, 200417 RESPIRATORY INFECTIONS  normal flues  sinusitis  the incidence is higher in mouldy houses  some toxins restrain the cilial movement in the respiratory tract in vitro

18. Markku Seuri, FIOH, 200418 DISEASES 1  asthma is the most common  mechanism is not known  most asthma cases seen in mouldy houses are not allergic  the risk of asthma is about two in the mouldy houses, but the risk is not divided evenly among them

19. Markku Seuri, FIOH, 200419 DISEASES 2  allergic rhinitis have been shown  some clusters of inflammatory rheumatic diseases have been published –the causal link not established –the risk of these diseases seen rarely