| Overview of Investigations into Pulmonary Hemorrhage among Infants in Cleveland, Ohio Dorr G. Dearborn,1 Iwona Yike,1 W.G. Sorenson,2 Martha J. Miller,1 and Ruth A. Etzel3 1Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio USA; 2Division for Respiratory Disease Studies, National Institute of Occupational Safety and Health, Morgantown, West Virginia USA; 3Centers for Disease Control and Prevention, Atlanta, Georgia USA Abstract
Idiopathic pulmonary hemorrhage was diagnosed in 37 infants in the Cleveland, Ohio, area between 1993 and 1998. This rare disorder has been related to 12 deaths, including 7 originally thought to be sudden infant death syndrome. Thirty of the infants were African American, all of whom lived in a limited geographic area of eastern metropolitan Cleveland, an area of older housing stock. An investigation led by the Centers for Disease Control and Prevention has found an association with household exposure to a toxigenic mold, Stachybotrys chartarum, and other fungi. The rapidly growing lungs of young infants appear to be especially vulnerable to the toxins made by toxigenic molds. Environmental tobacco smoke was frequently present in the infants' homes and may be a trigger precipitating the acute bleeding. Stachybotrys, although not thought to be a common mold, is known to have a wide geographic distribution. An additional 101 cases of acute, idiopathic pulmonary hemorrhage have been reported in infants in the United States over the past 5 years. In this overview, the investigations are summarized, the clinical profile is described, the toxicity of S. chartarum is discussed, and pathophysiologic concepts are presented. Key words: environmental tobacco smoke, idiopathic pulmonary hemosiderosis, indoor mold, pulmonary hemorrhage, satratoxins, Stachybotrys chartarum, sudden infant death syndrome, toxigenic fungi, trichothecenes. -- Environ Health Perspect 107(suppl 3) :495-499 (1999) . http://ehpnet1.niehs.nih.gov/docs/1999/suppl-3/495-499dearborn/abstract.html
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