The Mould Show Dr Cameron Jones

Science is all about observation and forming hypotheses to answer questions. For scientists like myself, I’m interested in how the environment affects health, and specifically, how water-damaged buildings and exposure to poor indoor air quality can affect quality of life. For this week on The Mould Show, we're going to be talking about fungal mycotoxins and myalgic encephalomyelitis termed ME for short and chronic fatigue syndrome  (ME/CFS). 

The reason I've chosen this topic is that I've met a family whom I've now done three separate mould inspections for.  Why this is unusual is that the symptoms experienced by the female occupant and her daughter are classic ME/CFS symptoms.  Across all 3 of the different properties hidden mould problems were discovered.  That information in itself was useful for this family and helped them to break their lease due to the fact that there was verified mould present. However, that's not the point of this podcast and even the positive mould confirmation as an environmental trigger didn’t help the mother and daughter from understanding why they reacted so strongly when indoors. They thought they were going crazy, since how could 3 different properties cause them so much trouble? They couldn’t understand why some buildings caused no issues, and the 3 they’d chosen to rent all set them off?

This has bothered me all year.  I know mould is a huge issue for some people – but what exactly might be going on for THIS family?

A very interesting article on Substack focuses on his experience with chronic pain and ME/CFS and how after 25 years of suffering, he discovered by chance, following a recommendation from a friend to read a book that talked about the connection between ME and chronic fatigue syndrome and mitochondrial dysfunction. So that is the true focus of the topic today. 

• Could exposure to fungal mycotoxins be the reason why they were tired and experiencing pain?  
• Could this be the reason you’re tired? Is this another aspect to environmental illness?
• And could this be classified as Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS)? 
• Are there any patient-specific tests to verify ME/CFS or mould exposure and what can be done to alleviate the symptoms?  

Firstly, let's define what ME/CFS is. There are three core symptoms + at least one or more other symptoms which include:
 
1. an inability to participate in routine activities that would have been possible before becoming ill and that lasts for greater than six months. 
2. the fatigue which is also a primary symptom tends to worsen after physical, mental or emotional effort. 
3. and does not resolve after sleep, termed ‘unrefreshing sleep’. 

Other problems include:

a) an inability to concentrate or memory impairment and/or 
b) something called orthostatic intolerance. This means that when people stand up, they feel lightheaded or dizzy and can even faint. 

The family that moved into those three different properties all complained that after a few days of occupying the mould-contaminated building the wife especially experienced episodes of unexpected fainting and collapsing into her husband's arms. 

Those 3 inspections coupled with reading the Substack article led me to investigate further whether there was any published literature, focusing on exposure to fungal cells or their mycotoxins in the ME/CFS literature. 

Very recently a publication appeared in the International Journal of Environmental Research and Public Health that has looked at exactly this topic. These scientists looked at the levels of Aspergillus toxins like aflatoxin, ochratoxin, and gliotoxin in the urine of 236 ME/CFS patients who had a known exposure to mould from water-damaged buildings. 

The evidence from two types of urine mycotoxin testing from Real-Time

This week on The Mould Show we're going to be looking at the gut microbiome and in particular some emerging research that is showing that the diversity of microorganisms found in the gut may be linked to different immune responses and may even affect the pathogenesis of conditions like multiple sclerosis, MS. I'll be reviewing two of the dominant papers in the MS literature around gut microflora and looking at this concept of species diversity. In these papers the scientists looked at the number of different microorganisms between healthy controls and MS patients. Multiple sclerosis is a neuroinflammatory autoimmune disease known to affect two and a half million people worldwide with most patients experiencing what is termed relapsing-remitting Multiple Sclerosis which as the name suggests shows periods of stasis punctuated with symptoms but overwhelmingly moves towards more frequent symptoms as the disease progresses. There are currently no known treatments for MS. However, there is an abundant literature showing that healthy lifestyle factors such as no current smoking, a healthy diet regular exercise and maintaining a low body mass index all help reduce symptoms. The two papers we're looking at today ask the question: Are there some fungi that can be measured in the gut that are correlated with MS and healthy controls? Essentially, what is the role that microbiology plays in MS?. These two papers strongly suggest that bacterial and fungal diversity is indeed connected and can differentiate healthy controls from MS patients. This research is exciting because it offers the opportunity not only for individualized testing as a risk predictor, but also the opportunity for individualized dietary modifications to be made to change the composition of the gut microflora. Both papers determined that fungi like Candida, Epicoccum, Malassezia and Saccharomyces all seem to show statistical relationships that could be a value to predict or at least classify individuals into different risk categories. Interestingly, when we drill into the literature and look at the species diversity for Saccharomyces which is a typical yeast found in breads and grains there is another set of literature that has looked at the gut microbiota and the day 28-day mortality for critically ill patients admitted to hospital. Of course, many of the underlying reasons for hospital admission includes chronic lung disease, chronic heart disease, immunosuppression, active cancer and acute kidney injury. Nevertheless, when sampling was performed, they found clear evidence that species diversity in the gut was predictive for which patients survived versus those that died? So, what to make of these facts? Well, there is an opportunity to look at what readily available compounds might be used nutritionally or therapeutically, to mitigate, delay, or reverse these diseases? One of the compounds being actively researched is called Astaxanthin and is commonly found in shellfish and lobsters and green micro algae. It’s been shown to not only possess anti-microbial or antibiotic type activity but there is emerging research it can be used for a range of neurodegenerative diseases, including stroke, multiple sclerosis, Alzheimer’s and even conditions like chronic fatigue syndrome. This research into use of astaxanthin suggests that even if it cannot be used as a topical anti-microbial (due to high dosage), it may exert its beneficial effect by altering the composition of the gut microflora at lower dosage. Other elegant research has looked at how astaxanthin has been able to protect the myelin sheath in Multiple Sclerosis models in rats. This research strongly suggests that astaxanthin exerts its effect because they help reduce inflammation and oxidative stress. We can only hope that more research into the therapeutic effects of natural compounds like astaxanthin may lead towards wide-spread use of targeted dietary modifications.  

Imagine that at your workplace - you move to new offices and these offices are sited partially below ground level. Within three months of moving into the new offices, every person who works there has started to suffer from symptoms that consistent with exposure to a water damage buildings and are reacting to the microbes and moulds that are commonly found in these environments.  
 
When the symptoms became unbearable, the office staff started looking for answers. This week on The Mould Show, I'm going to be reviewing the research results that carefully examined each of those office workers to work out two things: 
 
Firstly, was the building contributing something toxic that the workers were being exposed to? And secondly, how could this be best measured by the medical doctors who were involved? 

This publication looks at whether or not immunosuppression and adverse events can be measured. And if so, how does one go about doing this? This publication appeared on the 21st of January 2022 in the Journal of Fungi: Toxic Indoor Air Is a Potential Risk of Causing Immuno Suppression and Morbidity-A Pilot Study. 
 
What the scientists did was examine both the patient (that is the occupants of the workplace), and they also looked at the building to see what type of toxins and microbes could be detected. 

The purpose of the research was how to prove causality between the symptoms experienced by the workers and exposure to the toxic indoor air. But the scientists weren't satisfied with just using microbiological technique to measure for mould, because it's well recognized that even though these tests are very sensitive and accurate to measure mould spore levels in the air - they can often miss the breakdown fragments of microbes that grow on water damaged buildings. 

And therefore, this very exciting research from Finland has implemented a new method to assess toxicity indoors, which looks at collecting condensed indoor air water vapour and test that.  Now what does this mean? 
 
Well, essentially, they have devised and patented a method of rapidly collecting water vapor out of the air but again, how did they do this? 

The Finnish scientists used three toxicity test methods to see how the indoor air might be compromised. The first one was to use THP-1 macrophages.  We cover the other two cell, lines in the podcast.

But what about all those people who are working in water damaged building interiors? We know if they're being exposed to particulate matter, like mould spores and cell fragments, from typical indoor air quality tests like spore traps, bio tape lifts or direct microbiology from the air or surfaces onto Petri plates.  But many of the mycotoxins can also be measured in urine? Thanks to this breaking research, there are other, new biomarkers like mycophenolic acid – which is tested from the water vapour indoors. 

In turn, what do you think the contribution is to adverse health from mycophenolic acid exposure? The Finnish data shows that mycophenolic acid reduces immune function and the other types of in vitro tests showed that macrophages activity is reduced and that mitochondrial activity is increased, but also that bore sperm motility is interfered with. 

Vaali K, Tuomela M, Mannerström M, Heinonen T, Tuuminen T. Toxic Indoor Air Is a Potential Risk of Causing Immuno Suppression and Morbidity-A Pilot Study. J Fungi (Basel). 2022 Jan 21;8(2):104. doi: 10.3390/jof8020104. PMID: 35205859; PMCID: PMC8877819. https://pubmed.ncbi.nlm.nih.gov/35205859/

If you're dealing with water damage building interiors, or just wondering what is the best way to clean textiles and clothing that might have become mould contaminated - you might be thinking, why can't I just put them all into the washing machine? Your next question might be: is there something I can do to the washing cycle that will help reduce the population of any germs that might be on those textiles? The answer is yes, there is an optimal way of washing your clothing to remove specific germs like classes of fungi that cause skin and nail infections. These fungi are termed dermatophytes and are superficial fungal infections that colonize the skin, hair or nails. This group of fungi thrive in moist areas of the skin and are easily transferred to clothing and towels and they are also found in soil. The statistics around dermatophytes report that 20 to 25% of the world's population is currently infected with a dermatophyte fungus. A paper that was published in late May 2022, looked at whether you could freeze material contaminated with dermatophyte fungi, or heat them up in a laundromat or domestic dryer, or whether it was best to wash them – and if so, what’s the best way to reduce the viability of these dermatophytes? This is an interesting question because although dermatophyte fungi are specific causative agents of skin, hair and nail infections they nevertheless represent a class of fungi that if we understand how they respond to the washing cycle - then this could extend to other types of fungi found in the home, on the floor, or on porous personal items of personal property that might benefit from being washed. So the central question of this live stream is: hot cycle versus cold cycle versus heat drying versus freezing - which is better? To answer this question, I'm going to summarize the key findings of a paper that came out in the Journal of Fungi which looked at how to test between these different treatments. What the scientists did was deliberately contaminate gauze pads with three of the most common fungi that affect humans (Trichophyton tonsurans, Trichophyton rubrum and Trichophyton interdigitale). We know the effects of these fungi when they attack feet and other moist skin areas and cause, for example, Athlete's Foot. We should also respect the fact that these fungi are easily transmitted. Think – of contact with infected individuals or even skin contact with inanimate objects like flooring. And so what the scientists did was they deliberately infected small gauze pads and then cleaned them in different ways. The. They looked at the recovery rate for the dermatophyte fungi. Successful cleaning meant there were no fungi recovered. The first treatment looked at how temperature and cleaning time impacted on fungal recovery. The next question for the washing machine method was whether adding detergent helps? Another cleaning method looked at whether freezing the textile gauze pad could kill the fungi? The results are compelling:•Low temperature washing for example, at 40 degrees Celsius for 100 minutes with or without detergent did not reduce the viability of Trichophyton fungi. •Increasing the temperature to either 60 degrees Celsius or 90 degrees Celsius for either 100 minutes or 150 minutes resulted in the loss of viability for Trichophyton fungi. •The higher temperature was effective with or without detergent. •Unfortunately, heat drying the contaminated material in either a domestic machine or a laundromat machine for anywhere from 10 minutes to 150 minutes, did not reduce the population viability of Trichophyton fungi. •And somewhat counter-intuitively, it was not possible to freeze the fungus and cause it to stop growing even if freezing was carried out for one day, two days, or even seven days – the persistent viability of the Trichophyton fungi was preserved. The take-home message, therefore, was that domestic washing machines with or without detergent are hig

In Australia, we're currently suffering from torrential rain all along the east coast, affecting Queensland and New South Wales and potentially moving towards Victoria. Regardless of where you're living, unexpected water damage and mould may be a new problem for you to begin dealing with. This live stream and podcast will focus on how to deal with mould and water damage affecting paper documents. We can all imagine sodden books and libraries underwater, but I'll leave that problem for the archivists. This show segment will focus exclusively on how you can deal with mould contamination of paper documents.  To do this, I’ll review a recent paper that came out that looked at how to sterilize paper during a crisis. The authors compared two types of sterilization methods called (1) gamma sterilization which uses radiation to perform cold sterilization and (2) dry heat sterilization. Why this paper is interesting is that all of us have access to dry heat using a convection drying oven. 
 
The scientists performed several types of tests looking at the efficiency of gamma radiation versus dry heat. They discovered that gamma radiation inactivated 100% of the test organisms, including fungi and gram-positive and gram-negative bacteria but what about the efficacy of dry heat? The scientists looked at three temperatures: 100, 150, and 200 degrees Celsius for 15, 30 or 60 minutes. They also looked at the impact of two different sterilization techniques on the structural integrity of the paper using scanning electron microscopy. When we focus only on fungi, (because bacteria are easier to kill)  it was shown that a conservative temperature of 100 degrees Celsius for 15 minutes achieved a 97.1% inactivation. This also had the lowest comparative impact on the paper structure. 
 
Obviously, other methods of water damage restoration indoors such as increasing ventilation to provide additional air circulation or the use of a dehumidifier are also valuable methods of dealing with water damage. 
 
The take-home message from this paper is that a convection oven can effectively disinfect and nearly sterilize water-damaged papers using a conservative time and temperature of 100 degrees Celcius for 15minutes. 
 
I hope this information helps any persons dealing with mould contamination of paper documents.
 
REFERENCES:
 
Alshammari, F.H., Hussein, HA.A. Sterilization of paper during crisis. AMB Expr 12, 13 (2022). https://doi.org/10.1186/s13568-022-01345-6

Many people ask me the question: can you really get sick from spending time inside a water-damaged property? Or another related question: Does mould really make people sick? Sometimes I even get questions along the lines of: I can understand why people might not like the smell of mould or even its visual presence, but surely, a little bit of mould can't hurt you? 

If you've ever been part of these conversations, and want definitive proof that mould can in fact, cause serious problems for occupants then this live stream and podcast is for you. A paper came out at the end of 2021 in the Journal of Hygiene and Infection Control, discussing the situation for a family of five, who developed severe health problems after spending six years inside a water damaged home.  Your first reaction might be: why did they stay six years? For many people, this is unavoidable and for this family, it was because it was a new home construction.  They battled on trying the get the builder to fix the problems. This case study deep dives into something called building-related illness and explores its relationship with sick building syndrome. 

The paper is important because it includes an evaluation of the home from an Occupational Hygiene viewpoint as well as the Environmental Medicine perspective. This case study highlights many of the building-specific factors that contributed to water damage and mould as well as the complaint pattern and medical symptoms that were experienced by the children, the mother and the father.  

The outcome of this case study revealed that until the family changed their place of residence unwanted health complaints persisted. But once they left the father's health symptoms improved after two weeks. The three children took six months to recover and the mother's symptoms went away after 18 months. 

This paper highlights that long term exposure to mould was the cause of building-related illness. Use this paper to support your position especially if you're ever needing to prove the health hazards from mould inside buildings

REFERENCE: 

Kramer A, Wichelhaus TA, Kempf V, Hogardt M, Zacharowski K. Building-related illness (BRI) in all family members caused by mold infestation after dampness damage of the building. GMS Hyg Infect Control. 2021 Dec 7;16:Doc32. doi: 10.3205/dgkh000403. PMID: 34956824; PMCID: PMC8662741.