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Fungal Levels in the Home and Lower Respiratory Tract Illnesses in the First Year of Life

Department of Environmental Health, Harvard University School of Public Health; Biostatistics Research Center, Division of Clinical Care Research, Department of Medicine, Tufts-New England Medical Center; Department of Biostatistics, Harvard University School of Public Health; and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and the Harvard Medical School, Boston, Massachusetts

Correspondence and requests for reprints should be addressed to Diane R. Gold, M.D., M.P.H., Channing Laboratory, 181 Longwood Avenue, Boston, MA 02115. E-mail: diane.gold{at}channing.harvard.edu

The association between home dampness and lower respiratory symptoms in children has been well documented. Whether fungal exposures contribute to this association is uncertain. In a prospective birth cohort of 499 children of parents with asthma/allergies, we examined in-home fungal concentrations as predictors of lower respiratory illnesses (LRI) (croup, pneumonia, bronchitis, and bronchiolitis) in the first year. In multivariate analyses, we found a significant increased relative risk (RR) between LRI and high levels (more than the 90th percentile) of airborne Penicillium (RR = 1.73, 95% confidence interval [CI], 1.23, 2.43), dust-borne Cladosporium (RR = 1.52; CI, 1.02, 2.25), Zygomycetes (RR = 1.96; CI, 1.35, 2.83), and Alternaria (RR = 1.51; CI, 1.00, 2.28), after controlling for sex, presence of water damage or visible mold/mildew, born in winter, breastfeeding, and being exposed to other children through siblings. In a multivariate analysis, the RR of LRI was elevated in households with any fungal level at more than the 90th percentile (RR = 1.86; CI, 1.21, 2.88). Exposure to high fungal levels increased the risk of LRI in infancy, even for infants with nonwheezing LRI. Actual mechanisms remain unknown, but fungi and their components (glucans, mycotoxins, and proteins) may increase the risk of LRI by acting as irritants or through increasing susceptibility to infection.

Key Words: fungi • respiratory tract infections • infants • public health

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