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Published ahead of print on April 30, 2003, doi:10.1164/rccm.200207-730OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 2, July 2003, 232-237

A more recent version of this article appeared on July 15, 2003
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Submitted on July 22, 2002
Accepted on April 26, 2003

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

Paul C Stark1, Harriet A Burge2, Louise M Ryan3, Donald K Milton2, and Diane R Gold4*

1 Environmental Health, Harvard University School of Public Health, Boston, MA, USA; Medicine, Division of Clinical Care Research, Tufts-New England Medical Center, Biostatistics Research Center, Boston, MA, USA, 2 Environmental Health, Harvard University School of Public Health, Boston, MA, USA, 3 Biostatistics, Harvard University School of Public Health, Boston, MA, USA, 4 Medicine, Channing Laboratory - Brigham and Women's Hospital and the Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed. 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 asthmatic/allergic parents, we examined in-home fungal concentrations as predictors of lower respiratory illnesses (croup, pneumonia, bronchitis, and bronchiolitis) (LRI) 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: 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, breast-feeding and being exposed to other children through siblings. In a multivariate analysis, the relative risk 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 lower respiratory illness in infancy, even for infants with non-wheezing 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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