Human & Animal Diseases Caused by Mold - A Summary of Risks, History of Mold Related Illnesses, Resources
Recent near-panic media reports of dangerous mold in pancake mix and cake batters need to be understood with an accurate perspective on the hazards to humans or other animals from eating moldy foods. Here we provide a brief history of major mold-related-illness outbreaks and additional detail on mold toxicity associated with food products.
People who do not have a mold allergy eat moldy food without issue - such as blue cheese; people in developing countries survive eating moldy food and fruit thrown into waste bins.
Harmless or Helpful Molds
There are plenty of molds that grow on and in foods that are harmless, and many many foods whose preparation deliberately involves the action of mold- Camembert and Roquefort cheese, Quorn microprotein, Rhizopus oligosporous used to make tempeh, Aspergillus oryzae used in the production of Miso and other soy products.
Molds are also used to produce important drugs used to treat illness in humans, animals (antibiotics such as penicillin), and other molds are used in pest control applications.
A Concise History of Mold Related Illness in People & Animals
857 A.D. - Mycotoxicosis has been documented and is famous beginning with the outbreak of gangrenous ergotism in the Rhine Valley in 857 A.D. This is the earliest detailed mycotoxicosis report, though there are also biblical references to mold concerns as well as mold remediation advice.
The victims of ergotism were exposed to lysergic acid diethylamide (LSD), a hallucinogen, produced during the baking of bread made with ergot-contaminated wheat, as well as to other ergot toxins and hallucinogens, as well as belladonna alkaloids from mandragora apple, which was used to treat ergotism. ... Ergot is the common name of the sclerotia of fungal species within the genus Claviceps, which produce ergot alkaloids. The sclerotium is the dark-coloured, hard fungal mass that replaces the seed or kernel of a plant following infestation. Ergot alkaloids are also secondary metabolites of some strains of Penicillium, Aspergillus and Rhizopus spp. -
Ergotism is extremely rare today, primarily because the normal grain cleaning and milling processes remove most of the ergot so that only very low levels of alkaloids remain in the resultant flours. In addition, the alkaloids that are the causative agents of ergotism are relatively labile and are usually destroyed during baking and cooking.- World Health Organization Mold Bulletin
1913 - Alimentary Toxic Aleukia in Siberia - more outbreaks during WWII, claimed to have killed 100,000 people, due to eating moldy bread that was made from wheat contaminated by mycotoxins (trichothecene) produced by Fusarium sporotrichioides and Fusarium poae.
1930 - Mycotoxicosis outbreak in horses who were fed moldy grain contaminated with Stachybotrys chartrarum (saratoxins L,D,F,G, & H) - also reported in farm workers handling contaminated hay. In general the risks from S. chartarum occur during extreme conditions such as during demolition of moldy drywall in a building; this spore is not normally easily airborne as it's large (10 x 20 u) and sticky (designed to be spread in nature by sticking to the foot of an animal walking through moldy grass or straw).
Our lab photo (above left) shows Stachybotrys chartarum mold collected by adhesive tape during a field investigation by DF and identified in our laboratory.
1960 - England - turkeys and other birds died after being fed moldy feed contaminated with an aflatoxin produced by Aspergillus flavus and Aspergillus parasiticus.
General interest in mycotoxins rose in 1960 when a feed-related mycotoxicosis called turkey X disease, which was later proved to be caused by aflatoxins, appeared in farm animals in England. Subsequently it was found that aflatoxins are hepatocarcinogens in animals and humans, and this stimulated research on mycotoxins. - Op.Cit.
Our lab photo of Aspergillus sp. (below left) was made from a tape lift surface sample of mold growing in a building -- DF.
1974 - India - aflatoxicosis resulted in 106 deaths among 397 cases
Several outbreaks of aflatoxicosis have occurred in tropical countries, mostly among adults in rural populations with a poor level of nutrition for whom maize is the staple food. The clinical picture presented by cases indicated acute toxic liver injury, which was confirmed by morphological changes in liver autopsy specimens that were indicative of toxic hepatitis. Mortality rates in the acute phase were 10-60 %. At the end of one year, surviving patients
had no jaundice, and most of them had recovered clinically. - Op.Cit.
1975 - India - ergotism
The other type of ergotism, a convulsive form related to intoxication with clavine alkaloids from Claviceps fusiformis was last seen during 1975 in India when 78 persons were affected. It was characterized by gastrointestinal symptoms (nausea, vomiting and giddiness) followed by effects on the central nervous system (drowsiness, prolonged sleepiness, twitching, convulsions, blindness and paralysis). The onset of symptoms occurred 1-48 hours following exposure; there were no fatalities. - Op.Cit.
1987 - India - gastrointestinal illness in the Kashmir valley from consuming mold-contaminated wheat products - Aspergillus sp. & Fusarium sp.
2004 - Kenya - 125 deaths from eating corn contaminated with Aspergillus flavus, aflatoxin contaminated - corn was stored in damp conditions
Use Common Sense in Avoiding Moldy Food Products
A general panic about possible mold in foods would be undue, misplaced, and an exaggeration.
Mold is everywhere, all the time. We do not live and should not try to live in a "mold free" environment - mycophobia contains its own risks. It is interesting to note that the incidence of asthma was found lowest among children of farmers whose environment contained very high levels of exposure to mold and other airborne allergens. Seeking to protect our children by placing them in a "too-clean" environment in many instances actually increases the ultimate risk to their health from subsequent exposure to common mold and bacteria against which they will have developed no resistance.
What Are the Potential Hazards from Eating Moldy Foods? - Mold Allergies, Mycotoxins, Aflatoxins, Ochratoxins & Bacterial Hazards in Food
But we certainly agree that there are potential hazards from ingesting mold in some specific cases:
The hazards from eating moldy food are
Mold allergic-people: asthmatics, people with a mold allergy, compromised immune system, infant, elderly, especially to someone who has a severe mold allergy
Mycotoxins, aflatoxins, ochratoxins etc: from food that contains mycotoxins, aflatoxins (chemically poisonous) (unlikely in dry pancake mix that has been properly stored) - we describe these substances in detail at World Health Organization Mold Bulletin
Mycotoxins are secondary metabolites of molds that exert toxic effects on animals and humans. The toxic effect of mycotoxins on animal and human health is referred to as mycotoxicosis, the severity of which depends on the toxicity of the mycotoxin, the extent of exposure, age and nutritional status of the individual and possible synergistic effects of other chemicals to which the individual is exposed. The chemical structures of mycotoxins vary considerably, but they are all relatively low molecular mass organic compounds. The untoward effect of molds and fungi was known already in ancient times. In the seventh and eighth centuries BC the festival "Robigalia" was established to honour the god Robigus, who had to be propitiated in order to protect grain and trees. It was celebrated on 25 April because that was the most likely time for crops to be attacked by rust or mildew - Op.Cit.
Aflatoxins occur in nuts, cereals and rice under conditions of high humidity and temperature and present a risk to human health that is insufficiently recognized. ...
Aflatoxins are acutely toxic, immunosuppressive, mutagenic, teratogenic and carcinogenic compounds. The main target organ for toxicity and carcinogenicity is the liver. The evaluation of epidemiological and laboratory results carried out in 1987 by the International Agency for Research on Cancer (IARC) found that there is sufficient evidence in humans for the carcinogenicity of naturally occurring mixtures of aflatoxins, which are therefore classified as Group 1 carcinogens, except for aflatoxin [M.sub.1], which is possibly carcinogenic to humans (Group 2B). - Op.Cit.
Ochratoxins are secondary metabolites of Aspergillus and Penicillium strains, found on cereals, coffee and bread, as well as on all kinds of food commodities of animal origin in many countries. The most frequent is ochratoxin A, which is also the most toxic. It has been shown to be nephrotoxic, immunosuppressive, carcinogenic and teratogenic in all experimental animals tested so far. ... Acute renal failure in one person, possibly caused by inhalation of ochratoxin A in a granary which had been closed for 2 years, was reported in Italy. - Op.Cit.
Bacteria found in the same food product: from that same food that may contain mold, there is a still higher risk of food poisoning from bacterial contamination such as by Staphylococcus aureus, Salmonella, Clostridium perfringens, Campylobacter, Listeria monocytogenes, Vibrio parahaemolyticus, Bacillus cereus, and entero-pathogenic Escherichia coli.
In general, moldy feed - grains - is particularly risky (more than say fruit) due to possible presence of mycotoxins or bacterial contamination.
But it's not simply the age of a product or throwing it away based on an expiration date that describe the risk. Even a new off the shelf product, particularly grain-based, that has been improperly stored under damp conditions, could be a risk. There could be a risk from buying a new grain product that itself was made from moldy raw product - say grain stored under damp conditions - but that seems to be less likely in countries where manufacturers are well aware of the hazard.
Ergotism is extremely rare today, primarily because the normal grain cleaning and milling processes remove most of the ergot so that only very low levels of alkaloids remain in the resultant flours. In addition, the alkaloids that are the causative agents of ergotism are relatively labile and are usually destroyed during baking and cooking. - Op.Cit.
To err on the side of caution, If your cake mix, bread mix, or pancake mix or any other food product looks or smells funny or moldy, or has been stored wet or damp just throw it away.
Putting Mold Related Illness Hazards in Perspective
Risk management: there are risks associated with mold exposure; certainly any large mold reservoir in a building (more than 30 sq.ft.. contiguous non-cosmetic mold) should be removed and its cause corrected -see ACTION GUIDE - WHAT TO DO ABOUT INDOOR MOLD.
And where people are at extra risk, extra care is needed to protect them from mold exposure - see MOLD EXPERT, WHEN TO HIRE for help in deciding when conditions justify bringing in a mold expert.
But don't forget these sources of immediate life-safety risk: lack of exercise, smoking, failure to install smoke and CO alarms in your home, failure fasten your seatbelt in the car, driving while texting, and falling down the stairs.
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Additional technical contributors & reference sources for this article are listed below.
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Mold Exposure Standards - levels of allergenic & toxic mold: how much mold means a problem? - http://www.inspectapedia.com/sickhouse/Mold_Standards.htm
US EPA: Mold and Moisture - see http://www.epa.gov/mold/index.html
Guidance for Clinicians on the Recognition and Management of Health Effects Related to Mold Exposure and Moisture Indoors, [on file as /mold/Mold_Guide_UConn.pdf] - Eileen Storey, MD MPH, Kenneth H. Dangman, MD PhD MPH, Paula Schenck MPH, Robert L DeBernardo MD MPH, Chin S Yang PhD, Anne Bracker CIH MPH, Michael J Hodgson MD MPH, University of Connecticut Health Center, Division of Occupational and Environmental Medicine, Center for Indoor Environments and Health, 266 Farmington Ave., Farmington CT 06030-6210, 30 September 2004. [We have edited this file to remove blank pages in order to speed its load-time and to add a link back to this website.] This document was designed to help the healthcare provider address patients with illnesses related to mold in the indoor environment by providing background understanding of how mold may be affecting patients. The guidance was published in 2004, with support from a grant by the U.S. EPA, by the Center for Indoor Environments and Health, or CIEH at the University of Connecticut Health Center. " -- original source: oehc.uchc.edu/images/PDFs/MOLD%20GUIDE.pdf (1.13MB PDF file, slow loading)
History of major mold outbreaks: see the WHO bulletin above, also see a nice summary of the history of major mold related illness outbreaks is at moldbacteria.com/newsletters/2005/sep2005.html provided by Dr. Jackson Kung'U, a microbiologist, mycologist, writing for that website.
Media Report of Student's Reaction to Consuming Suspected-Moldy-Pancakes - March 2010 A student at HBHS (high school) had pancakes and it almost became fatal. His mom (a registered nurse) made him pancakes, dropped him off at school afterward, and headed to play tennis. She usually never took her cell phone on the court, but did so this time, and her son called to say he was having trouble breathing. She told him to go to the nurse immediately and proceeded to call his school and alert the nurse. The nurse called the paramedics and they were there in 3 minutes. They worked on the boy all the way to the hospital. He came very close to dying. Evidently this is more common than I ever knew. Check the expiration dates on packages like pancakes and cake mixes that have yeast, which over time develop spores. Apparently, the mold that forms in old mixes can be toxic! Throw away ALL OUTDATED pancake mix, brownie mixes, Bisquick, cake & cookie mixes, etc., you have in your home. P.S. Tell this to your children, grandchildren, nephews, nieces and anyone else who keeps these types of mixes in the cupboard.-- snopes.com/medical/toxins/pancake.asp
Books & Articles on Building & Environmental Inspection, Testing, Diagnosis, & Repair
Our recommended books about building & mechanical systems design, inspection, problem diagnosis, and repair, and about indoor environment and IAQ testing, diagnosis, and cleanup are at the InspectAPedia Bookstore. Also see our Book Reviews - InspectAPedia.
Kansas State University, department of plant pathology, extension plant pathology web page on wheat rust fungus: see http://www.oznet.ksu.edu/path-ext/factSheets/Wheat/Wheat%20Leaf%20Rust.asp
"A Brief Guide to Mold, Moisture, and Your Home",
U.S. Environmental Protection Agency US EPA - includes basic advice for building owners, occupants, and mold cleanup operations. See http://www.epa.gov/mold/moldguide.htm
US EPA - Mold Remediation in Schools and Commercial Building [Copy on file at /sickhouse/EPA_Mold_Remediation_in_Schools.pdf ] - US EPA
US EPA - Una Breva Guia a Moho - Hongo [Copy on file as /sickhouse/EPA_Moho_Guia_sp.pdf - en Espanol
Allergies, Allergens, Allergy Testing in Buildings - References & Products
Allergen Tests in Buildings advice about how to test, what to look for, in evaluating the level of dog, cat, or other animal allergens in a building
"IgG Food Allergy Testing by ELISA/EIA, What do they really tell us?" Sheryl B. Miller, MT (ASCP), PhD, Clinical Laboratory Director, Bastyr University Natural Health Clinic - ELISA testing accuracy: Here is an example of Miller's critique of ELISA
http://www.betterhealthusa.com/public/282.cfm - Townsend Letter for Doctors and Patients
The critique included in that article raises compelling questions about IgG testing assays, which prompts our interest in actually screening for the presence of high levels of particles that could carry allergens - dog dander or cat dander in the case at hand.
http://www.tldp.com/issue/174/IgG%20Food%20Allergy.html contains similar criticism in another venue but interestingly by the same author, Sheryl Miller. Sheryl Miller, MT (ASCP), PhD, is an Immunologist and Associate Professor of Basic and Medical Sciences at Bastyr University in Bothell, Washington. She is also the Laboratory Director of the Bastyr Natural Health Clinic Laboratory.
Allergens: Testing for the level of exposure to animal allergens is discussed at http://www.animalhealthchannel.com/animalallergy/diagnosis.shtml (lab animal exposure study is interesting because it involves a higher exposure level in some cases
Allergens: WebMD discusses allergy tests for humans at webmd.com/allergies/allergy-tests
Animal Allergens: Dog, Cat, and Other Animal Dander - Cleanup & Prevention Information for Asthmatics and regarding Indoor Air Quality.
Recognizing Allergens: What various indoor allergens look like - identification photos to help identify pollen, dust mites, animal dander, toxic or allergenic mold - Common Mold and other Allergens, Irritants, Remedies & Advice
Rodent control issues, including dander, fecal, and urine contamination of Buildings and Building insulation are discussed at our
Associations: Sick House, Sick Building, SBS - Air Quality, Government, Private Associations and Information Resources
Atlas of Clinical Fungi, 2nd Ed., GS deHoog, J Guarro, J Gene, & MJ Figueras, Centraalbureau voor Schimmelcultures, Universitat Rovira I Virgili, 2000, ISBN 90-70351-43-9 (you can buy this book at Amazon) - The Atlas of Clinical Fungi is also available on CD ROM
Atlas of Indoor Mold, Online Clinical Mold Atlas, Toxins, Pathogens, Allergens and Other Indoor Particles - Medical Health Effects of Mold (separate online document)
Black Mold that is Harmless Photos of recognizable, usually harmless black mold on wood, bluestain, ceratocystis, ophistoma
Building Floods: quick steps after a building flood or plumbing leak can prevent costly mold contamination
Classes of Mold: what types of cosmetic, allergenic, or toxic mold are a problem? Can mold be cleaned-up successfully?
"A Brief Guide to Mold, Moisture, and Your Home", U.S. Environmental Protection Agency US EPA - includes basic advice for building owners, occupants, and mold cleanup operations. See http://www.epa.gov/mold/moldguide.htm
"Disease Prevention Program for Certain Vegetable Crops," David B. Langston, Jr., Extension Plant Pathologist - Vegetables, University of Georgia (PDF document) original source: www.reeis.usda.gov/web/crisprojectpages/209797.html
"Disease Prevention in Home Vegetable Gardens,"
Patricia Donald,
Department of Plant Microbiology and Pathology,
Lewis Jett
Department of Horticulture, University of Missouri Extension - extension.missouri.edu/publications/DisplayPub.aspx?P=G6202
Fifth Kingdom, Bryce Kendrick, ISBN13: 9781585100224, is available from the InspectAPedia online bookstore - we recommend the CD-ROM version of this book. This 3rd/edition is a compact but comprehensive encyclopedia of all things mycological. Every aspect of the fungi, from aflatoxin to zppspores, with an accessible blend of verve and wit. The 24 chapters are filled with up-to-date information of classification, yeast, lichens, spore dispersal, allergies, ecology, genetics, plant pathology, predatory fungi, biological control, mutualistic symbioses with animals and plants, fungi as food, food spoilage and mycotoxins.
Ozone Warnings - Use of Ozone as a "mold" remedy is ineffective and may be dangerous.
Rot concerns in buildings-some building mold such as Meruliporia incrassata "Poria" risks serious rot and hidden structural damage
US EPA: Una Breva Guia a Moho - Hongo [Copy on file as /sickhouse/EPA_Moho_Guia_sp.pdf - en Espanol
OTHER IAQ ISSUES: How To Find and Address Other Indoor Air or Indoor Environment Contaminants Besides Mold
Mold or allergens may not be the only or even the main indoor environmental contaminant. Don't let media attention to mold
cause so much enviro-scare fear that other, possibly more urgent hazards go un-addressed.
Ozone Warnings - Use of Ozone as a "mold"
remedy is ineffective and may be dangerous.
Pet control - if you can't say goodbye to your bird, cat, dog, guinea pig, hamster, tropical fish, then limit the
areas they occupy and limit the airflow from that area to sleeping or other areas of the building, use allergenic
bedding, eliminate wall-to-wall carpeting, improve housecleaning including use of a HEPA-rated vacuum cleaner. For more details
see our article Dog, Cat, and Other Animal Dander - Information for Asthmatics and Indoor Air Quality
Rodents, Mice, Squirrel Control - I find high levels of mouse and rodent dander, fecal dust, and urine-contaminated dust in some buildings,
and high levels of these materials in building insulation in those locations. If you have a mouse problem, particularly if mice and their waste (fecals or urine) are contaminating
the building HVAC or building insulation, may need both steps to clean up or remove infected materials and steps to stop an ongoing
rodent problem. If squirrels are a problem, the cleanup needs to include closing off entry openings into the building. Get some
help from a licensed pest control expert.
The Mold Information Center: