title: Hydrophilic fungi and ergosterol associated with respiratory illness in a water-damaged building.
abstract: BACKGROUND
  Damp building-related respiratory illnesses are an important public health issue.
  
  
  OBJECTIVE
  We compared three respiratory case groups defined by questionnaire responses [200 respiratory cases, 123 of the respiratory cases who met the epidemiologic asthma definition, and 49 of the epidemiologic asthma cases who had current physician-diagnosed asthma with post-occupancy onset] to a comparison group of 152 asymptomatic employees in an office building with a history of water damage.
  
  
  METHODS
  We analyzed dust samples collected from floors and chairs of 323 cases and comparisons for culturable fungi, ergosterol, endotoxin, and cat and dog allergens. We examined associations of total fungi, hydrophilic fungi (requiring water activity > or = 0.9), and ergosterol with the health outcomes using logistic regression models.
  
  
  RESULTS
  In models adjusted for demographics, respiratory illnesses showed significant linear exposure-response relationships to total culturable fungi [interquartile range odds ratios (IQR-OR) = 1.37-1.72], hydrophilic fungi (IQR-OR = 1.45-2.19), and ergosterol (IQR-OR = 1.54-1.60) in floor and chair dusts. Of three outcomes analyzed, current asthma with postoccupancy physician diagnosis was most strongly associated with exposure to hydrophilic fungi in models adjusted for ergosterol, endotoxin, and demographics (IQR-OR = 2.09 for floor and 1.79 for chair dusts). Ergosterol levels in floor dust were significantly associated with epidemiologic asthma independent of culturable fungi (IQR-OR = 1.54-1.55).
  
  
  CONCLUSIONS
  Our findings extend the 2004 conclusions of the Institute of Medicine [Human health effects associated with damp indoor environments. In: Damp Indoor Spaces and Health. Washington DC:National Academies Press, 183-269] by showing that mold levels in dust were associated with new-onset asthma in this damp indoor environment. Hydrophilic fungi and ergosterol as measures of fungal biomass may have promise as markers of risk of building-related respiratory diseases in damp indoor environments.
authors.affiliation: Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Morgantown, WV 26505, USA. gzp8@cdc.gov
authors.forename: Ju-Hyeong
authors.initials: JH
authors.lastname: Park
authors.forename: Jean M
authors.initials: JM
authors.lastname: Cox-Ganser
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kreiss
authors.forename: Sandra K
authors.initials: SK
authors.lastname: White
authors.forename: Carol Y
authors.initials: CY
authors.lastname: Rao
mesh_terms: D000393:Air Pollutants / Q000032:analysis*; D016902:Air Pollution, Indoor / Q000032:analysis*; D000485:Allergens / Q000032:analysis; D001249:Asthma / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D015169:Colony Count, Microbial; D004391:Dust / Q000032:analysis; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D004875:Ergosterol / Q000032:analysis*; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis*; D014867:Water
chemical_list: D000393:Air Pollutants; D000485:Allergens; D004391:Dust; D014867:Water; D004875:Ergosterol