Week of June 10, 2024

1/ Cross contamination, Aspergillus Penicillioides

Q: In an effort to avoid re-exposure I have moved several times with each sequential HERTSMI-2 score showing increasing levels of Aspergillus penicillioides. Should I simply discard my belongings?

A: Aspergillus penicillioides is routinely observed in indoor environments with water saturation between 80% and 90% in areas of reduced ventilation. What this means is that the areas of greatest concern will be leaks in closets, in cabinets and underneath as well

as rooms that are not well ventilated. It is more likely to me that the contamination that you are experiencing is due to water damage in the home as opposed to simple cross contamination where we would expect a greater diversity of organisms in addition to Aspergillus penicillioides. First, set about finding the root of the contamination. If moisture leak/s or water damage is identified, then correcting it is required as well as CIRS-safe remediation of the home, air purification systems, plus improved ventilation. will provide the necessary fix for contaminated water damaged buildings.

I would suggest that you take a look on this site at the reports and the opinions of well-respected experts (Michael Pinto and Greg Weatherman) regarding proper building remediation. There are numerous discussions in both of my books, Surviving Mold and Mold Warriors that may also be of benefit. I will also refer you to the Consensus Statement on Remediation available on this site.

The Surviving Mold Membership & List Serve Q&A Volumes also provide in-depth answers to remediation questions.

See the links provided below.

Recommended Resources on Remediation and Rigorous Cleaning:

The 2021 Indoor Environmental Consensus Statement on Remediation

The Membership & List Serve Q&A Volumes available on Surviving Mold website

The Rigorous Spring Cleaning Checklist Article

https://www.survivingmold.com/legal-resources/community/cirs-spring-cleaning-checklist

The Condensed Remediation Plan by AerobioLogical Solutions Inc

https://www.survivingmold.com/docs/CondensedRemediationPlan_v2-1.pdf

The AerobioLogical Solutions Remediation Investigation Report by environmental expert Greg Weatherman. This report provides images and citations to help determine the safety, culprits and causes of possible water damage in a home including basement areas.

https://www.survivingmold.com/docs/REPORTSHOEMAKER.PDF

Environmental expert Greg Weatherman is available for consults at survivivingremediation.com.

The House Hunting with CIRS Guide (includes contact info):  

This compact guide contains 30 critical observations, compiled by qualified environmental and medical professionals, to evaluate individual and multi-family buildings. Multiple pictures provide examples of water damage that are frequently overlooked. Contact information for environmental experts, with extensive knowledge and experience with CIRS, is included.

2/ Cross-contamination

Q: We have had professional inspectors identify conditions in our rental home that are typical of a water-damaged building. We have multiple questions on what to do including remediation, avoidance of cross contamination and access to treatment.

A: There are several resources on the Surviving Mold website devoted to remediation issues. See the above question for resources to get you started.

In addition, there are several chapters in both of my books, Mold Warriors and Surviving Mold, dedicated to these questions.

The important issue in avoidance of cross contamination is to recognize that the particulates from the air of the water-damaged building that you transfer on your possessions will make you sick in the new building just like they can make you sick in the old building. As such, removal of these particulates before the move is mandatory.

Porous materials, such as textiles and fabric used in upholstery and curtains, as well as carpeting, have never been confirmed to be successfully cleaned by any technique. No  one will say, “Save the sofa or the rug,” without creating the risk of cross contamination.

Literature on this vitally important topic is scanty at best but you should be prepared to reupholster furniture or to sell porous materials. Non-porous materials can be HEPA vacuumed after having been wiped down outside of the old residence. Then the item can be moved successfully. Any cellulose materials including photographs and books are problematic. Discarding some of these possessions

is painful for most of us.

The vast bulk of cleaning possessions is something I personally think anyone can do provided time is available. I feel that if you want a job done right, do it yourself, as opposed to paying someone thousands of dollars when they don’t have the same vested interest as keeping you healthy as you might.

3/ Cross contamination from filing cabinet contents

Q: I am moving my possessions from my moldy office to storage. I rarely use filing cabinets any more but have many documents that could have been exposed to particulates in the air.

My suggestion is to have the documents copied in an open air environment when you need them but to box the bulk of such documents in sealed plastic containers, keeping them out of your breathing spaces until such time as you need them copied.

Also see the recommended remediation resources above.

4/  Biological supplements

Q: I have confirmed that I have CIRS as evidenced by exposure to a water-damaged building with visible mold in the basement for the past 20 years. I am HLA DR 4-3-53, with MSH of 9 and (+) visual contrast sensitivity. I have tried to take biological supplements including blue green algae, Cordyceps (mushrooms), Reishi fruiting

bodies (spores) Maitake fruiting bodies (more spores), Lions Mane and Chlorella. Understanding that I need cholestyramine, could the supplements actually be hurting me?

A: The source of inflammation found in CIRS comes from inhalation and not from ingestion. While I worry about blue green algae being contaminated with Microcystis, I have seen no data showing adverse health affects from use of algae-based products like Chlorella or Spirulina. Similarly, the dietary ingestion of fungi, including spores, as well as fermented products, cheeses, beer and bread for example, are not ones that I have any data to show injury. I certainly have spoken to patients who feel they are worsened by eating bread or fermented cheeses or mushrooms, for example, but once again there are no clinical trials showing adverse health effects (note: I am not talking about gluten here). Chlorella has been the subject of prior questions and once again we have no data showing benefit or no data showing worsening. It would be instructive once you are out of a moldy environment and your health is restored by using our published protocols for you to do diagnostic re-exposures, one at a time, with these supplements to determine whether they are helping you or not. When multiple interventions are done simultaneously you lose the ability to apply scientific principles and logic to assessment of benefit/worsening.

5/ Borax for washing clothes

Q: I have read that Borax is useful to wash clothes that were exposed to the interior environment of water-damaged buildings. Unfortunately, I have also read that Borax may be toxic and has no effect on mycotoxins.

A: Greg Weatherman has presented data at the March 2013 EPA/Hurricane Sandy meetings showing benefit of borax used in a fine aerosol fogging solution to help clear particulates smaller than 0.3 microns out of air. Note, in this case, Borax is used in a solution with the purpose of air fogging. The use of Borax as a cleaner in order to remove mold has been shown to be ineffective for a few reasons, including it doesn’t target the root of the problem or the circulating biotoxin fragments. At best, as a cleaner it is used to only wipe away fragments on surface areas.  Ammonia-based cleaners like Fantastic are shown to work best for maintenance cleaning of surfaces (after remediation, fogging, etc).

I am unable to give you any data that says washing clothes in Borax is safe or not. Over the years I have had people launder their clothes in regular laundry detergent as they are removed from a water-damaged building and the clothes have been safe to use. One very sensitive person washed her clothes in cholestyramine with good results though all her clothes looked like they had been marinated in a saffron solution.

While I don’t have information on finding Borax to be a general “toxin,” I have seen patients who have used Greg’s cleaning solution show marked improvement after the fogging solution when nothing that had been done before helped.

6/ Building testing, air sampling

Q: A physician writes, “I become ill following exposure to the interior environment of my new office. There is no evidence of water intrusion or history of microbial amplification. A CIH inspection concluded that all was fine. Eleven air samples were done with results given to me verbally that said all was well. Does this mean my office is safe?”

A: Please forward the actual reports of the air samples. What I expect to see after reading the reports is that to have spent as much time and money as your office manager did (easily $5000) and neglected to do ERMI or HERTSMI-2 is illogical. The problem with air

samples are that they are done for 5, sometimes 10 minutes, in the middle of a room without any mechanism to sample the air that is moving slowly along the edges of the room due to the “boundary” affects. An air sample does not rule out contamination as

cited in the 2009 World Health Organization report on wet buildings and the 2010 Experts Treating Physicians Consensus Report.

Air samples themselves can not possibly separate species of Aspergillus versus Penicillium; such speciation is mandatory. Further, air samples will never show Wallemia, a finding that I continue to find odd. Wallemia is notorious for causing illness due to its colonization of HVAC duct work, particularly fiberglass sections. Even more importantly, an air sample has no chance to show any contamination from fragments of biologic agents that are less than 3 microns in size. Multiple studies have shown that over 99% of the inflammagens and biotoxin burden found in bioaerosols in water damaged buildings are due to fragments (most are 0.45-0.60 microns) that simply pass through the very large pore size used to trap intact spores.

If you are being pressured to return to work I would suggest you do HERTSMI-2 testing using a Swiffer cloth (its use will avoid the undue notice that a vacuum cleaner would bring) at a total cost of $125. Your persistent multisystem, multisymptom illness with reexposure is one that carries more weight than a visual inspection by someone who refuses to use QPCR testing.

7/ C3a, Bartonella

Q: A physician writes, will C3a levels be elevated in other organisms of interest in tick borne disease such as Mycoplasma, Anaplasma, Bartonella and Babesia? Because Mycoplasma and Babesia are intracellular dwelling organisms, it is unlikely that they will present a significant bacterial membrane as a platform to provide for cleavage

of C3 thereby raising C3a. We have no data on C3a levels in Anaplasma.

A: The difficulty with confirmation of Bartonella is still a problem. In my mind the absence of reliable markers for the illness creates terrible problems for those trying to avoid assumptions. We are faced with using IgG and IgM studies from commercial laboratories with

unknown reliability. It is possible that Galaxy Labs will be bringing reliable tests to commercial use in the future. What these comments mean is that I can not tell you that Bartonella causes elevated C3a.

8/ Anti-inflammatory pathways, muscles

Q: Do muscles act as an endocrine gland to decrease inflammation?

A: The important regulators of inflammation remain the neuropeptides, MSH and VIP. These hormones will have a variety of effects on metabolic pathways and muscle; but muscle itself is not an endocrine gland. ACTH and cortisol are important mediators of inflammation as well, though under regulation of MSH and VIP, among others, but muscle effects are due to other hormones, including ACTH and cortisol.

9/ Aromatase

Q: How do aromatase and low MSH fit into fertility issues?

A: If we have up regulated aromatase due to inflammatory responses in CIRS, and this is incredibly common, we will see enhanced conversion of testosterone to estrone and then to estradiol. Such disruption of normal androgens can have fertility effects both on men and women. MSH has a significant role in regulation of LH and FSH, the gonadotrophins that regulate production of sex steroids. If there is evidence of abnormalities of FSH or LH, correction of MSH is a desired part of treatment.

10/ Aspergillus in sinuses, UV light

Q: I am diagnosed with having Aspergillus and Pseudomonas in my sinuses that are reportedly the triggers for my chronic bronchitis. I have read that UV light will be of benefit in eradicating these organisms. Do you know of a mechanism to deliver UV light to sinus conditions?

A: First, I hope that your culture was done of material obtained by sinus drainage and not from nasal aspiration. Obtaining material from sinuses is difficult; children often are given the inviting prospect of having sinus puncture done at the bed side. I cringe even talking about this. Endoscopy in adults can help to obtain pure sinus materials for staining, PCR and culture. There are a variety of fungi found in sinuses that can create a chronic rhinosinusitis (CRS) as work from David Sherris and his colleagues (who were at Mayo but now are at the State University of New York at Buffalo) have shown. Unfortunately, control patients in the early Mayo studies also had fungi found in sinuses. They key was to identify 21 interleukin 13 and IL-17 in sinuses related to colonization (not infection) from particular non toxin-forming species. Pseudomonads are gram negative bacteria that can be a very dangerous pathogen if in blood, soft tissue or lung. A study done years ago looking at nurses new to working in the ICU showed that they picked up nasal colonization of gram negative rods, including Pseudomonas, within one month of occupational exposure. What this means is that you need to be very careful saying that you have sinus infection with Pseudomonas versus simple nasal colonization. Similarly, finding a fungus in a nasal swab does not equate to having a fungal sinusitis. Thirdly, having fungi found inside sinuses does not necessarily convert over to a source of an ongoing fungal infection requiring antibiotics, at least according to the Mayo and SUNY data.

11/ Autism

Q: Do you have statistics regarding the prevalence of visual contrast sensitivity deficits in children with attention deficit and autism? I am a developmental optometrist. Also, is there a role to assess visual evoked potentials in these children?

A: To date, I have only evaluated 12 children with confirmed autism, understanding the case definition of autism is still based in psychiatric terms and not on objective biometric parameters. As far as attention deficit disorder goes, I see many children diagnosed with this condition but when the inflammatory burden placed on the blood brain barrier in the central nervous system by innate immune activation is cleared, the ADD disappears. It is therefore hard for me to answer your question. Simply stated, if attention deficit disorder is a catch-all diagnosis in which children are placed in part due to lack of consideration in underlying mechanisms, then how can we develop a meaningful pathophysiology? No physiology, no targeted cure. Dr. Norman Swartz sent me PAXgene tubes on two patients with autism. These assays will be run through the genomics program when funding is restored. Regarding visual evoked potentials I would more interested in pursing use of NeuroQuant in children as this would require 10 minutes of magnetic resonance imaging time and has provided a fingerprint showing physiologic disturbances in adults with mold. Here we will see distinctive fingerprints of microscopic interstitial edema in some areas of the brain and caudate atrophy. Similarly, with Lyme disease we see reduction of forebrain parenchyma size together with reduced putamen. Also, in Lyme we see increased cerebellum and increased thalamus size as well. If these disorders are similar in adults and children then we expect to find central nervous system changes that can be readily treated and documented as the course of treatment proceeds.

12/ Autoimmune response (see T regs)

Q: I have autoantibodies to gliadin and cardiolipins. My HLA is 1-5 and 13-6-52C. Are there other foodstuffs to which I may have autoantibodies? I am preparing to test my blood for antibodies to food.

A: The mechanism for autoimmune illness remains less well defined then what we might like. Specifically, we know that there is a tremendous importance of both high TGF beta1 and levels of T-regulatory cells that are too low that are important in the pathogenesis of autoimmunity. Normally, rising levels of TGF beta-1 will cause the migration of Tregulatory cells into tissue to suppress inflammation and suppress autoimmunity. In tissue, if the levels of the retinoic acid orphan receptor (ROR) are too low bad things will happen to our friends the T reg cells: they are converted to pathogenic T cells that make more TGF beta-1! The vicious cycle that is then created sets off the syndrome with elevated TGF beta-1 and low T regs. This tissue basis of uncontrolled inflammation is an additional burden for CIRS patients. There are problems with abnormal control mechanisms in autoimmune illness, particularly in CIRS, where we commonly find autoantibodies. Children, more than adults, will have autoimmune problems. In 2009 our group showed that (i) low dose losartan safely lowered TGF beta-1 and that (ii) lowered TGF beta-1 was accompanied by resolution of autoimmune defects. This study was flawed in that we did not have a good T-regulatory cell assay at that time. The mechanism of autoantibody production that we see most commonly involves antigliadin antibodies of the IgG class and anticardiolipins of the IgM class. There are other autoantibodies made to gliadin and cardiolipin. Separate from the issue from autoimmune problems are the concerns regarding antibodies to foods. This is an area of some controversy. I have seen lab results to show terrible food allergies when there is no clinical evidence of food allergy at all. I urge extreme caution in diagnosing food allergy in the absence of a diagnostic re-exposure trial. A special condition is Food Protein Induced Enterocolitis (FPIEC) which is now recognized as a CIRS. Together with (i) MSH deficiency-associated gliadin autoantibody positivity and (ii) true celiac disease, both of which also are CIRS, these three CIRS illnesses demand immediate attention in treatment as opposed to simple exclusion of foods. There illnesses are not an antibody illness; these are an autoantibody illness. There are a group of people with food intolerance, for example, most commonly to gluten, in which there is no autoantibody or antibody found. Patients simply can’t eat the given food safely. The reasonable, prudent physician will suggest that such foods not be consumed. Along with that avoidance of consumption, after a period of stability, approximately 3 months, a diagnostic re-challenge can be undertaken to follow inflammatory parameters appearing in blood following a reintroduction of the food stuff (usually gluten, diary, soy, corn) into the diet. If illness symptoms develop and inflammatory markers develop then there is no question that those foods most be avoided.