Human impairment from living near confined animal (hog) feeding operations.

PROBLEM: To determine whether neighbors around manure lagoons and massive hog confinement buildings who complained of offensive odors and symptoms had impaired brain and lung functions. METHOD: We compared near hog manure neighbors of lagoons to people living beyond 3 kilometers in Ohio and to unexposed people controls in a nearby state for neurophysiological, cognitive, recall and memory functions, and pulmonary performance. RESULTS: The 25 exposed subjects averaged 4.3 neurobehavioral abnormalities, significantly different from 2.5 for local controls and 2.3 for Tennessee controls. Exposed subjects mean forced vital capacity and expiratory volume in 1 sec were reduced significantly compared to local and regional controls. CONCLUSIONS: Near neighbors of hog enclosures and manure lagoon gases had impaired neurobehavioral functions and pulmonary functions and these effects extended to nearby people thought to be controls. Hydrogen sulfide must be abated because people living near lagoons cannot avoid rotten egg gas.

A water-damaged home and health of occupants: a case study.

A family of five and pet dog who rented a water-damaged home and developed multiple health problems. The home was analyzed for species of mold and bacteria. The diagnostics included MRI for chronic sinusitis with ENT and sinus surgery, and neurological testing for neurocognitive deficits. Bulk samples from the home, tissue from the sinuses, urine, nasal secretions, placenta, umbilical cord, and breast milk were tested for the presence of trichothecenes, aflatoxins, and Ochratoxin A. The family had the following diagnosed conditions: chronic sinusitis, neurological deficits, coughing with wheeze, nose bleeds, and fatigue among other symptoms. An infant was born with a total body flare, developed multiple Cafe-au-Lait pigmented skin spots and diagnoses with NF1 at age 2. The mycotoxins were detected in bulk samples, urine and nasal secretions, breast milk, placenta, and umbilical cord. Pseudomonas aueroginosa, Acinetobacter, Penicillium, and Aspergillus fumigatus were cultured from nasal secretions (father and daughter). RT-PCR revealed A. fumigatus DNA in sinus tissues of the daughter. The dog had 72 skin lesions (sebaceous glands and lipomas) from which trichothecenes and ochratoxin A. were detected. The health of the family is discussed in relation to the most recent published literature regarding microbial contamination and toxic by-products present in water-damaged buildings.

Low-level hydrogen sulfide and central nervous system dysfunction.

Forty-nine adults living in Lovington, Tatum, and Artesia, the sour gas/oil sector of Southeastern New Mexico, were tested for neurobehavioral impairment. Contributing hydrogen sulfide were (1) an anaerobic sewage plant; (2) two oil refineries; (3) natural gas/oil wells and (4) a cheese-manufacturing plant and its waste lagoons. Comparisons were to unexposed Wickenburg, Arizona, adults. Neurobehavioral functions were measured in 26 Lovington adults including 23 people from Tatum and Artesia, New Mexico, and 42 unexposed Arizona people. Participants completed questionnaires including chemical exposures, symptom frequencies and the Profile of Mood States. Measurements included balance, reaction time, color discrimination, blink reflex, visual fields, grip strength, hearing, vibration, problem solving, verbal recall, long-term memory, peg placement, trail making and fingertip number writing errors (FTNWE). Average numbers of abnormalities and test scores were adjusted for age, gender, educational level, height and weight, expressed as percent predicted (% pred) and compared by analysis of variance (ANOVA). Ages and educational attainment of the three groups were not statistically significantly different (ssd). Mean values of Lovington residents were ssd from the unexposed Arizona people for simple and choice reaction times, balance with eyes open and closed, visual field score, hearing and grip strength. Culture Fair, digit symbol substitution, vocabulary, verbal recall, peg placement, trail making A and B, FTNWE, information, picture completion and similarities were also ssd. The Lovington adults who averaged 11.8 abnormalities were ssd from, Tatum-Artesia adults who had 3.6 and from unexposed subjects with 2.0. Multiple source community hydrogen sulfide exposures impaired neurobehavioral functions.

Isolation of sulfur reducing and oxidizing bacteria found in contaminated drywall.

Drywall from China has been reported to release sulfur producing products which are corrosive to metals, result in noxious odors, and represent a significant health risk. It has been reported that these emissions produce medical symptoms such as respiratory or asthma type problems, sinusitis, gastrointestinal disorders, and vision problems in home owners and their household pets. We report here a method of identifying a causative agent for these emissions by sampling affected gypsum wallboard and subjecting those samples to Real Time Polymerase Chain Reaction [RT-PCR] studies. Specific DNA probes and primers have been designed and patented that detect a specific iron and sulfur reducing bacterium (i.e., Thiobacillus ferrooxidans). One hundred percent of affected drywall samples obtained from homes located in the southeastern United States tested positive for the presence of T. ferrooxidans. All negative controls consisting of unaffected wallboard and internal controls, Geotrichum sp., tested negative within our limits of detection.

Do terbutaline- and mold-associated impairments of the brain and lung relate to autism?

Increased prevalence of the autism spectrum disorders (ASD) and the failure to find genetic explanations has pushed the hunt for environmental causes. These disorders are defined clinically but lack objective characterization. To meet this need, we measured neurobehavioral and pulmonary functions in eight ASD boys aged 8 to 19 years diagnosed clinically and compared them to 145 unaffected children from a community with no known chemical exposures. As 6 of 35 consecutive mold/mycotoxin (mold)-exposed children aged 5 to 13 years had ASD, we compared them to the 29 non-ASD mold-exposed children, and to the eight ASD boys. Comparisons were adjusted for age, height, weight, and grade attained in school. The eight ASD boys averaged 6.8 abnormalities compared to 1.0 in community control boys. The six mold-exposed ASD children averaged 12.2 abnormalities. The most frequent abnormality in both groups was balance, followed by visual field quadrants, and then prolonged blink reflex latency. Neuropsychological abnormalities were more frequent in mold-exposed than in terbutaline-exposed children and included digit symbol substitution, peg placement, fingertip number writing errors, and picture completion. Profile of mood status scores averaged 26.8 in terbutaline-exposed, 52 in mold exposed, and 26 in unexposed. The mean frequencies of 35 symptoms were 4.7 in terbutaline, 5.4 in mold/mycotoxins exposed and 1.7 in community controls.

Neurobehavioral and pulmonary impairment in 105 adults with indoor exposure to molds compared to 100 exposed to chemicals.

Patients exposed at home to molds and mycotoxins and those exposed to chemicals (CE) have many similar symptoms of eye, nose, and throat irritation and poor memory, concentration, and other neurobehavioral dysfunctions. To compare the neurobehavioral and pulmonary impairments associated with indoor exposures to mold and to chemicals. 105 consecutive adults exposed to molds (ME) indoors at home and 100 patients exposed to other chemicals were compared to 202 community referents without mold or chemical exposure. To assess brain functions, we measured 26 neurobehavioral functions. Medical and exposure histories, mood states score, and symptoms frequencies were obtained. Vital capacity and flows were measured by spirometry. Groups were compared by analysis of variance (ANOVA) after adjusting for age, educational attainment, and sex, by calculating predicted values (observed/predicted x 100 = % predicted). And p < .05 indicated statistical significance for total abnormalities, and test scores that were outside the confidence limits of the mean of the percentage predicted. People exposed to mold had a total of 6.1 abnormalities and those exposed to chemicals had 7.1 compared to 1.2 abnormalities in referents. Compared to referents, the exposed groups had balance decreased, longer reaction times, and blink reflex latentcies lengthened. Also, color discrimination errors were increased and visual field performances and grip strengths were reduced. The cognitive and memory performance measures were abnormal in both exposed groups. Culture Fair scores, digit symbol substitution, immediate and delayed verbal recall, picture completion, and information were reduced. Times for peg-placement and trail making A and B were increased. One difference was that chemically exposed patients had excess fingertip number writing errors, but the mold-exposed did not. Mood State scores and symptom frequencies were greater in both exposed groups than in referents. Vital capacities were reduced in both groups. Neurobehavioral and pulmonary impairments associated with exposures to indoor molds and mycotoxins were not different from those with various chemical exposures.

Effects of onboard insecticide use on airline flight attendants.

Flight attendants (FAs) exposed to insecticide spray in an aircraft were compared with unexposed subjects for neurobehavioral function, pulmonary function, mood states, and symptoms. The 33 symptomatic FAs were self-selected, and 5 had retired for disability. Testing procedures included balance, reaction time, color discrimination, visual fields, grip strength, verbal recall, problem solving, attention and discrimination functions, and long-term memory functions. Measurements were expressed as a percentage of their predicted values (derived from unexposed controls), and the author compared the means of the percentage predicted values by analysis of variance. Symptom frequencies and Profile of Mood States (POMS) scores were assessed. FAs were significantly more impaired than controls with respect to balance with eyes closed, grip strength, and color discrimination. Nearly half had 3 or more abnormal neurobehavioral functions, after adjustment was made for age, sex, and education level. Neither elevated POMS scores nor frequencies of average symptoms correlated with their numbers of abnormal measurements. Occupational exposure to synthetic pyrethrin insecticides on airliners was associated with neurobehavioral impairment and disability retirement.

Brain but not lung functions impaired after a chlorine incident.

A workplace bleach exposure incident was studied in 13 women to determine whether chlorine caused neurobehavioral and pulmonary functional effects. We compared neurophysiological and neuropsychological measurements in 13 chlorine-exposed women, 4.5 years after exposure, and 41 unexposed women. Reaction times, balance, blink reflex latency, color discrimination and several psychological tests were measured. Pulmonary function was assessed by spirometry. A profile of mood states and frequencies of 35 symptoms were obtained. Chlorine exposed women performed statistically significantly below unexposed women for simple and choice reaction times, balance with eyes open and eyes closed, color discrimination, grip strength, Culture Fair, digit symbol substitution, vocabulary, trail making B and pegboard. Profile of mood states scores and frequency symptoms were elevated. Respiratory symptoms were elevated but pulmonary volumes and flows were not reduced. Chlorine bleach exposure was associated with impaired neurobehavioral functions and elevated POMS scores and symptom frequencies. Alternatives to chlorine should be used.

Stop inhaling smoke: prevent coronary heart disease.

Acute myocardial infarction (AMI) was rare a century ago and was diagnosed in few living patients prior to 1925. By 1950, it was the most common heart problem seen by clinicians. Thought at first to have been overlooked, there were many explanations offered for its neglect. Smoking, hypertension, and elevated cholesterol are associated with AMI, but of these only smoking should be considered a cause. Hypertension and hypercholesterolemia may be co-effects, perhaps of inflammation stimulated in the lung and blood vessels by smoking and air pollution, thus affecting vessels and arteries subjected to systemic blood pressure. Air pollution--the 20th century's other "big smoke"--deserves consideration as a 2nd cause. Auto exhaust blankets the world's cities. It consists of smoke and other effluents of petroleum vaporization and combustion that emanate from the crankcases and exhaust pipes of trucks and automobiles. The major living spaces (conurbations) of the world now imitate and exceed Los Angeles in their levels of air pollution. Auto exhaust gases fit the timeline, and their increasing amounts parallel the worldwide rise in coronary heart disease. Increasing doses of these chemicals imitate cigarette smoke and stimulate inflammation in the lungs. They appear to be absorbed into the blood, where they cause inflammation in blood vessels, increased blood pressure, and clogged coronary arteries. Avoidance is the obvious solution. Quit inhaling cigarette smoke and motor vehicle exhaust. The benefits have been shown and can be proved by intervention. The quest for clean air is hygienic-like avoiding water contaminated with feces was 150 yr ago. Clear air must be made a moral right. Its attainment requires a major revolution in priorities for energy use and lifestyle. Two types of smoke must be avoided. The world's most lethal disease.

Effects of hydrogen sulfide on neurobehavioral function.

BACKGROUND: Nineteen hydrogen sulfide (H2S)-exposed patients were compared with 202 unexposed subjects. This 1997-to-2001 case-referent series was compared with 16 previous (1991-1996) case-referent patients. METHODS: New patients were bystanders of H2S exposure and none had been unconscious. In contrast, 13 members of the prior group were exposed at work and 7 had been unconscious. The three groups were compared on the basis of 8 physiologic and 12 psychological measurements. Observed measurements were compared with predicted ones after adjusting for age, sex, educational attainment (years), and other significant factors (observed/predicted x 100). RESULTS: The new group performed poorly compared with unexposed controls and were similar to the first group on balance, reaction time, color discrimination, visual performance, hearing, Culture Fair, digit symbol, vocabulary, verbal recall, peg placement, trail making A and B, and information. CONCLUSION: H2S impairments associated with H2S were similar in 19 workers (44% had been unconscious) and in 16 bystanders who had not been unconscious.

Effects of chlorine and its cresylate byproducts on brain and lung performance.

Chlorine and potassium cresylate spilled from a train wreck forced evacuation of nearly 1000 people in and near the town of Alberton, Montana, in 1996. Because respiratory and other symptoms persisted in this population, neurobehavioral and pulmonary functions were evaluated in a cohort of exposed vs. unexposed individuals. Ninety-seven subjects were tested 7 wk after exposure. Three years later, 36 of the original subjects were retested, along with 21 new patients exposed in the same incident. These 57 were compared with 22 unexposed individuals. Twenty-six neurobehavioral functions were tested, and spirometry was performed on each subject. At 7 wk postexposure, patients showed significant differences in 5 neurobehavioral functions (i.e., balance, simple reaction time, abnormal visual quadrants, vocabulary, and information), compared with the unexposed individuals recruited in 1999. Patients' Profile of Mood States scores and frequencies of 35 symptoms were also elevated, compared with the unexposed group. At 3 yr postexposure, patients exhibited differences in 7 additional neurobehavioral functions (i.e., choice reaction time, balance with eyes open, color errors, visual fields, Culture Fair, and verbal recall). Respiratory symptoms were increased, but pulmonary functions did not change. Exposure to chlorine and potassium cresylate produced neurobehavioral impairments that have been observed to increase across 3 yr. Spills in heavily populated areas could injure thousands, overwhelming medical facilities.

Summary of the 5th International Conference on Bioaerosols, Fungi, Bacteria, Mycotoxins, and Human Health.

Risk assessment of bioaerosols indoors has been summarized in terms of human health effects (e.g., allergy, infection, and irritation), but neurotoxicity has been a topic of heated debate . However, this debate has been resolved rather clearly by evidence presented at this conference (and at the 21st Annual International Symposium on Man and His Environment in Health and Disease, Dallas, Texas, June 2003) which showed that neurotoxicity, as well as pulmonary and immune dysfunction, can result from exposure to molds in the indoor environment. Toxicity is apparent, and confirming studies are being published. For more information regarding the conference, visit . For details on the research summarized herein, please contact the presenting authors via their e-mail addresses. This reference system should aid in the dissemination of information that is current but not yet published.

Indoor mold exposure associated with neurobehavioral and pulmonary impairment: a preliminary report.

Recently, patients who have been exposed indoors to mixed molds, spores, and mycotoxins have reported asthma, airway irritation and bleeding, dizziness, and impaired memory and concentration, all of which suggest the presence of pulmonary and neurobehavioral problems. The author evaluated whether such patients had measurable pulmonary and neurobehavioral impairments by comparing consecutive cases in a series vs. a referent group. Sixty-five consecutive outpatients exposed to mold in their respective homes in Arizona, California, and Texas were compared with 202 community subjects who had no known mold or chemical exposures. Balance, choice reaction time, color discrimination, blink reflex, visual fields, grip, hearing, problem-solving, verbal recall, perceptual motor speed, and memory were measured. Medical histories, mood states, and symptom frequencies were recorded with checklists, and spirometry was used to measure various pulmonary volumes and flows. Neurobehavioral comparisons were made after individual measurements were adjusted for age, educational attainment, and sex. Significant differences between groups were assessed by analysis of variance; a p value of less than 0.05 was used for all statistical tests. The mold-exposed group exhibited decreased function for balance, reaction time, blink-reflex latency, color discrimination, visual fields, and grip, compared with referents. The exposed group's scores were reduced for the following tests: digit-symbol substitution, peg placement, trail making, verbal recall, and picture completion. Twenty-one of 26 functions tested were abnormal. Airway obstructions were found, and vital capacities were reduced. Mood state scores and symptom frequencies were elevated. The author concluded that indoor mold exposures were associated with neurobehavioral and pulmonary impairments that likely resulted from the presence of mycotoxins, such as trichothecenes.

Is neurotoxicity associated with environmental trichloroethylene (TCE)?

Individuals who lived near 2 electronic manufacturing plants were exposed to odorous chlorinated solvents by inhalation (directly) and by out gassing from well water. An exposure zone was defined by concentrations of trichloroethylene, 1,1,1-trichloroethane, tetrachloroethylene, and vinyl chloride in groundwater. The author adopted trichloroethylene as a "shorthand" for the exposure designation. Residents complained of impaired recall and concentration, and of dizziness; therefore, the focus of this investigation was brain functions. Neurobehavioral functions, Profile of Mood States, frequencies of 35 symptoms, and questionnaire responses provided by 236 residents from exposure zones were compared with responses provided by 161 unexposed regional referents and by 67 Phoenix residents who lived outside the exposure zone areas. Pulmonary functions were measured with spirometry. Residents of the exposure zones were compared with regional referents, and the former had significantly (p < .05) delayed simple and choice reaction times, impaired balance, delayed blink reflex latency R-1, and abnormal color discrimination. In addition, these individuals had impaired (1) cognitive functions, (2) attention and perceptual motor speed, and (3) recall. Individuals who lived in exposure zones had airway obstructions. Adverse mood state scores and frequencies of 33 of 35 symptoms were elevated. In conclusion, individuals who lived in the exposure zones had neurobehavioral impairments, reduced pulmonary functions, elevated Profile of Mood State scores, and excessive symptom frequencies.

Do duration of exposure, proximity to electronic manufacturing plants, and involvement in a lawsuit affect chlorinated solvent toxicity?

The author examined the effects of duration of residence, proximity to microchip plants, and being a party in litigation involving neurobehavioral functioning in individuals who had been chronically exposed to trichloroethylene-associated solvents from the environment. The author compared duration of exposure for the 236 residents, all of whom were located in 3 proximity zones in Phoenix, Arizona; some of the individuals had been in the process of solvent-related litigation for fewer than 10 yr, whereas some had been involved for more than 10 yr. The 236 residents were compared with 58 nonclaimants in 3 residential areas within the exposure zones. Neurobehavioral function testing was described in the study that appears prior to this study in this issue. Prior to comparisons, test scores were adjusted for age, sex, education level, and other significant factors. Individuals who had been exposed for fewer than 10 yr were not different from individuals who had been exposed for longer periods. Proximity to microchip plants produced no statistically significant effects. Among the 169 exposed subjects (i.e., exposure for 15 yr to trichloroethylene-associated solvents), of whom some were parties in lawsuits, those who lived in the near west area (Zone A) of Phoenix did not differ with respect to results of the 14 neurobehavioral tests that were administered. However, Zone B subjects, located to the north of the plant, differed with respect to 2 of the tests; and Zone C subjects, located beyond Zone A, Phoenix, differed with respect to 3 of the tests. In conclusion, duration of residence, proximity to microchip plants, and being a party to a lawsuit had no significant effects on neurobehavioral functioning, but, in this study, parties in the lawsuit were subjects who experienced more frequent symptoms.