Update on Stachybotrys chartarum—Black Mold Perceived as Toxigenic and Potentially Pathogenic to Humans

Abstract

In nature, there are many species of fungi known to produce various mycotoxins, allergens and volatile organic compounds (VOCs), as well as the commonly known etiological agents of various types of mycoses. So far, none of them have provoked so much emotion among homeowners, builders, conservators, mycologists and clinicians as Stachybotrys chartarum. This species compared to fungi of the genera Fusarium and Aspergillus is not as frequently described to be a micromycete that is toxigenic and hazardous to human and animal health, but interest in it has been growing consistently for three decades. Depending on the authors of any given review article, attention is focused either on the clinical aspects alongside the role of this fungus in deterioration of biomaterials, or aspects related to its biology, ecology and taxonomic position. On the one hand, it is well established that inhalation of conidia, containing the highest concentrations of toxic metabolites, may cause serious damage to the mammalian lung, particularly with repeated exposure. On the other hand, we can find articles in which authors demonstrate that S. chartarum conidia can germinate and form hyphae in lungs but are not able to establish an effective infection. Finally, we can find case reports that suggest that S. chartarum infection is linked with acute pulmonary hemorrhage, based on fungal structures recovered from patient lung tissue. New scientific reports have verified the current state of knowledge and note that clinical significance of this fungus is exceedingly controversial. For these reasons, understanding S. chartarum requires reviewing the well-known toxigenic features and harmful factors associated with this fungus, by gathering the newest ones into a coherent whole. The research problem related to this fungus seems to be not overly publicized, and there is still a demand to truthfully define the real threats of S. chartarum and phylogenetically related species. The most important problem, which should be fully elucidated as soon as possible, remains the clarification of the pathogenicity of S. chartarum and related species. Maybe it is urgent time to ask a critical question, namely what exactly do we know 28 years after the outbreak of pulmonary hemorrhage in infants in Cleveland, Ohio, USA most likely caused by S. chartarum?

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“…In indoor air, impurities are inflated compared to outdoor air wherein the content of every breath differs from the next [ 4 , 47 ]. In forested and green environments, the air contains a diverse microbiota.…”

Medizinisch klinische Diagnostik bei Schimmelpilzexposition in Innenräumen – Update 2023 (AWMF-Register-Nr. 161/001)

“…Zum jetzigen Zeitpunkt ist es nicht gerechtfertigt, zwischen pulmonalen Hämorrhagien und dem Vorhandensein von Schimmelpilzen im Innenraum einen kausalen Bezug herzustellen [356]. Nichtsdestoweniger kann eine gewisse Assoziation nicht ausgeschlossen werden [371,372]. Bei Kindern mit AIPH wird empfohlen, anamnestisch nach Feuchtigkeit/Schimmel zu fragen [96,128].…”

AWMF mold guideline “Medical clinical diagnostics for indoor mold exposure” – Update 2023 AWMF Register No. 161/001

“…At the present time, it is not justified to establish a causal relationship between pulmonary hemorrhages and the presence of indoor mold [ 369 ]. Nevertheless, a certain association cannot be excluded [ 127 , 154 ]. In children with AIPH, it is recommended to ask if there is a history of moisture/mold [ 108 , 437 ].…”