BIOTOXINS IN THE ENVIRONMENT: A Case Study

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BIOTOXINS IN THE ENVIRONMENT A Case Study

• Jyl Burgener
• M.S., M.B.A.,RBP,CBSP

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Topics for Discussion

• Background on biotoxins and organisms known to
  produce them
• Case histories including treatment regimes
• Outcomes
• Literature on subject of biotoxins in indoor
  environments

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Definition of Biotoxin

• A biotoxin is any toxin produced by a living
  organism (plant, animal, fungus, bacteria).

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Biotoxin Production Varies

• Many Genera make some toxins, many Genera make
  multiple toxins (e.g. Penicillium may produce
  more than 100 different mycotoxins may vary
  according to specific isolate and prevailing
  growth conditions).

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Biotoxins can be Highly Potent
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Toxin Producers

• Dinoflagellates Pfiesteria, Ciguatera,
• Fungi Stachy botyrs, Fusarium,
• Bacteria Pseudonomas fluorescens
• Spirochetes Borrelai (Lyme disease)
• Blue-Green Algae - Microcystis

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Pfiesteria piscicida

• In 1988, JoAnn Burkholder, PhD, an aquatic
  botanist at North Carolina State University
  discovered pfiesteria piscicida and pioneered
  much of the early scientific research on fish
  kills in North Carolina's Neuse River and Pamlico
  Sound.

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Pfiesteria piscicida

• Researchers in the NC State lab of Dr. JoAnn
  Burkholder quickly found that Pfiesteria toxins
  cause neurological symptoms, including memory
  loss, disorientation, and speech impediments. One
  researcher had to be hospitalized before adequate
  laboratory precautions were worked out.

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Pfiesteria piscicida

• Pfiesteria piscicida has been implicated in
  about 30 percent of all fish kills in North
  Carolina. Some experts say the appearance of
  toxic algal blooms, also known as red tides, is
  increasing along the East Coast, perhaps due to
  greater pollution from river runoff, killing
  millions of fish every year.

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Pfiesteria piscicida

• At Duke University, researcher Edward Levin, PhD,
  has linked pfiesteria to learning problems in
  rats.
• Pfiesteria has become a big problem in waters
  having low oxygen levels and high nutrient loads
  caused by sewage discharges and agricultural
  runoff. (MD, FL)

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Visual Contrast Sensitivity (VCS)

• VCS has been a sensitive indicator of
  neurotoxicity induced by organic solvents.
  Persistent or permanent VCS deficits in the
  presence of normal visual acuity have been
  observed in styrene and mixed-solvent exposed
  workers in the absence of detectable optical,
  retinal or optic nerve head pathology.

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Visual Contrast Sensitivity (VCS)

• Ken Hudnell (neurotoxicologist) was the first
  to use VCS to measure the effects of biotoxin
  exposure and heavy metal toxicity or as a marker
  for neurotoxic exposures like Pfiesteria.

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Visual Contrast Sensitivity (VCS)

• VCS testing has also revealed neurologic
  deficits associated with exposure to toxic
  Pfiesteria sp. and other biotoxins ( Ciguatera
  (Chronic Ciguatera Seafood Poisoning),
  cyanobacteria such as Cylindrospermopsis and
  Microcystis, various species of fungi such as
  Stachybotrys, Aspergillus, Penicillium, and
  Fusarium, and Brown Recluse spider venom as well
  as Borrelia burgdorferi (Lyme disease organism) .

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Stachybotrys chartarum (S. atra)

• Produces numerous compounds
• Trichothecene mycotoxins implicated in health
  effects
• These included macrocyclic trichothecense
  verrucarins B and J, riridin E. satratoxins F, G,
  H and isisatratoxins F, G H

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BioMarkers

• Genotype HLA-DR found in 20 of population
  and 90 of patients developing chronic Lyme
  disease and chronic ciguatera poisoning.
• People who cannot naturally eliminate biotoxins
  develop chronic illness.

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Two Case Studies from One Building Location

• 30 year old building with almost a 30 year
  history of Sick Building Syndrome
• No vapor barrier on outside wall of building
• Slanted external wall, internal straight
  wallboard and heating registers which were slanted

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Reported Symptoms (Cumulative)

• Headache
• chronic sinus congestion
• Irritated eyes (redness of eyes)
• Allergic Rhinitis, HP
• Hoarseness, sore throat
• Muscle ache, fatigue
• Cognitive dysfunction (memory loss, slow
  thinking)

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Details of Chronic Exposure

• Caucasian female age 53 years previous
  history of chemical sensitivity to
  organosulfur-containing chemicals
• Assigned to building February 22, 2003
• Time in building approximately 12 months with
  symptoms beginning in 7 months
• Symptom development and progression severe
  headaches, fatigue, irritated eyes, respiratory
  irritation, progressed to difficulty breathing,
  frequent severe headaches, muscle / body
  soreness, fibermyalgia (diagnosed through
  neurological testing by physician), cognitive
  impairment
• Final Removal from building March 5, 2004

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Details of Chronic Exposure

• Following removal of building, lesser severity
  but symptoms persisted
• Following first CSM treatment approximate 50
  removal of symptoms
• Following second CSM treatment - additional 30
• Following third CSM treatment additional
  increment (10)
• Total of 90 as measured on pain index scale and
  also respiratory capacity.
• Visual acuity to pre-exposure levels after third
  treatment

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Details of Acute Exposure

• 49 year old caucasian woman previous history of
  pollen, formaldehyde, and bee sting allergies
• Exposed to visible pockets of mold in various
  locations of building (series of exposure)
• Initially felt pin pricks on skin
• Developed cognitive impairment, loss of memory of
  recent events, difficulty in assimilating new
  knowledge, difficulty in abstract handling of
  numbers, problems with word finding in
  conversation, confusion, difficulty sustaining
  concentration, disorientation, slow thinking

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Details of Acute Exposure

• Following removal of from exposure, lesser
  severity but symptoms persisted
• Following first CSM treatment approximate 80
  removal of symptoms
• Following second CSM treatment - additional
  10-20 of symptoms

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Outcomes of Case Study

• Stachybotyrs positively identified.
• Both women removed from building, but their
  specific symptoms (slightly lessened) continued.
• Both women took VCS test and were found to be
  positive.
• Both women convinced separate personal physicians
  to prescribe CSM
• CSM treatments were found to relieve symptoms

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Recent Publication

• Guidance for Clinicians on the Recognition and
  Management of Health Effects Related to Mold
  Exposure and Moisture Indoors
• University of Connecticut Health Center, Div. of
  Occ. And Environ. Medicine, Farmington, CT Sept.
  30, 2004 (Developed under cooperative agreement
  by EPA)

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NIH Review on Moldy Environments and Health
Effects (2002-2004)

• May 2004 final report . Review found
  sufficient evidence of an association between
  indoor mold and upper respiratory symptoms,
  asthma symptoms in sensitized persons, HP in
  susceptible persons and suggestive evidence of
  association with respiratory illness in healthy
  children.

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NIH Review on Moldy Environments and Health
Effects (2002-2004)

• Currently insufficient info to establish an
  association with
• Development of asthma
• Acute idiopathic pulmonary hemorrhage in infants
• Skin symptoms
• Neuropsychiatric Symptoms

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Summary

• Evidence is building on the causal relationship
  of biotoxin exposure, health impacts, and
  possible treatment modalities.
• More epidemiological studies needed to examine
  populations for these effects and causal
  relationships.

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Putting the Pieces Together
Biotoxin
VCS
Stachy Botyrs
Pfiesteria
HLA-DR