Hello, and welcome to The Mould Show. In this week's episode, we're going to be talking about something called building-related illness. Now, how does this differ from sick building syndrome? Well, watch on or listen, and I will explain what the differences are.
How I'm going to be approaching this episode is to drill in and make a deep dive into a recent publication which has connected the dots between an occupational hygiene survey, that is a mould assessment inside a home, and then the medical findings. This is for a family of five who lived in a water-damaged building for six years. I'm going to be describing a lot of the issues and problems and reasons for not only the building becoming wet, but how the medical practitioners were able to deal and assess with this particular family. I hope that this episode will be valuable for other people who might find themselves in similar situations where it's unavoidable that they continue living in a water-damaged building. This might help you put pressure on either your builder or the insurer to accelerate the remediation effort.
In any case, what we're talking about today is one family's experience with building-related illness. Now, this is a really important topic and to deal with this, we are going to jump in and I'm going to be reviewing the paper. Again, you will be able to get all of this in the show notes.
Now, if I pull up the paper that we are discussing today, it appeared in the journal GMS Hygiene and Infection Control at the end of 2021. So it's highly relevant and topical. The title of the paper is Building-related illness in all family members caused by mould infestation after dampness damage of the building. Now it's a really important German study. It's been very well done. And again, I'm going to be putting all of these links in the show notes, so you will be able to pull these up yourself and get them.
Now, what I want you to be aware of is that the context of this study began back in 2010 for this particular family. It was a new home undergoing construction. The end result of water damage was, as you can see highlighted on screen, massive mould infestation. Now, five of the family members, all of them who lived here, developed severe health problems. So this case study investigates the extent and cause of the water damage in addition to the various visible and not so visible fungal infestations. This was analyzed by a specialized laboratory, just like mine. We're going to be diving into exactly what they did.
I've got the hard copy here, I've got the digital copy up on screen, and we're going to be going through not only the context for what occurred for this family, but how they went about assessing the family's symptoms. What were those symptoms? Were they the same for each family member or were they different? They're also children involved in this case study. So this is a really relevant study for all those families out there who are experiencing water damage, or have grandchildren who are concerned to go to their grandparents' house because it smells of mould or has had a known water damage problem.
Also, we'll be looking at the clinical findings because there's some unusual findings here which could impact on you. We're also going to be talking about not only the timeline for the remediation, but I'm going to be drilling into what were the specific building problems, because every single home that suffers water damage has a intrusion point or points, and this particular paper does a really good job of highlighting some of the fine detail. This may help you also with your own cases.
Then we're going to conclude with how long it took for the symptoms, the adverse health symptoms, to dissipate or go away, and how the family achieved resolution for their adverse health. So what we're going to do is I'm going to drill into this publication now. I'll just essentially get up the first point that I want to highlight for you.
I'm doing something a little bit different for this livestream. I'm actually using an interactive tablet to pull up the information here. So hopefully this will be really interesting for you. So now, let's have a look at this. So the context of this is that there was a rapid build. And what do these scientists who were authoring this public mean by this? Well, they immediately moved into it right after their new home construction. One of the problems with new homes is often they are built on concrete foundations and there may be, as you can see in the red box, inadequate drying or inadequate ventilation.
Now, it's all very well with older style homes built on brick piers or timber foundations, or timber homes with adequate cross-flow ventilation, that it will be possible not to have an accumulation of moisture under the home. You would hope that the soil would just allow the percolation of the water away from the home. But for a lot of buildings that are built on concrete foundations, not only the moisture retained in the concrete slab adds moisture to the new home, which can then cause all sorts of condensation effects indoors, but often the insulated exterior cladding, coupled with tight windows, leads to compromised problems. This is the issue of sick building syndrome.
Sick building syndrome is defined next in this publication. Again, what I'm going to do is put up in the show notes for you. Again, the link that will be available on my website and also on Facebook is going to be focusing on this issue of VOCs. What are these VOCs? Where do they come from? Well, they're given off by building materials, varnishes, paints and adhesives, wallpapers, floor coverings, carpets, even natural wood. They pollute the indoor air. These VOCs also are added to by something called MVOCs or the microbial volatile organic compounds. These are given off preferentially by moulds, hence the prefix M for the MVOCs. They contribute to the mould problems.
If these and MVOCs get into your air conditioning system or the filters or the ducts in your home, they can add to problems with poor indoor air quality, and this impacts on people. The issue is that typical symptoms after long-term exposure to this twin problem of VOCs and MVOCs include mucus membrane irritation to the eyes, nose, and throat, headaches, unusual tiredness or fatigue, and sometimes even dry or itchy skin.
Now, oftentimes people notice that their symptoms go away after they leave these contaminated or polluted environments. However, the point of this paper is to emphasize the fact that not all people who suffer adverse health symptoms are due to the VOCs or the MVOCs, but the mould and the mould spores themselves can contribute to something more serious called building-related illness. The acronym for this is BRI. This is similar to sick building syndrome, but as the authors point out, is medically more serious and is caused by exposure to all of the problems in the home. This includes the particulate matter, as well as the VOCs or these odor molecules.
Now, it is also important that I emphasize that mould illness presents with no clear dose response relationship, because different people have different sensitivities. This is really, really important to emphasize.
Now, what did the scientists continue doing? I'm going to go through now how they approached this particular case study, because it's really important that you understand this. So if we look at this now, and I pull up the PDF again, what happened is that the home was built, as I said, in 2010, and an initial interview was conducted in 2012. This included the complaints. Now this was carried out by someone like myself, doing an occupational hygiene or environmental medicine review of the property. So discussions were held with each of the family members, and at the same time, the mould infestation was visually assessed and follow-up investigations took place over the next couple of years through to 2020.
Now, this is a really interesting study and we will go through next what they did with the mould diagnostics. But in this particular study, they used PCR testing to get a fine-grained analysis of the types of fungi that were found inside the building. Now, this differs from spore trap testing or viable testing or tape lift testing, but essentially the outcome is the same type of data points. You are determining, with a good degree of precision, exactly what type of genera and species of fungi are present inside the home.
We're going to go through some of this information in a minute. Now, I just want to assess again, or review for you, exactly what happened. I want to set the stage for what happened to this family, because this story is representative of a lot of stories that I hear all the time. So in 2010, the family's home was completed. Right after they moved in, there was water ingress into the basement, and subsequently, or later in that year, there was severe moisture damage with black-looking mould that appeared firstly in the basement, and then in the next season, the winter season, it was also identified and noted in the sleeping area on the first floor. At the same time, they discovered that large amounts of stratum water was flowing to the house and could not be led away.
If you consider this, this is the water which flows towards the property and just gets trapped there. So essentially, this resulted in what is described as a permanent buildup of water. In turn, the subsoil softened and the building lost its load-bearing capacity, which led to a lot of movement of the building. When the builder followed up to determine what was wrong, they discovered that poor drainage systems had been reused and that this was a whole set of additive causes, essentially connected with unprofessional building practices. That is never a good idea.
Now, what I also want to show now is a set of some of the problems that we see in properties. So what I might do is I'm going to pull this up now, and so let's go through now some of the issues about what they discovered. So they discovered that there was a lack of a soil survey prior to the start of construction. Now, you wouldn't think that that would ever happen, but I guess it does, and that's why this is highlighted here. So certainly for people who are undertaking new building constructions, ask to make sure that a soil survey was done, because you'll see, when I drill into some of this further information, that they reused some of the soil containing clay, which just moved the bad soil from one location to another.
The existing drainage and pipe works were not checked before or during the construction phase. The external basement staircase was not dismantled during construction of the additional floor slab. So it acted as a conduit or a funnel for all of this incoming water. Now, the drainage design was bad, and over the years, this put significant pressure onto the property. The basement also had unsuitable exterior insulation, which wasn't well matched to really the building type or the location of the building, and that there was no surface drainage away from the floor slab. As well as certain standards hadn't been met by the building, which I assume were signed off on at the time. Furthermore, there was incorrect dimensions used for the ventilation system.
So if you've got a poorly matched ventilation system, it means that calculations weren't properly applied during the design stage of the property. This can have all sorts of flow-on effects to condensation and poor indoor air quality later in the life cycle of the property.
Now, I want to move into now some of the specific types of mould that were detected, and I have highlighted some of the genus and species here, just to draw to your attention that Cladosporium is something that you always want to look out for in your mould assessment reports. Same with Chaetomium, Scopularius and Aspergillus versicolor, Acremonium, and Aspergillus species.
If I zoom into the next column, the authors also point out that Aspergillus niger is a problem along with Alternaria. And in other livestreams and podcasts, we've gone over some of the seven dominant fungal species that you want to look out for, and this publication is really reemphasizing the fact that a lot of these that I have just mentioned are the types of moulds which have a significant impact on health and safety inside a home subjected to water.
But again, I want to read out directly from the red box, which explains the outcome of this. What it says is that, "Undeniable health complaints in the form of building-related illness are associated with exposure to long-term residential mould infestation. This is sufficient for the evaluation of causality, comprehensive species identification was not mandatory, since all black mould species release microbial volatile organic compounds." It is this which contributes to poor indoor air quality.
Now, for many of you, you are probably wondering where we're going with this, and I want to get to the health symptoms which were experienced by the different members of this family, because this is the key to the importance of this livestream. Because all of you are probably wondering, what did it do to the family and how did they recover and what happened to them? Do your symptoms or my symptoms of exposure to water damage are linked? Could I use this publication to help me explain to others that my home is a potential health risk and health trap? Well, we're going to go through this right now.
To do that, I'm going to bring this up full size and we're going to go through what's occurred. Now, there were two boys, six and four years old, and an 11-month-old girl that was exposed to this sick building, this building-related illness dwelling, right after the vulnerable phases after birth. For the children, both boys suffered from recurrent nose bleeds that generally occurred once per week, and, in subsequent years, up to four times a week, primarily at night when they slept. Now, in 2018, this changed a little bit, and it only occurred six times per month in the older boy, and at least twice per month in the younger son. But the girl also suffered from recurrent nose bleeds, which for her began in 2012.
The other issue is that from 2013 onwards, the three children regularly experienced nocturnal coughs associated with sleep disturbances and recurrent respiratory infections, six times a year. Now, six times a year is pretty shocking, isn't it? I know that with my own family, I would be horrified if my daughter or my partner had influenza type illness six times per year, but this is what the medical symptoms are showing us.
So when we pull this up again, I will just get this here, put it onto the right hand-side here. So the final set of symptoms associated with the children were concentration difficulties that started to become noticeable in both boys beginning in 2013. So this is this issue of brain fog or neuro attenuation. What do I mean by neuro attenuation? Well, it means the cognitive decline or changes in cognitive capacity through exposure to water-damaged building interiors.
Now, what about the mum? Well, the mother, who wasn't that old, was born in 1975, she manifested a severe course once she was exposed to this building, and she had excessive physical and mental exhaustion and severe chronic fatigue syndrome. Now, she also had regularly occurring sore throat, five or six times per year. Certainly in this era of COVID awareness, none of us want to experience a sore throat, because that could mean that we've been exposed to SARS-CoV-2 virus, but it could be a water-damaged building interior.
Obviously, there are other issues, more common issues like severe headaches several times a month, chronic rhinitis, problems with word finding, concentration difficulties, forgetfulness, cognitive impairment, and even partial amnesia associated with reduced short-term memory. She had dry eyes, morning stiffness, and shivering from time to time, as well as extreme thirst at sometimes, even though diabetes was ruled out by her clinician. She also suffered from menstrual disorders with irregular as well as increased bleeding.
Now, this is just not a good idea, is it? I shouldn't say it isn't a good idea. It is a horrible set of symptoms which this family was experiencing. The good point is that I point out that obviously some remediation occurred because it's written up in the publication, and it says, "After elimination of the fungal infestation in the mother's wardrobe, her symptoms improved slightly."
What about the father? What happened to dad? Well, it says that the dad was only home for a relative short period of time every day. He was frequently on the road. He was significantly less exposed than the rest of the family. Therefore, his building-related illness was much milder. However, when he was present inside the house, he experienced a nocturnal irritable cough, rhinitis, and marked fatigue the next day.
Now, what was the outcome? Well, unfortunately, the family were unable to successfully remediate their property and they had to leave. Essentially, they had to vacate. They had to change their place of residence. This occurred in 2018 when the complaints were dominant, and following the move into another home, the father was free of all symptoms after two weeks, the three children after six months, but the mother took 18 months before her symptoms dissipated or went back to normal.
I want to pull up the conclusion in the discussion now. I'll make this as big as possible, because I want to read this out in its entirety, because it essentially discusses the findings. "The complaint pattern is consistent with reports in the literature that microbial volatile organic compounds released by moulds cause fatigue, sleep disturbances, poor concentration, and headache, as well as recurrent upper respiratory tract infections. Due to the high, long-term exposure, the course in the children was aggravated by recurrent nose bleeds, which has not been previously reported in the literature."
Now, I think that this is an outstanding case study. I urge you to download this yourself. I'm going to put all the links up on my website. So you'll be able to get that at biologicalhealthservices.com.au. I also reposted all of these livestream transcripts and blog posts to drcameronjones.com, so you will be also able to get them there.
In any case, I want to finish off this livestream by telling you that you can go to drcameronjones.com. You can download a free ebook which covers mould exposure. There's also a survey that you can take which may help or assist you with determining whether or not mould is a health risk inside your property, as well as all of the blogs relating to all of the livestreams and podcasts, which I've put up over the last couple of years.
In any case, I hope that this case study and discussion about building-related illness and its connection with sick building syndrome has been helpful to you. I hope that you'll be able to use this publication that I've discussed at length today to solve your own mould exposure and water damage problems with the key people who are responsible, in some cases, for these adverse problems happening at your residence. Anyway, bye for now. See you next week. See you later.
Kramer A, Wichelhaus TA, Kempf V, Hogardt M, Zacharowski K. Building-related illness (BRI) in all family members caused by mold infestation after dampness damage of the building. GMS Hyg Infect Control. 2021 Dec 7;16:Doc32. doi: 10.3205/dgkh000403. PMID: 34956824; PMCID: PMC8662741.