Indoor air bacterial and fungal burden in the environment of an atopic child: implications for elevated urine mycotoxin levels
References
- World Health Organization. WHO Guidelines for Indoor Air Quality: Dampness and Mould. Copenhagen: WHO Regional Office for Europe; 2009.
- World Health Organization. WHO Guidelines for Indoor Air Quality: Selected Pollutants. Copenhagen: WHO Regional Office for Europe; 2010.
- Awad AHA, Farag SA. An indoor bio-contaminants air quality. Int J Environ Health Res 1999;9:313–9. doi: 10.1080/09603129973100
- Hayleeyesus SF, Manaye AM. Microbiological quality of indoor air in university libraries. Asian Pac J Trop Biomed 2014;4:S312–7. doi: 10.12980/APJTB.4.2014C807
- Raju S, Siddharthan T, McCormack MC. Indoor air pollution and respiratory health. Clin Chest Med 2020;41:825–43. doi: 10.1016/j.ccm.2020.08.014
- Ilies AB, Burtă O, Hadeel SAH, Mircea C, Al Shomali M, Caciora T, Ratiu M, Peres AC, Hassan TH, Janzakov B, Lazar L. Integrated analysis of indoor air quality and fungal microbiota in educational heritage buildings: implications for health and sustainability. Sustainability 2025;17:1091. doi: 10.3390/su17031091
- Enitan SS, Ihongbe JC, Ochei JO, Effedua HI, Adeyemi O, Phillips T. Microbiological assessment of indoor air quality of some selected private primary schools in Ilishan-Remo, Ogun state, Nigeria. Int J Med Heal Res 2017;3:8–19.
- Naga Madhan Mohan K, Ramprasad S, Maruthi YA. Microbiological air quality of indoors in primary and secondary schools of Visakhapatnam, India. Int Res J Curr Microbiol Appl Sci 2014;3:880–7.
- Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect 2011;119:748–56. doi: 10.1289/ehp.1002410
- Daisey JM, Angell WJ, Apte MG. Indoor air quality, ventilation and health symptoms in schools: an analysis of existing information. Indoor Air 2003;13:53–64. doi: 10.1034/j.1600-0668.2003.00153.x
- Bornehag CG, Sundell J, Hagerhed-Engman L, Sigsggard T, Janson S, Aberg N; DBH Study Group. “Dampness” at home and its association with airway, nose, and skin symptoms among 10,851 preschool children in Sweden: a cross-sectional study. Indoor Air 2005;15:48–55. doi: 10.1111/j.1600-0668.2005.00306.x
- Cooley JD, Wong WC, Jumper CA, Straus DC. Fungi and the indoor environment: their impact on human health. Adv Appl Microbiol 2004;55:1–30. doi: 10.1016/S0065-2164(04)55001-3
- Mudarri D, Fisk WJ. Public health and economic impact of dampness and mold. Indoor Air 2007;17:226–35. doi: 10.1111/j.1600-0668.2007.00474.x
- Thacher JD, Gruzieva O, Pershagen G, Melén E, Lorentzen JC, Kull I, Bergström A. Mold and dampness exposure and allergic outcomes from birth to adolescence: data from the BAMSE cohort. Allergy 2017;72:967–74. doi: 10.1111/all.13102
- Hagerhed-Engman L, Bornehag C-G, Sundell J, Aberg N. Day-care attendance and increased risk for respiratory and allergic symptoms in. Allergy 2006;61:447–53. doi: 10.1111/j.1398-9995.2006.01031
- Harding CF, Pytte CL, Page KG, Ryberg KJ, Normand E, Remigio GJ, DeStefano RA, Morris DB, Voronina J, Lopez A, Stalbow LA, Williams EP, Abreu N. Mold inhalation causes innate immune activation, neural, cognitive and emotional dysfunction. Brain Behav Immun 2020;87:218–28. doi: 10.1016/j.bbi.2019.11.006
- Kohler JR, Casadevall A, Perfect J. The spectrum of fungi that infects humans. Cold Spring Harb Perspect Med 2015;5(1):a019273. doi: 10.1101/cshperspect.a019273
- Saghir SA, Bancroft J, Ansari R. Molds and mycotoxins indoors I: Current issues and way forward. Arch Clin Toxicol 2025;7:1–7. doi: 10.46439/toxicology.7.032
- Fisk WJ, Eliseeva EA, Mendell MJ. Association of residential dampness and mold with respiratory tract infections and bronchitis: a meta-analysis. Environ Heal 2010;9:72. doi: 10.1186/1476-069X-9-72
- Omebeyinje MH, Adeluyi A, Mitra C, Chakraborty P, Gandee GM, Patel N, Verghese B, Farrance CE, Hull M, Basu P, Lee K, Adhikari A, Adivar B, Horney JA, Chanda A. Increased prevalence of indoor Aspergillus and Penicillium species is associated with indoor flooding and coastal proximity: a case study of 28 moldy buildings. Environ Sci Process Impacts 2021;23:1681–7. doi: 10.1039/D1EM00202C
- Weinmayr G, Gehring U, Genuneit J, Büchele G, Kleiner A, Siebers R, Wickens K, Crane J, Brunekreef B, Strachan DP; ISAAC Phase Two Study Group. Dampness and moulds in relation to respiratory and allergic symptoms in children: results from Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC Phase Two). Clin Exp Allergy 2013;43:762–74. doi: 10.1111/cea.12107
- Keall M, Baker MG, Howden-Chapman P, Cunningham M, Ormandy D. Assessing housing quality and its impact on health, safety and sustainability. J Epidemiol Community Heal 2010;64:765–71. doi: 10.1136/jech.2009.100701
- Sharpe RA, Taylor T, Fleming LE, Morrissey K, Morris G, Wigglesworth R. Making the case for “whole system” approaches: integrating public health and housing. Int J Environ Res Public Health 2018;15(11):2345. doi: 10.3390/ijerph15112345
- Omotayo OP, Omotayo AO, Mwanza M, Babalola OO. Prevalence of mycotoxins and their consequences on human health. Toxicol Res 2019;35:1–7. doi: 10.5487/TR.2019.35.1.001
- Gatto MR, Li A, Bentley R. Health and social impacts of exposure to mould-affected housing in Australia: a qualitative study. Public Health Res Pract 2025;35:PU24024. doi: 10.1071/PU24024
- Hyvonen SM, Lohi JJ, Rasanen LA, Heinonen T, Mannerstrom M, Vaali K, Tuuminen T. Association of toxic indoor air with multi-organ symptoms in pupils attending a moisture-damaged school in Finland. Am J Clin Exp Immunol 2020;9:101–13. PMCID: PMC7811924
- Godoi RHM, Avigo D, Campos VP, Tavares TM, de Marchi MRR, Van Grieken R, Godoi AFL. Indoor air quality assessment of elementary schools in Curitiba, Brazil. Water Air Soil Pollut: Focus 2009;9:171–7. doi: 10.1007/s11267-009-9220-3
- Wallace J, Moscardini L, Rae A, Watson A. Following the Science: A systematic literature review of studies surrounding singing and brass, woodwind, and bagpipe playing during the COVID-19 pandemic [displayed 3 March 2026]. Available at
https://orca.cardiff.ac.uk/id/eprint/136639/1/FollowingtheScienceReportNovember2020.pdf - Köberlein M, Hermann L, Gantner S, Tur B, Peters G, Westphalen C, Benthaus T, Döllinger M, Kniesburges S, Echternach M. Impulse dispersion of aerosols during playing the recorder and evaluation of safety measures. PLoS One 2022;17(9):e0266991. doi: 10.1371/journal.pone.0266991
- International Organization for Standardization (ISO). ISO 16000-18:2011 Indoor air Part 18: Detection and enumeration of moulds – Sampling by impaction 2011.
- International Organization for Standardization (ISO). ISO 16000-18:2011/Cor 1:2011 Indoor air – Part 18: Detection and enumeration of moulds – Sampling by impaction Technical Corrigendum 1 2011.
- International Organization for Standardization (ISO). ISO 16000-17:2008 – Detection and enumeration of moulds – Culture-based method 2008.
- International Organization for Standardization (ISO). ISO 16000-17:2008/Cor 1:2009 Indoor air – Part 17: Detection and enumeration of moulds – Culture-based method Technical Corrigendum 1 2009.
- International Organization for Standardization (ISO). ISO 16000-1:2004 Indoor air Part 1: General aspects of sampling strategy 2004.
- International Organization for Standardization (ISO). ISO 16000-19:2012 Indoor air Part 19: Sampling strategy for moulds 2012.
- European Standards. EN 13098:2019 – Workplace exposure – Measurement of airborne micro-organisms and microbial compounds – General requirements 2019.
- VWR International. SAS Super 100/180, DUO SAS Super 360, SAS Isolator: instruction manual [displayed 3 March 2026]. Available at
https://www.usmslab.com/wp-content/uploads/2018/08/SAS-360-Operating-Instructions.pdf - Bruker Daltonics. MALDI Biotyper BT – Information Sheet. Billerica (MA): Bruker Daltonics; 2024. [displayed 3 March 2026]. Available at
https://www.squ.edu.om/Portals/8/DNNGallery/uploads/2024/11/19/MALDI%20Biotyper%20BT%20Information%20Sheet.pdf - Urine Sample Collection Instructions [Internet]. Overland Park (KS): MosaicDX; 2023 [displayed 3 March 2026]. Available at
https://mosaicdx.com/resource/urine-collection-instructions/ - Chawla H, Anand P, Garg K, Bhagat N, Varmani SG, Bansal T, McBain AJ, Marwah RG. A comprehensive review of microbial contamination in the indoor environment: sources, sampling, health risks, and mitigation strategies. Front Public Health 2023;11:1285393. doi: 10.3389/fpubh.2023.1285393
- Wanner HU. European collaborative action. indoor air quality & its impact on man’ (formerly COST project 613). Geneva: Commission of the European Communities, Directorate General for Science, Research and Development; 1993.
- Ministérios do Ambiente Ordenamento do Território e Energia da Saúde e da Solidariedad Emprego e Segurança Social. Portaria n.o 353-A/2013 [Ordinance No. 353-A/2013 of 4 December 2014, in Portuguese]. Diário Da República [displayed 17 February 2026]. Available at
https://diariodarepublica.pt/dr/detalhe/portaria/353-a-2013-331868 - Wu TY, Khorramshahi T, Taylor LA, Bansal NS, Rodriguez B, Rey IR. Prevalence of Aspergillus-derived mycotoxins (chratoxin, aflatoxin, and gliotoxin) and their distribution in the urinalysis of ME/CFS patients. Int J Environ Res Public Health 2022;19:2052. doi: 10.3390/ijerph19042052
- Mousavi B, Hedayati MT, Hedayati N, Ilkit M, Syedmousavi S. Aspergillus species in indoor environments and their possible occupational and public health hazards. Curr Med Mycol 2016;2:36–42. doi: 10.18869/acadpub.cmm.2.1.36
- Varga J, Baranyi N, Chandrasekaran M, Vágvölgyi C, Kocsubé S. Mycotoxin producers in the Aspergillus genus: an update. Acta Biol Szeged 2015;59:151–67.
- Nieminen SM, Kärki R, Auriola S, Toivola M, Laatsch H, Laatikainen R, Hyvärinen A, Von Wright A. Isolation and identification of Aspergillus fumigatus mycotoxins on growth medium and some building materials. Appl Environ Microbiol 2002;68:4871–5. doi: 10.1128/AEM.68.10.4871–4875.2002
- Hernandez-Ramirez G, Barber D, Tome-Amat J, Garrido-Arandia M, Diaz-Perales A. Alternaria as an inducer of allergic sensitization. J Fungi (Basel) 2021;7:838. doi: 10.3390/jof7100838
- Ehsanifar M, Rajati R, Gholami A, Reiss JP. Mold and mycotoxin exposure and brain disorders. J Integr Neurosci 2023;22(6):137. doi: 10.31083/j.jin2206137
- Kraft S, Buchenauer L, Polte T. Mold, Mycotoxins and a dysregulated immune system: a combination of concern? Int J Mol Sci 2021;22(22):12269. doi: 10.3390/ijms222212269
- Salin JT, Salkinoja-Salonen M, Salin PJ, Nelo K, Holma T, Ohtonen P, Syrjälä H. Building-related symptoms are linked to the in vitro toxicity of indoor dust and airborne microbial propagules in schools: A cross-sectional study. Environ Res 2017;154:234–9. doi: 10.1016/j.envres.2017.01.015
- Tuuminen T, Vaali K, Valtonen V. Dampness and mold hypersensitivity syndrome as an umbrella for many chronic diseases - the clinician’s point of view. In: Nriagu JO, editor. Encyclopedia of Environmental Health. 2nd ed. Elsevier, 2019. p. 1–9. doi: 10.1016/B978-0-12-409548-9.11454-X
- Segers FJJ, Dijksterhuis J, Giesbers M, Debets AJM. Natural folding of airborne fungal spores: a mechanism for dispersal and long-term survival? Fungal Biol Rev 2023;44:100292. doi: 10.1016/j.fbr.2022.10.005
- Lindemann V, Schleiner T, Maier U, Fels H, Cramer B, Humpf H-U. Analysis of mold and mycotoxins in naturally infested indoor building materials. Mycotoxin Res 2022;38:205–20. doi: 10.1007/s12550-022-00461-3
- Hooper DG, Bolton VE, Guilford FT, Straus DC. Mycotoxin detection in human samples from patients exposed to environmental molds. Int J Mol Sci 2009;10:1465–75. doi: 10.3390/ijms10041465
- Brewer JH, Thrasher JD, Straus DC, Madison RA, Hooper D. Detection of mycotoxins in patients with chronic fatigue syndrome. Toxins 2013;5:605–17. doi: 10.3390/toxins5040605
- Baxi SN, Portnoy JM, Larenas-Linnemann D, Phipatanakul W. Environmental Allergens Workgroup. Exposure and health effects of fungi on humans. J Allergy Clin Immunol Pract 2016;4:396–404. doi: 10.1016/j.jaip.2016.01.008
- Thrasher JD, Prokop C, Roberts C, Hooper D. A family with ME/CFS following exposure to molds, mycotoxins and bacteria in a water-damaged home: a case report. Int J Clin Toxicol 2016;4:1–10.
- Saghir SA, Bancroft J, Ansari R. Molds and mycotoxins indoors II: Toxicological perspective. Arch Clin Toxicol 2025;7:8–40. doi: 10.46439/toxicology.7.033
- Saghir SA, Bancroft J, Ansari R. Molds and mycotoxins indoors III. Three case reports. Arch Clin Toxicol 2025;7:41–5. doi: 10.46439/toxicology.7.034
- Viljoen M, Claassen N. Pathophysiological aspects of exposure to dampness-associated indoor mould and mycotoxins: a mini-overview. J Hazard Mater Adv 2023;9:100228. doi: 10.1016/j.hazadv.2022.100228
- Valtonen V. Clinical diagnosis of the dampness and mold hypersensitivity syndrome: review of the literature and suggested diagnostic criteria. Front Immunol 2017;8:1–6. doi: 10.3389/fimmu.2017.00951
- Vaali K, Tuomela M, Mannerström M, Heinonen T, Tuuminen T. Toxic indoor air is a potential risk of causing immuno suppression and morbidity - A pilot study. J Fungi 2022;8(2):104. doi: 10.3390/jof8020104
- Bornehag C-G, Sundell J, Sigsgaard T. Dampness in buildings and health (DBH): Report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden. Indoor Air 2004;14(Suppl 7):59–66. doi: 10.1111/j.1600-0668.2004.00274.x
- Fog Nielsen K., Mycotoxin production by indoor molds. Fungal Genet Biol 2003;39:103–17. doi: 10.1016/S1087-1845(03)00026-4
Language: English, Croatian, Slovenian
Page range: 65 - 72
Submitted on: Jul 1, 2025
Accepted on: Mar 1, 2026
Published on: Mar 30, 2026
Published by: Institute for Medical Research and Occupational Health
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Related subjects:
© 2026 Ivona Majić, Adela Krivohlavek, Elvira Kovač Andrić, Ranka Godec, published by Institute for Medical Research and Occupational Health
This work is licensed under the Creative Commons Attribution 4.0 License.