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Interviewer: Arlene Van Dyke
Interviewee: Michael G. Rinaldi, Ph.D.
                      The University of Texas Health Science Center at San Antonio
(Dr. Rinaldi is Professor of Pathology, Medicine, Microbiology, and Clinical Laboratory Science. Director, Fungus Testing Laboratory Department of Pathology.)
Date: October 6, 2001
Place: IAQA (Indoor Air Quality Association) Convention

Q: What do you do?

A: I am in a field called clinical mycology, which is basically the study of those fungi which cause human disease. To most medical folk's minds that would not equate to all fungal disease but rather to infectious diseases caused by fungi, that is the ability of these fungal organisms to invade into human tissue and cause as a result an infection. I guess you could view infections as covering lots of different kinds of infections, but basically the general term would be just those fungal problems that have to do with infections. I am a clinical mycologist who studies fungal infections of humans and animals.

Q: In the research being done today, do they have research that ties fungus into health problems with humans? Generally what we see in your slide presentations are extreme cases of fungal infections, but what about minor cases? When would people have to worry about fungal infections?

A: If you look at the major diseases of mankind, and everyone would agree for instance that a common cold is a major disease or, if you looked in the world, what is the major infectious disease in the world? It still remains malaria. Following very quickly behind that is things like TB. But amongst these most common infections known to mankind is one that I think you can go anywhere on the earth where they wear shoes and socks in a first world country or in a place that was considered to be western and that would be of course "athlete's foot". So even something so mundane as that turns out to be a fungal infection of a great amount of importance because there is not anybody I know on the earth that does not have "athlete's foot" in a large percentage of their population. So that is one example, but you are absolutely right the more deep invasive fungal diseases are almost inevitably occurring in those people whose immune systems are screwed up, who are compromised either from their underlying disease or from what we do to treat their underlying disease and we ourselves turn them into what I like to call "living petri plates". Unfortunately, over the last decade in human medicine we have continued to create "living petri dishes" at an ever growing rate, and so now-a-days in medicine this whole business of these opportunistic infections where microbes, which are essentially harmless, take the opportunity to fall into these "living petri dishes" causes terrible kinds of infectious disease. Amongst these opportunistic infections the fungi have now become probably the number one problem. So anyplace in the earth that does transplant programs, anybody who cares for HIV patients, anybody who has to have surgery, anybody who is in the intensive care unit, all of these people become susceptible to fungal disease. And now it has become a problem in medicine that cannot be neglected any longer because it is so prevalent.

Q: What about people in their own homes that have asthma or allergies or are taking some type of medication, should they worry about mold in the house?

A: If you broke down fungal diseases, not fungal infectious diseases, but fungal diseases into categories you might break them down this way. You might say the first category of disease a fungi can cause is allergy, and in fact if you look at the cause of allergy on earth without question there is nothing else that even comes close to the fungi. In fact they are the major cause of allergy on all the earth. So if a person has allergy to fungal protein or they are asthmatic and have another underlying problem which renders them more susceptible to fungal organisms in the air then, sure, even in their own home they have to be prudent in trying to remove themselves from the source of the organism.

The second big kind of fungal disease would be when one thinks if they ate a bad mushroom and you have mushroom poisoning. Although this is not an allergy problem or an infection problem this is more of an intoxication problem, never the less, we would have to put that under fungal disease and as it turns out in people's back yards grow mushroom which, if they ate them, they could kill them. And this turns out not to be a small problem when you look at the total United States or the total globe. There are a lot of people who eat a lot of mushrooms out there and do not know what they are eating. So that would be a second area.

A third area would be one that is the stuff of nightmares and horror movies of which we are all afraid of and that is Ben Ladin and Sadum Hussein and what if they took a fungal toxin produced by a fungal organism that was perfectly acceptable to be used as a bio-terrorist mechanism? That is to say this whole field called mycotoxicoses where these fungi produce toxins as a result of their growth and these toxins then turn out to have very harmful effects on humans. Once again, not an allergic condition, not an infectious condition, but a toxicologic condition, but still you would have to add it under the category of fungal diseases.

Lastly, the one we discussed a second ago, that is infections caused by fungi.

So any of these possibilities can occur given the right scenario at any given place at any given moment. But for your average guy in their home and in their yard, the biggest single problem would clearly be fungal allergies.

Q: How much fungal growth would they have to worry about? What if it were a small spot on the wall, or we could be talking about a whole basement?

A: Of course, as with all microbes, no matter what one ever did they are always going to be around. So you would never rid your home or your building of all microbes and you certainly would never rid it of all fungi. But also if fungal organisms become visible to the naked eye, that is too much. As to how the people react, it really depends on their level of sensitivity. Some people are just amazingly hypersensitive to any amount of mold and then other people can sleep in it and it does not bother them at all. So really, it comes to be an immunological problem. It comes to be to the host human being's immune system. If their immune system is particularly sensitive to these particular fungal agents then they are the ones that suffer the most. And one never knows that until one comes in contact with that kind of a situation. We all know people who are highly allergic to eggs and another guy right next to him is not allergic to eggs and the list goes the same for fungi. So I would say as always, if you had a house that has fungus in it, it would be good to get the fungus out of it whether you are sensitive or not because that is not a good scenario anyway.

Q: I know when allergy tests are done they do a mold test, but are there specific tests that people can take for specific molds?

A: There are some allergists, some clinical immunologists, some laboratories, which have the ability to separate out all kinds of different molds and test for allergies against specific species and specific genera. But on the whole, if you look at when the weather guy comes on at night and says "Today's mold count was...", what they are generally referring to are the basic mold of the air of which there is one genus that is overwhelming, it's called Cladosporium. Most people when they are talking about airborne fungi they are talking about Cladosporium and most of these single allergic tests that you get at your doctor or extracts that have been prepared are from Cladosporium species. So they figure if you are allergic to that one, because that is the most prevalent mold in the earth, that you are probably going to have problems with many of the other ones as well.

Q: Is there a way of cleaning fungi? People take bleach and wipe the wall and think they are taking care of their problem.

A: You can do that, and there will be no doubt that it will appear pristine to you for a while, but I can promise you it will return, and what you need to do is stop the reason the fungus is growing there to begin with. And that inevitably involves one thing, water. Whenever water gets into a place it is not supposed to be, like a pipe breaking in the wall, the roof is not constructed properly, water has been seeping down the wall for a long time, whatever, whenever water is there and the fix of the water problem is not done, you can bleach all you want to, repair the wallpaper all you want to, in fact you can even put in new wallpaper, and sooner or later that fungus will come back because it has the source that it needs. Fungi love three things, they love dark, they love wet, and they love sugar. If you give them those three things, they will continue to grow no matter what you do. So in these cases remediation in my mind means that you fix the source of the problem of why the fungus is growing as well as getting rid of the obvious fungal growth. And until you do that the fungus will come back again and again and again.

Q: Could you give us information on dose response? If a person that is not sensitive to say Penicillium and they are exposed, over a period of time, to high amounts or elevated amounts of Penicillium, is the percentage of eventually becoming sensitive high?

A: Allergies are really immunologic phenomena where your system's immune response generates some sort of a specific reaction against some particular antigen. And as we talked a minute ago, if you are sensitive, then it just takes a slight little bit of that, usually a protein but it can be other things, it could be lipid, carbohydrate, mixtures of those three to cause a reaction. Bottom line of it is that, if you are highly sensitive to a tiny amount of it, it is unlikely that you obviously are not going to be amazingly sensitive to a huge amount of it. But on the other side of the coin, if some guy has no sensitivity to a particular antigen at all, and you keep increasing the amount of concentrations of that antigen, chances are high they will never react. You could probably spray them with it and they probably would not react because their immune system is just not sensitive to that particular protein. Now having said that, that is not a recommendation that anyone should live in a sea of molds even if they turned out not to be allergic to them because the higher the inoculum with a foreign microbe the greater the risk of other kinds of problems. For instance, a perfectly normal guy could be overwhelmed just in terms of sheer number of fungal spores which could then compromise their breathing. Not necessarily have anything to do with asthma or allergy but just the mechanical presence of so many fungi falling into their nose and mouth every night, pretty soon they would start to hack and spit and all that stuff. So, I think, no matter what that eventual reason would be you would still always recommend the best way to deal with this problem is to get the human being away from the fungus.

Q: When molds sporulate, when they are sending particles out into the air, how is that done?

A: The fungus grows in nature and its job in life, like all living things, is to replicate itself for future generations. And fungi has been so immensely successful at this because of the huge number of these asexual spores that they make which are properly termed conidia. You can think of it being like the Carl Sagan show that used to be on TV called NOVA where he used to come on and talk about billions and billions of stars. We are talking here about billions and billions of conidia. These conidia then fall onto inanimate objects, fall onto the earth, fall onto the floor, fall into your shoes, fall into your hair, wherever they happen to be, and then they germinate. The actual spore sends out a germ tube which eventually becomes an entire fungal organism and each one of those little teeny spores could each become a whole new fungal organism. So you can begin to appreciate, if millions of spores are produced, these are amongst the most successful organisms on earth, because all they need is just a little bit of carbon to grow and that is virtually found everywhere.

Q: You mentioned sugar. We hear an awful lot about cellulose. Is there a correlation between the two?

A: Sure. Cellulose is nothing more than a polymer of various sorts of molecules of carbohydrate hooked together. So, sure, that is a sugar like or sugar analogous kind of a compound which many, well take bread for instance as a good example, you have all known about the bread mold, they will grow on that just fine, and that is basically a polymer of cellulose.

Q: What is your basic recommendation to individuals that are facing a mold problem?

A: Number 1, do your very best to find someone that knows what they are talking about. This field right now is so full of frauds and people that pretend to be experts in mold problems which have no training at all. Not only in mold problems but in the basic science of molds. But it is a hot area that generates a lot of money and the only winners in this whole business are in my view the attorneys. So that is my first advice to actually contact someone that really does have the experience and the training and the proper credentials in what the problem is that you are trying to deal with. Once that is done, then you follow what they say because the bottom line will be they will inevitably tell you either you need to remove yourself from the source of the mold or remove the source of the mold from you. I don't care what you do to delude yourself that is the bottom line. You can dance around the pole all week about repairing this and repairing that and fixing this and fixing that, and unless you get that mold out of there and stop the reason it came there to start with then you will always have problems with mold. So you might as well either move to another place, move to another business, or tear the building down and start over again because it is never going to fix the mold problem. Because that is the way the biology of mold works.

Q: What you are saying then is there is no one quick fix for mold?

A: The fix, as with almost all things in life, is called knowledge. Find the right business that does this. This would be a good place to start to look in this group here. For instance these are all the highest quality air control guys in the country. Clearly in this room here with all of these guys there has got to be someone in here that has a great expertise with mold problems. That would certainly be a good place to start. Contacting a company like that.

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