Purpose: This CDC report marks the first publication of the investigation of a cluster of pediatric pulmonary hemosiderosis cases.

Design: Case Series (Public Health Service Announcement).

Outcome: This was the first report from the CDC pertaining to a potential association between exposure to Stachybotrys and pulmonary hemorrhaging in eight black infants from a single hospital in Cleveland, Ohio between January 1993 and November 1994. Dearborn and colleagues described the laboratory signs and clinical symptoms observed in these children. The report stated that the blood testing showed results consistent with pulmonary hemorrhage. These indications persisted more than two weeks after the initial treatment of the disease. Five infants required mechanical ventilation for respiratory assistance, and there was one death, resulting from recurring hemorrhaging. Elevated antibody (IgG) levels to cow's milk were detected in over 70% of the infants tested.

Significant Quotes: "Cultures of blood, urine, and bronchoalveolar lavage from seven infants were negative for bacterial, mycotic, and viral pathogens." (p. 882).

"Massive acute pulmonary hemorrhage occurs rarely in infants; it usually is attributed to cardiac or vascular malformations, infectious processes, immune vasculitides, trauma, or known milk protein allergies." (p. 882).

Defendants' Perspective: This original report from the federal government did not associate the cluster of pediatric pulmonary hemosiderosis cases with exposure to indoor mold.

Plaintiffs' Perspective: Plaintiffs' experts may use this CDC report to claim that mold was responsible for the health problems in these children.

Peer Review: No.

Relevance to Ongoing Cases: Defense experts may use this article to cross examine plaintiffs' experts who rely on the Cleveland case series as scientific evidence of an association between indoor mold and illness.

How to Obtain the Article: http://www.cdc.gov/mmwr/