Acute Pulmonary Hemorrhage in Infants

The following factsheet was developed in 1997 prior to a new study by the CDC which found "serious shortcomings in the collection, analysis, and reporting of data resulted in inflated measures of association and restricted interpretation of the reports. The associations should be considered not proven. The etiology of AIPH is unresolved." (MMWR 10 Mar 2000)

Scope Of Problem

The scope of this problem is unknown since pulmonary hemorrhage is not a disease that is reported to health departments or to the Centers for Disease Control and Prevention (CDC). Through informal means, CDC has received reports of 82 cases in infants during the past four years.

Risk Groups

In a recent outbreak in Cleveland (MMWR 1997; 46:33-35), infants (particularly African-American males) under one year of age appeared to be at risk. Infants living in homes with smokers were at a higher risk than those in smoke-free homes. Infants in homes with water damage or flooding were at highest risk.

Sequelae

Long-term sequelae are unknown. There is a 10 to 15 percent mortality in acute illness. Fifty percent of the infants in the Cleveland outbreak had recurrent hemorrhages after returning to their homes.

Association With Toxigenic Mold

In the Cleveland outbreak, water damage promoted growth of a variety of molds, including Stachybotrys atra. S. atra produces potent toxins which cause gastrointestinal hemorrhage and hemolysis in farm animals ingesting moldy grain.

Prevalence of Toxigenic Mold

We do not know the prevalence of toxigenic molds, but S. atra appears to be uncommon in homes.

Prevention

After flooding, molds should be removed by washing walls and other water-damaged items with a bleach solution. Wet carpets should be replaced.

Research Priorities

• To develop a national surveillance system to determine how widespread this problem is.
• To conduct a national case-control study to identify risk factors for this disease.
• To develop methods for assessing the presence of toxigenic molds in homes.
• To determine how to eradicate toxigenic molds and/or prevent their growth.

April 1997
Courtesy of the Centers for Disease Control and Prevention