My last two post both dealt with ME/CFS patients with high Prevotella copri which is associated with mold. The association of mold to a subset of ME/CFS patients goes back to the last millennium. A man called Erik Johnson was nicked name the “Mold Warrior” and mentioned in articles such as:  Chester Levine “Association of concurrence between sick building syndrome and CFS: Epidemic neurasthenia revisited” [1994] – that is 30 years ago!!! He has a YouTube channel for those who are interested as well as many interviews with him by others.

A mycotoxin is a toxic secondary metabolite / chemical produced by fungi and is capable of causing disease and death in both humans and other animals. A car’s “mycotoxin” is carbon monoxide and other air pollution products.

What is Mold?

We need to tread gently not to overgeneralized or over simplified this. As a starting point: “”the most important mycotoxins associated with human and veterinary diseases, including aflatoxin, citrinin, ergot akaloids, fumonisins, ochratoxin A, patulin, trichothecenes, and zearalenone.” Mycotoxins[2003]. Molds are a group of fungi called “Hyphomycetes“. For many people they are two words for the same thing.

Going over to my favorite definitive source, KEGG: Kyoto Encyclopedia of Genes and Genomes, we get a much more complete list. (Click on the C-link to get more information on each)

Mycotoxins

Aflatoxins

C06800 Aflatoxin B1

C16753 Aflatoxin B2

C16754 Aflatoxin G2

C16755 Aflatoxin G1

C16756 Aflatoxin M1

Trichothecenes

C09662 Diacetoxyscirpenol

C19952 HT-2 Toxin

C09738 T-2 Toxin

C19583 Fusarenone X

C06080 Nivalenol

C09747 Vomitoxin

C20017 Satratoxin H

Fumonisins

C19241 Fumonisin B1

C19242 Fumonisin B2

Ergot alkaloids

C09023 Agroclavine

C09162 Ergocornine

C09164 Ergocristine

C07545 alpha-Ergocryptine

C20590 beta-Ergocryptine

C07543 Ergonovine

C07544 Ergotamine

Indole diterpene alkaloids

C20555 Aflatrem

C20527 Emindole SB

C20600 Janthitrem B

C20601 Janthitrem C

C20551 Lolitrem B

C20530 Paspaline

C20553 Paspalicine

C20554 Paspalinine

C13782 Paxilline

C20070 Penitrem A

C20731 Penitrem B

C20795 Penitrem C

C20596 Penitrem D

C20597 Penitrem E

C20598 Penitrem F

C20599 Pennigritrem

C20546 Terpendole C

Others

C16765 Citrinin

C09955 Ochratoxin A

C16748 Patulin

C09981 Zearalenone

C16838 Alternariol

C08511 Tenuazonic acid

C08441 Tentoxin

C11590 Beauvericin

C15740 Enniatin B

C15757 Enniatin D

C20591 Fusaproliferin

C20592 Moniliformin

C16766 Citreoviridin

C19379 Cyclochlorotine

C03032 Cyclopiazonic acid

C19953 Cytochalasin A

C19954 Cytochalasin B

C10595 Gliotoxin

C16763 Luteoskyrin

C20046 Mollicellin C

C16804 Penicillic acid

C19955 Phomopsin A

C06079 PR-toxin

C16767 Rubratoxin B

C16764 Rugulosin

C16768 Sporidesmin J

C00961 Sterigmatocystin

C20045 Verruculogen

C14752 alpha-Zearalanol

C14750 alpha-Zearalenol

C14751 beta-Zearalenol

These toxins are the product of molds. Different molds produces different ones in different amounts. See Growth of Fungal Cells and the Production of Mycotoxins [2018] for more discussion. One fungi is Candida. There are many more as shown below.

The amount of research is actually very sparse. One rule of thumb (applies to some cases only) is that excessive Prevotella growth may happen from some fungi.

• “Furthermore, the culture supernatants of Candida spp. grown with arabinoxylan promoted rapid proliferation of Prevotella copri. ” Comparison of Japanese and Indian intestinal microbiota shows diet-dependent interaction between bacteria and fungi [2019]
• Evaluation of an oral subchronic exposure of deoxynivalenol on the composition of human gut microbiota in a model of human microbiota-associated rats.  [2013] “significantly increased Bacteroides/Prevotella group and decreased concentration levels for Escherichia coli.”

Different mycotoxins may cause increase or decrease of different bacteria. This is made worse in clinical practice because only a few may be tested for.

Literature Review

• There are a number of article on the impact on the gut (for example “leaky gut”)
  • The Compromised Intestinal Barrier Induced by Mycotoxins [2020] clarifies its importance for leaky gut etc.
  • Mycotoxin: Its Impact on Gut Health and Microbiota [2018]
  • Impact of mycotoxins on the intestine: are mucus and microbiota new targets? [2017]
  • Effects of Dietary Mycotoxins on Gut Microbiome [2017]
• There are some known impacts on the microbiome of some of the mycotoxins:
  • The effect of experimental fusarium mycotoxicosis on microbiota diversity in porcine ascending colon contents. [2014]”significantly reduced amounts of Clostridium perfringens, Escherichia coli, and Enterobacteriaceae but increased the biodiversity.”
  • Combination of metagenomics and culture-based methods to study the interaction between ochratoxin a and gut microbiota.[2014]  “Bacteroides, Dorea, Escherichia, Oribacterium, Ruminococcus, and Syntrophococcus were decreased and Lactobacillus increased”
  • “increased the relative abundance of cecum Bacteroides and decreased the butyric acid producing bacteria”  Protective effect of curcumin on ochratoxin A-induced liver oxidative injury in duck is mediated by modulating lipid metabolism and the intestinal microbiota.[2020]
  • A longer list of impacts is below
• There is considerable evidence that it may play a significant factor for ME/CFS (and likely many co-morbid conditions) as well as COVID (and Long COVID)
  • Metatranscriptomic analysis revealed Prevotella as a potential biomarker of oropharyngeal microbiomes in SARS-CoV-2 infection [2023]
  • COVID-19–Associated Mold Infection in Critically Ill Patients, Chile [2021] “Centers in Europe, China, and the United States have reported cases of fungal superinfections among patients with severe coronavirus disease (COVID-19).”
  • “Association of concurrence between sick building syndrome and CFS: Epidemic neurasthenia revisited” [1994] “We conclude that CFS is often associated with Sick Building Syndrome”.
  • Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome [2013] “”Urine specimens from 104 of 112 patients (93%) were positive for at least one mycotoxin” 
  • Prevalence of Aspergillus-Derived Mycotoxins (Ochratoxin, Aflatoxin, and Gliotoxin) and Their Distribution in the Urinalysis of ME/CFS Patients [2022] (chart is below)

There is limited study of the microbiome and mycotoxins. There is an association of mycotoxins and Prevotella copri but in the clinical literature, high levels of Prevotella copri is not reported for ME/CFS – thus we should infer that it impacts a subset only.

Mycotoxin impact on the microbiome

Information here is sparse (and high level)

Oral Sub-Chronic Ochratoxin a Exposure Induces Gut Microbiota Alterations in Mice [2021]. This study found that the the shifts were positive or negative depending on dosages (marked with a * indicating shift seen for low dosages).

Unclassified Bacteroidales	Increases
Bacteroidaceae	Increases
Porphyromonadaceae	Increases
Prevotellaceae	Increases
Rikenellaceae	Increases
S24-7	Increases
Odoribacteraceae	Increases
Unclassified Cyanobacteria	Increases
Deferribacteraceae	Decreases*
Lactobacillaceae	Increases
Streptococcaceae	Major Increase
Unclassified Clostridiales	Decreases
Clostridiaceae	Increases
Dehalobacteriaceae	Increases
Lachnospiraceae	Decreases*
Peptococcaceae	Increases
Ruminococcaceae	Decreases
Mogibacteriaceae	Increases
Erysipelotrichaceae	Decreases
Unclassified Alphaproteobacteria	Decreases
Alcaligenaceae	Decreases
Desulfovibrionaceae	Increases
Enterobacteriaceae	Major Increase
Anaeroplasmataceae	Increases

Prevotella copri Levels Of Concern

A Summary is below — but bacteria do not follow a bell curve. Instead look at the chart below

Values over 0.01% are of concern (IMHO)

Bottom Line

We know that we do not know much about different mycotoxins and their associated fungi. This is made worse because of an absence of standards!

In most cases, if visible mold growth is present, sampling [for mold] is unnecessary. Since no EPA or other federal limits have been set for mold or mold spores, sampling cannot be used to check a building’s compliance with federal mold standards. Surface sampling may be useful to determine if an area has been adequately cleaned or remediated. 

Mold Testing or Sampling – United States Environmental Protection Agency

As you can see from the chart below, ideally some 34,000 species should be tested for. Often people test using a $10 kits (Home Depot) or use an inspector that tests for only a few species. Chart Source

Can we definitively say that high Prevotella copri indicate a fungi issue — No. for some types of fungi that appears true but not for all.

We know that fungi can alter the microbiome but details on the fine print is missing.

Beware of Mycotoxins in Food

Mycotoxins are chemicals — sterilization does not kill the mycotoxins. It will kill the fungi producing the mycotoxins but the mycotoxin will still be there. Some examples:

• Special Issue: Coffee, Fungi, Mycotoxins, and Climate Change. [2023]
• Mycotoxins in milk: Occurrence and evaluation of certain detoxification attempts [2023]
• Filamentous fungi in artisanal cheeses: A problem to be avoided or a market opportunity? [2023]
• Occurrence of Types A and B Trichothecenes in Cereal Products Sold in Romanian Markets [2023]
  “Results indicated trichothecene contamination in 90.08% of our samples, with deoxynivalenol predominating by at least 78% in each examined group. Co-occurrence of three or four trichothecenes were found in 23.85% of our samples. “
• Alimentary Risk of Mycotoxins for Humans and Animals [2021]
  “Memis et al. [79] showed the presence of AFM₁, OTA, ZEN, and DON in human milk.”
  “Their occurrence is favored by factors commonly present in our environment, including humidity. Modified mycotoxins may be a particularly significant risk. However, no legal regulations regarding safe levels in food and feed exist, and risk assessment studies are still ongoing. Mycotoxins show resistance to technological processes and have the ability to accumulate in tissues. “

In short, storage in a humid environment increased mycotoxin risk.

Keep your environment dry!

This usually means dehumidifiers. We have one as part of our heat pump system and smaller units in storage area. We usually set it to 40% humidity or less. We also picked up some Airthings monitors which send us messages when humidity becomes a concern.

Low humidity is also helpful for dealing with heat. The body is able to cool you down faster by sweat.

Image from Best Dehumidifiers for Your Home

We use a unit ($25) like below to keep an eye on each room. One for Three Digital Thermometer Hygrometer