00:00:04
[sirens wailing]
00:00:06
911 OPERATOR: 911.
00:00:07
CALLER: Have a little emergency.
00:00:09
I think the baby's choking.
00:00:10
911 OPERATOR: OK,
we'll be right there.
00:00:12
CALLER: All right.
00:00:13
911 OPERATOR: Squads
needed for a baby
00:00:14
that's choking 804 Fife Street.
00:00:17
NARRATOR: In 1994,
an infant was rushed
00:00:20
to a hospital emergency room
with a serious breathing
00:00:24
problem.
00:00:26
The baby's lungs were bleeding,
a life threatening condition
00:00:29
which is extremely rare.
00:00:32
Within months, there were over
30 cases in Cleveland just
00:00:36
like it.
00:00:37
A rate 1,000 times higher than
anywhere else in the world.
00:00:42
Not all of the infants survived.
00:00:46
Doctors had never
seen anything like it
00:00:50
and frantically
searched for the cause.
00:00:54
[theme music]
00:01:18
On a chilly November
evening, Neema Williams
00:01:21
heated some baby formula for
her six-week-old son, Brian.
00:01:27
But during that feeding,
something went terribly wrong.
00:01:32
I heard him regurgitate,
so I figured it was milk.
00:01:35
But instead, when
I picked him up,
00:01:36
instead of seeing white milk,
I'm seeing bright red blood.
00:01:40
NARRATOR: Her baby was rushed
to Rainbow Babies and Children's
00:01:43
Hospital in Cleveland,
where doctors struggled
00:01:47
to save little Brian's life.
00:01:50
X-rays revealed
that Brian's lungs
00:01:53
were filling up with blood.
00:01:55
Unable to breathe on his own,
he was taken to intensive care
00:01:59
and placed on a ventilator.
00:02:01
These sections are
still pretty bloody.
00:02:03
I'm wondering it, but
I'm not thinking it.
00:02:05
You know, my baby
is going to be OK.
00:02:08
We're going to get through it.
00:02:09
But it's still in the back
of your mind, you know,
00:02:12
he could die.
00:02:14
Is this the last I'm
going to see Brian?
00:02:16
Is this my last look at him?
00:02:19
Brian was quite sick.
00:02:20
He had bled a lot.
00:02:21
He had dropped his
hematocrit almost in half
00:02:25
and required an acute
blood transfusion
00:02:28
on top of having to be
supported with a ventilator.
00:02:32
NARRATOR: Brian
Mitchell's condition
00:02:33
was diagnosed as idiopathic
pulmonary hemosiderosis,
00:02:38
which means unexplained
bleeding in the lungs.
00:02:42
Lung bleeding is usually
caused by a heart problem,
00:02:46
an infection, or child abuse.
00:02:49
But in Brian's case,
doctors eliminated
00:02:52
these as possible causes.
00:02:54
The hospital's medical records
revealed two other babies had
00:02:58
been treated for
unexplained lung bleeding,
00:03:01
and one of those babies died.
00:03:05
The incidence of lung
bleeding in infants
00:03:07
was 1,000 times
higher in Cleveland
00:03:10
than anywhere else in the world.
00:03:13
Brian Mitchell was fortunate.
00:03:16
After two weeks
of improvement, he
00:03:18
was released from the hospital.
00:03:20
His doctors suspected that
his lung bleeding was caused
00:03:24
by an allergic reaction
to his baby formula,
00:03:27
and they recommended his mother
change the type she was using.
00:03:31
But one week later,
Brian Mitchell
00:03:34
was back in the hospital
with more lung bleeding.
00:03:38
I was just to the point,
what's wrong with him?
00:03:40
He starts bleeding, we
bring him to the hospital.
00:03:43
You leave him in the
hospital for three days,
00:03:45
but you can't tell
us why he's here.
00:03:48
You can't tell us
what's wrong with him.
00:03:50
Why does he keep bleeding?
00:03:51
I don't know.
00:03:53
NARRATOR: Dr. Dearborn
discovered that Brian Mitchell
00:03:56
and the other is
sick babies all lived
00:03:59
within a six mile
radius of the hospital
00:04:03
on Cleveland's east side.
00:04:05
It was probably an
environmental component.
00:04:07
It said, not necessarily
that it was in their homes,
00:04:11
but something in that part of
the community was problematic.
00:04:16
NARRATOR: But there
was a complication.
00:04:18
Brian Mitchell had a
twin sister, Brianna,
00:04:22
who lived in the same
house, ate the same food,
00:04:25
and slept in the
same room as Brian,
00:04:29
and even shared the same crib.
00:04:32
If Dr. Dearborn was right and
the cause was environmental,
00:04:37
why did little Brian get
sick while his twin sister
00:04:41
was perfectly healthy?
00:04:43
And there was another problem,
only infants were getting sick.
00:04:48
None of the older
children or adults
00:04:51
in the same neighborhood
or even in the same homes
00:04:54
were affected.
00:04:55
Dr. Dearborn knew he needed
help, and called in the Centers
00:04:59
for Disease Control in Atlanta.
00:05:02
The fear is we were going
to continue to have more--
00:05:06
more of these
babies, and we would
00:05:07
get them too late to save them.
00:05:11
NARRATOR: Something mysterious
was happening in Cleveland,
00:05:14
causing the lungs of infants to
bleed for no apparent reason.
00:05:21
It was an outbreak
unlike any other before
00:05:24
in medical history,
and it was happening
00:05:28
ironically within
a six mile radius
00:05:31
of a Children's Hospital.
00:05:36
The Centers for Disease Control
assigned Dr. Ruth Etzel to lead
00:05:40
the investigation in Cleveland.
00:05:42
Her job was to find
out what caused
00:05:45
the death of one infant
and the life threatening
00:05:47
illness of seven others.
00:05:49
The job of a medical detective
is an awful lot like the job
00:05:53
of a criminal detective.
00:05:55
That is we're looking to try
to track down the culprit
00:05:59
of a specific unknown disease.
00:06:02
And if we can track
down that culprit,
00:06:03
we can prevent him
from attacking again.
00:06:06
NARRATOR: Dr. Etzel reviewed
all of the medical records
00:06:09
of the infants with
pulmonary hemosiderosis.
00:06:13
One thing caught her
eye, many of the infants
00:06:16
improved in the hospital
but started bleeding
00:06:20
again after they returned home.
00:06:23
So you use soaps and things
like that to clean it up.
00:06:25
NARRATOR: The families
of the sick infants
00:06:27
were interviewed using
a 230-item questionnaire
00:06:31
to see if they
differed in any way
00:06:34
from the families
of healthy children.
00:06:37
All of the homes were tested to
see if the pesticides used were
00:06:41
the type approved
for residential use,
00:06:45
and air samples from the
homes were also collected.
00:06:53
Within days of
the investigation,
00:06:56
two more babies with
pulmonary hemosiderosis
00:06:59
were rushed to the hospital
from the same neighborhood.
00:07:03
The total number of
cases was now 10.
00:07:07
Nine of those 10
were male, and all
00:07:10
of them were African-American.
00:07:13
So this made us start thinking
as to whether we were dealing
00:07:15
with something related
to the genetics of race,
00:07:19
whether we were dealing with
something that was particularly
00:07:23
susceptible in males.
00:07:27
So those were in the background
of our considerations,
00:07:31
so still, primarily,
something in the environment
00:07:33
was probably causing this.
00:07:35
NARRATOR: But if the
cause was environmental,
00:07:38
why was Brian Mitchell
sick while his twin sister
00:07:42
Brianna was healthy?
00:07:44
Both slept in the same
room, in the same crib,
00:07:48
ate the same food, and
breathed the same air.
00:07:52
Here, an infant, who had
no outward signs of bleeding,
00:07:56
had had ongoing low grade
bleeding for several weeks,
00:08:00
and yet at any time, she
could have had a stress,
00:08:03
and she would have
bled to death.
00:08:06
So this said to us, not
only frightening for her
00:08:10
but frightening
for the community.
00:08:13
How many infants
like Brianna were
00:08:15
out in the community
that were showing
00:08:17
no real significant problems?
00:08:20
How deep was this iceberg?
00:08:22
NARRATOR: As the
mystery intensified,
00:08:24
so did the fear among parents
in Cleveland's east side
00:08:28
neighborhoods.
00:08:29
The level of pesticides
in the sick babies homes
00:08:32
were all within normal range,
and there was no difference
00:08:36
in air samples collected from
the homes of the sick children
00:08:40
than those collected from the
homes of the healthy infants.
00:08:44
We want to prevent
another death.
00:08:46
We want to prevent another case.
00:08:47
And we didn't know where
to reach out to next.
00:08:50
So I think all the public
health authorities involved,
00:08:52
state, federal,
local, were really
00:08:55
trying to get together
in a think tank
00:08:57
and figure out some answers
because we didn't have any.
00:08:59
NARRATOR: But the data gathered
from the questionnaires
00:09:02
began to reveal some
important information, seven
00:09:07
of the 10 sick children lived
in homes with cigarette smokers.
00:09:12
All of the sick babies
had been bottle-fed,
00:09:14
none had been breastfed.
00:09:17
And all of the sick
babies lived in homes
00:09:20
that had recent water damage.
00:09:22
Was it possible that smoking,
baby formula, or something
00:09:27
in the water was causing
the deadly outbreak
00:09:31
of the bleeding
lungs in infants,
00:09:33
or was it something else?
00:09:39
Dr. Ruth Etzel spent
weeks trying to figure out
00:09:42
what was causing the
mysterious lung bleeding
00:09:46
among infants in Cleveland.
00:09:48
There had been 10 cases
reported so far with one death,
00:09:53
and Etzel was afraid
there would be more.
00:09:57
During the investigation,
Dr. Etzel met with a friend
00:10:00
for dinner.
00:10:01
She was a physician and a fellow
medical detective from Brazil.
00:10:06
She mentioned a lecture she once
attended and couldn't recall
00:10:10
all of the details but said
the lecture described how
00:10:14
mycotoxins caused
the serious illness
00:10:18
of some Brazilian children.
00:10:20
After dinner, Dr. Etzel
rushed to the library
00:10:24
to read all she could
about mycotoxins.
00:10:28
When she cross referenced the
words mycotoxin with the word
00:10:32
hemorrhage, the computer led
to an article about a mold
00:10:36
called Stachybotrys atra.
00:10:40
The article described how
Stachybotrys atra found
00:10:44
in some grain in Europe
over 40 years earlier
00:10:47
caused livestock to
bleed internally and die.
00:10:52
Stachybotrys is a dark green,
almost black, slimey mold.
00:10:58
It often grows on
cellulose-based items,
00:11:01
like straw and
paper, after coming
00:11:03
into contact with the water.
00:11:06
I began to wonder--
00:11:07
if mycotoxins could make animals
sick when they ate grain that
00:11:13
was moldy, could it be
possible that mycotoxins
00:11:16
could make babies sick
if they breathe them in?
00:11:19
NARRATOR: To test
her theory, Etzel
00:11:22
contacted Dr. Bill Sorenson.
00:11:25
He's a mycologist who
had done some research
00:11:28
on the Stachybotrys mold.
00:11:30
Sorenson knew that the only
possible way that Stachybotrys
00:11:33
could get into a
baby's lungs was
00:11:36
by the spores, the tiny, almost
invisible, seed-like structures
00:11:42
which are produced in the mold.
00:11:44
Once the mold dries, the
spores become light and powdery
00:11:49
and can flake away,
traveling great distances
00:11:53
through the air.
00:11:55
And so therefore, it would
be possible, if the spores are
00:11:58
present in large enough
numbers in the homes
00:12:02
and released into the air,
that they could be inhaled
00:12:06
and produce disease symptoms.
00:12:07
NARRATOR: There were
400 different types
00:12:10
of spores found in the
homes of the sick babies.
00:12:14
The spores were placed
on culture plates
00:12:16
and left to grow for 10 days.
00:12:19
When Sorenson analyzed
the culture plates,
00:12:23
he noticed that many contained
a dark green, almost black mold.
00:12:30
Under a microscope,
Sorenson noticed
00:12:33
that the samples from
the Cleveland homes
00:12:36
were structurally
similar to the mold which
00:12:38
killed the livestock in Europe.
00:12:41
It was in fact
Stachybotrys atra.
00:12:45
Investigators now knew that
spores from Stachybotrys atra
00:12:49
were in the air of the
sick babies' homes,
00:12:53
but they needed to know
whether the Stachybotrys
00:12:56
spores in Cleveland contained
the same toxins as those which
00:13:01
killed the livestock in Europe.
00:13:03
To find out, scientists grew the
spores found in the Cleveland
00:13:08
homes in a mixture of rice.
00:13:11
Stachybotrys grows
well in rice because
00:13:14
of the moisture in the grains.
00:13:17
The mold was then
ground and mixed
00:13:20
with a series of solvents
to extract the chemicals
00:13:23
contained in the spores.
00:13:26
Using what is called
high performance liquid
00:13:29
chromatography, the
physical characteristics
00:13:32
of the spore chemicals
were analyzed,
00:13:35
and scientists discovered
that the Cleveland spores were
00:13:38
identical to the highly
toxic mycotoxins that
00:13:42
killed the livestock
in Eastern Europe.
00:13:45
They were a special
class of mycotoxins
00:13:48
called trichothecenes.
00:13:51
The trichothecene
mycotoxins are
00:13:54
among the most potent protein
synthesis inhibitors known.
00:13:58
By that I mean they disrupt
the ability of cells
00:14:02
to make proteins, and without
that ability, a cell will die.
00:14:05
NARRATOR: When scientists
searched the homes
00:14:07
of the sick children,
they found the source
00:14:11
of the Stachybotrys
spores in mold
00:14:14
found growing in the basements.
00:14:17
The mold was found in all but
one of the sick babies homes.
00:14:22
But Stachybotrys was also
found in half the homes tested
00:14:26
where healthy children lived.
00:14:29
If it was Stachybotrys that
caused the death of one
00:14:33
Cleveland infant and the
serious illness of nine others,
00:14:38
why didn't it affect all
of the infants who lived
00:14:42
in homes where it was found?
00:14:48
Spores from the
Stachybotrys atra mold
00:14:51
were found in all but one
of the sick infants' homes
00:14:55
but were also found in half of
the homes of healthy children
00:14:59
living in the same neighborhood.
00:15:02
Scientists wanted to know why
some children developed lung
00:15:06
bleeding while others did not.
00:15:08
They soon discovered that
the number of airborne spores
00:15:12
in the sick babies homes were
far higher than in the homes
00:15:16
of healthy children.
00:15:18
In effect, the
homes of sick babies
00:15:20
contained more spores
and more poison.
00:15:23
Stachybotrys is generally
not considered one of the major
00:15:26
components in indoor
air-- major fungal
00:15:28
components in indoor air.
00:15:30
In fact, it's often
not observed at all.
00:15:32
In a study in Canada,
just a few years ago,
00:15:35
they examined a
few hundred houses,
00:15:36
I don't know the
exact number, but they
00:15:38
saw something like
three colonies
00:15:39
in all of these houses.
00:15:42
We observed levels
as high as 600
00:15:44
coliform units per
cubic meter there
00:15:46
in some of the Cleveland homes.
00:15:48
NARRATOR: Researchers
found the source
00:15:50
of the Stachybotrys spores--
00:15:52
in the basements,
growing on walls,
00:15:55
on boxes, and even on the
insulation behind the walls.
00:16:00
For Stachybotrys to develop,
two things are necessary,
00:16:05
a cellulose product and water.
00:16:08
Researchers discovered that
some heavy rainstorms caused
00:16:12
the sewer system and the
geographic cluster of case
00:16:15
homes to overflow,
which produced flooding
00:16:18
in many of the basements.
00:16:20
In other homes,
the residents said
00:16:23
they had some leaking pipes.
00:16:25
The water was not immediately
cleaned up and soaked
00:16:29
through the drywall and the
insulation inside the walls,
00:16:33
creating the perfect
medium for Stachybotrys
00:16:36
to grow in the warm,
moist, dark environment.
00:16:42
But if the Stachybotrys was in
the basement of these homes,
00:16:46
how did the children come
into contact with the spores
00:16:49
since none of the sick children
had been in the basement?
00:16:53
Researchers discovered
that when the mold dried,
00:16:57
the spores flaked away
and became airborne.
00:17:02
The furnaces of these homes
all drew air from the basement
00:17:06
instead of the upper floors.
00:17:08
The spores were sucked
into the furnace,
00:17:11
traveled through the duct
work, and made their way
00:17:14
into every room of the homes.
00:17:17
Tragically, they were
blown into the rooms
00:17:20
where they could
do the most damage,
00:17:23
into the infant's bedrooms
where the baby spent
00:17:26
most of their time sleeping.
00:17:30
Once inside the infant's
lungs, the spores
00:17:33
released the mycotoxins called
trichothecenes, which prevented
00:17:38
the infant cells from making
the protein needed to hold
00:17:42
their tiny vessels together.
00:17:45
With the vessels now
weak and fragile,
00:17:48
an external trigger may
have caused the tiny vessels
00:17:51
to rupture and bleed.
00:17:53
Since most of the sick
babies lived in homes
00:17:56
with cigarette smoking, this may
have been one of the triggers.
00:18:01
And none of the sick
babies had been breastfed,
00:18:04
leading researchers to
suspect that breast milk
00:18:07
offered some sort of immunity.
00:18:10
Older children and
adults were not
00:18:12
affected by the
Stachybotrys spores
00:18:14
because their lungs
were better developed.
00:18:18
And once researchers found
how the Stachybotrys spores
00:18:22
traveled from the basements
to the children's rooms,
00:18:26
they discovered why little Brian
Mitchell was so much sicker
00:18:30
than his twin sister Brianna.
00:18:33
Although the two slept
in the same crib,
00:18:36
Brian slept closer
to the heating vent,
00:18:39
where he probably inhaled more
spores than his twin sister.
00:18:44
By the time the
investigation was over,
00:18:48
there were over 30 cases
of pulmonary hemosiderosis
00:18:51
in Cleveland, and four
young infants died.
00:18:57
Health officials urged parents
to remove all visible mold
00:19:01
with bleach and
water, and to clean
00:19:04
up water damage
immediately to prevent
00:19:07
the mold from developing.
00:19:09
One year after
this investigation,
00:19:12
the coroner in Cleveland
reopened the files
00:19:15
of 117 babies who
died from what had
00:19:18
been listed as sudden
infant death syndrome.
00:19:22
Lung tissue samples
from their autopsies
00:19:25
were re-examined in
light of what doctors now
00:19:28
knew about Stachybotrys atra.
00:19:31
In six of those samples,
the lung samples
00:19:35
turned blue, an
indication that the babies
00:19:38
had bleeding in their
lungs prior to their death.
00:19:42
Officials believe
that Stachybotrys atra
00:19:45
may have played a role
in those six deaths.
00:19:50
Yolande Prevo is the mother
of one of those six babies.
00:19:55
Knowing the true cause
of her daughter's death
00:19:58
helps bring some closure
to her family's tragedy.
00:20:01
I don't think
that you could get
00:20:02
any worse than this outside of,
literally, going to Hell alive.
00:20:07
There's nothing worse than
this because this is something
00:20:12
you will never ever get over.
00:20:14
And you'll always wonder,
what could I have done?
00:20:18
No matter how many
times you hear it,
00:20:19
there was nothing
you could have done.
00:20:22
I feel remorse.
00:20:24
I feel the pain because I was
standing there at one time,
00:20:29
wondering if my son
is going to die.
00:20:32
NARRATOR: Neema Williams is
thankful that her two children,
00:20:35
Brian and Brianna, both
survived their encounter
00:20:39
with Stachybotrys atra.
00:20:41
When I see a little baby's
face who is doing well,
00:20:46
I think way beyond myself
and thank the help that
00:20:49
has come to all of us in
trying to sort this out
00:20:54
because we didn't do it alone.
00:20:56
Something simple,
but so deadly.
00:21:00
You don't get it.
00:21:01
I mean, mother nature
has a bunch of stuff
00:21:02
out there that we
don't know about yet,
00:21:04
and this was one of them.
00:21:06
[music playing]
