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