Measuring Urinary Mycotoxins: In Search Of Validation Of A Biomarker For Fungal Illness

Ritchie Shoemaker, David Lark


Beginning in 2010, there have been an increasing number of patients with a chronic multisystem illness who have been using measurements of mycotoxins in urine to diagnose a putative illness for which antifungals in various forms (oral, IV, sublingual and intranasal) are being used as therapy. Many of these patients and providers believe that the illness is caused by fungi living in the human body, making toxins, or has been acquired by exposure to the interior of water-damaged buildings (WDB). This practice persists despite the absence of (i) an accepted case definition; (ii) any validated control groups; (iii) any rigorous case/control studies; (iv) any prospective, placebo- controlled studies; (v) any confirmation of active fungal infection; (vi) any confirmation that urinary mycotoxins are not simply derived from diet; and presence of (vii) a sharp repudiation from the CDC of this practice and the use of antifungals in 2015; and presence of a robust literature demonstrating causation of illness acquired from WDB is inflammatory in causation, not infectious.

This review looks at the extensive published materials, including a definition of mycotoxins; a case definition for illness acquired following exposure to WDB from 2008 US GAO, multiple biomarkers, proteomics, transcriptomics, volumetric CNS imaging studies and more supporting the diagnosis of an active chronic inflammatory response syndrome (CIRS), acquired following exposure to the interior environment of WDB as a validated diagnosis that leads to use of published therapies with documented efficacy. The review also looks at (i) published literature of fungal contamination of foods; (ii) multiple world-wide studies showing contamination of urine with mycotoxins and metabolites in healthy controls finding 21 studies of 2756 controls with range of positive urinary mycotoxins from 60 to 100%; (iii) a tutorial on diagnostic testing for mycotoxins, including mass spectrometry and liquid chromatography; (iv) protective mechanisms to prevent…...


CIRS, antifungals, mycotoxins, TGF beta-1, transcriptomics, ochratoxin A, deoxynivalenol, aflatoxin, trichothecenes, metabolites

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