drcameronjones

Science is all about observation and forming hypotheses to answer questions. For scientists like myself, I’m interested in how the environment affects health, and specifically, how water damaged buildings and exposure to poor indoor air quality can affect quality of life. For this week on The Mould Show we're going to be talking about fungal mycotoxins and myalgic encephalomyelitis termed ME for short and chronic fatigue syndrome (ME/CFS). The reason I've chosen this topic is that I've met a family whom I've now done three separate mould inspections for. Why this is unusual is that the symptoms experienced by the female occupant and her daughter are classic ME/CFS symptoms. Across all 3 of the different properties hidden mould problems were discovered. That information in itself was useful for this family and helped them to break their lease due to the fact that there was verified mould present. However, that's not the point of this podcast and even the positive mould confirmation as an environmental trigger didn’t help the mother and daughter from understanding why they reacted so strongly when indoors. They thought they were going crazy, since how could 3 different properties cause them so much trouble? They couldn’t understand why some buildings caused no issues, and the 3 they’d chosen to rent all set them off? This has bothered me all year. I know mould is a huge issue for some people – but what exactly might be going on for THIS family? On a side note, I'm an avid reader and through the COVID pandemic I've enjoyed the increasing number of authors who choose to publish on a newsletter type subscription service termed Substack. One of these authors published a very interesting article in May this year focusing on his experience with chronic pain and ME/CFS and how after 25 years of suffering, he discovered by chance, following a recommendation from a friend to read a book that talked about the connection between ME and chronic fatigue syndrome and mitochondrial dysfunction. So that is the true focus of the topic today. • Could exposure to fungal mycotoxins be the reason why they were tired and experiencing pain? • Could this be the reason you’re tired? Is this another aspect to environmental illness? • And could this be classified as Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS)? • Are there any patient-specific tests to verify ME/CFS or mould exposure and what can be done to alleviate the symptoms? Firstly, let's define what ME/CFS is. There are three core symptoms + at least one or more other symptoms which include: 1. an inability to participate in routine activities that would have been possible before becoming ill and that lasts for greater than six months. 2. the fatigue which is also a primary symptom tends to worsen after physical, mental or emotional effort. 3. and does not resolve after sleep, termed ‘unrefreshing sleep’. Other problems include: a) an inability to concentrate or memory impairment and/or b) something called orthostatic intolerance. Which means that when people stand up, they feel lightheaded or dizzy and can even faint. The family that moved into those three different properties all complained that after a few days of occupying the mould contaminated building the wife especially experienced episodes of unexpected fainting and collapsing into her husband's arms. Those 3 inspections coupled with reading the Substack article led me to investigate further whether there was any published literature, focusing on exposure to fungal cells or their mycotoxins in the ME/CFS literature. Very recently a publication appeared in the International Journal of Environmental Research and Public Health that has looked at exactly this topic. These scientists looked at the levels of Aspergillus toxins like aflatoxin, ochratoxin, and gliotoxin in the urine of 236 ME/CFS patients who had a known exposure to mould from water damaged buildings. The evidence from two types of urine mycotoxin testing from Real Time Laboratories as well as from the Great Plains Laboratories revealed that 92.4% of ME/CFS patients who had exposure to water damaged buildings had mycotoxin evidence in their urine, with ochratoxin being the most prevalent. This study is extremely important because it validates what many of us mycologists and microbiologists have known for many years - that exposure to water damaged buildings leads to mould exposure and that it is the mycotoxins and not just the intact cell which contribute to adverse health. In this Livestream, I'll also be extending on the concept of mitochondrial dysfunction and we'll be looking at three additional publications which have looked at how the individual can improve their mitochondrial activity for better health. Watch the Livestream or listen to the podcast for further information on how nutritional supplements like cocoa flavanols or astaxanthin, resveratrol and even functional phenolics like quercetin, curcurmin, melatonin and even selected tea’s can be used to improve cellular mitochondrial activity. Examples are cited from the exercise literature and from contemporary anti-ageing research. It looks like ME/CFS is strongly influenced by not just bacterial, fungal or viral infections or from toxic man-made chemicals – but that commonly encountered mycotoxins should be added to the list of triggers. From an integrative perspective, functional foods and targeted use of nutraceuticals, together with healthy lifestyle choices, may help support mitochondrial biology and in turn promote better health. REFERENCES: Rogers, T. (2022). Chronic pain, ME/CFS, "post exertional malaise", what is killing the mitochondria, wrong theories of the case, and the slide into the metaverse. Retrieved 26 June 2022, from https://tobyrogers.substack.com/p/chronic-pain-mecfs-post-exertional Wu, T.Y.; Khorramshahi, T.; Taylor, L.A.; Bansal, N.S.; Rodriguez, B.; Rey, I.R. Prevalence of Aspergillus-Derived Mycotoxins (Ochratoxin, Aflatoxin, and Gliotoxin) and Their Distribution in the Urinalysis of ME/CFS Patients. Int. J. Environ. Res. Public Health 2022, 19, 2052. https://doi.org/10.3390/ijerph19042052 Daussin FN, Cuillerier A, Touron J, Bensaid S, Melo B, Al Rewashdy A, Vasam G, Menzies KJ, Harper ME, Heyman E, Burelle Y. Dietary Cocoa Flavanols Enhance Mitochondrial Function in Skeletal Muscle and Modify Whole-Body Metabolism in Healthy Mice. Nutrients. 2021 Sep 29;13(10):3466. doi: 10.3390/nu13103466. PMID: 34684467; PMCID: PMC8538722. https://pubmed.ncbi.nlm.nih.gov/34684467/ Lewis Luján LM, McCarty MF, Di Nicolantonio JJ, Gálvez Ruiz JC, Rosas-Burgos EC, Plascencia-Jatomea M, Iloki Assanga SB. Nutraceuticals/Drugs Promoting Mitophagy and Mitochondrial Biogenesis May Combat the Mitochondrial Dysfunction Driving Progression of Dry Age-Related Macular Degeneration. Nutrients. 2022 May 9;14(9):1985. doi: 10.3390/nu14091985. PMID: 35565950; PMCID: PMC9104458. https://pubmed.ncbi.nlm.nih.gov/35565950/ Gonçalves AC, Gaspar D, Flores-Félix JD, Falcão A, Alves G, Silva LR. Effects of Functional Phenolics Dietary Supplementation on Athletes' Performance and Recovery: A Review. Int J Mol Sci. 2022 Apr 22;23(9):4652. doi: 10.3390/ijms23094652. PMID: 35563043; PMCID: PMC9102074. https://pubmed.ncbi.nlm.nih.gov/35563043/ Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of High-Consequence Pathogens and Pathology (DHCPP). June 1, 2022. https://www.cdc.gov/me-cfs/index.html What is ME/CFS?. ME/CFS Australia Ltd. https://mecfs.org.au/about-mecfs/what-is-mecfs/ Myhill, S. (2018). Diagnosis and Treatment of Chronic Fatigue Syndrome and Myalgic Encephalitis, 2nd ed. - Chelsea Green Publishing. Retrieved 26 June 2022, from https://www.chelseagreen.com/product/diagnosis-and-treatment-of-chronic-fatigue-syndrome-and-myalgic-encephalitis/ Pizzorno J. Mitochondria-Fundamental to Life and Health. Integr Med (Encinitas). 2014 Apr;13(2):8-15. PMID: 26770084; PMCID: PMC4684129. https://pubmed.ncbi.nlm.nih.gov/26770084/

This week on The Mould Show we're going to be looking at the gut microbiome and in particular some emerging research that is showing that the diversity of microorganisms found in the gut may be linked to different immune responses and may even affect the pathogenesis of conditions like multiple sclerosis, MS. I'll be reviewing two of the dominant papers in the MS literature around gut microflora and looking at this concept of species diversity. In these papers the scientists looked at the number of different microorganisms between healthy controls and MS patients. Multiple sclerosis is a neuro inflammatory autoimmune disease known to affect two and a half million people worldwide with most patients experiencing what is termed relapsing remitting Multiple Sclerosis which as the name suggests shows periods of stasis punctuated with symptoms but overwhelmingly moves towards more frequent symptoms as the disease progresses. There are currently no known treatments for MS. However, there is an abundant literature showing that healthy lifestyle factors such as no current smoking, a healthy diet regular exercise and maintaining a low body mass index all help reduce symptoms. The two papers we're looking at today ask the question: Are there some fungi that can be measured in the gut that are correlated with MS and healthy controls? Essentially, what is the role that microbiology plays in MS?. These two papers strongly suggest that bacterial and fungal diversity is indeed connected and can differentiate healthy controls from MS patients. This research is exciting because it offers the opportunity not only for individualized testing as a risk predictor, but also the opportunity for individualized dietary modifications to be made to change the composition of the gut microflora. Both papers determined that fungi like Candida, Epicoccum, Malassezia and Saccharomyces all seem to show statistical relationships that could be a value to predict or at least classify individuals into different risk categories. Interestingly, when we drill into the literature and look at the species diversity for Saccharomyces which is a typical yeast found in breads and grains there is another set of literature that has looked at the gut microbiota and the day 28-day mortality for critically ill patients admitted to hospital. Of course, many of the underlying reasons for hospital admission includes chronic lung disease, chronic heart disease, immunosuppression, active cancer and acute kidney injury. Nevertheless, when sampling was performed, they found clear evidence that species diversity in the gut was predictive for which patients survived versus those that died? So, what to make of these facts? Well, there is opportunity to look at what readily available compounds might be used nutritionally or therapeutically, to mitigate, delay, or reverse these diseases? One of the compounds being actively researched is called Astaxanthin and is commonly found in shellfish and lobsters and green micro algae. It’s been shown to not only possess anti-microbial or antibiotic type activity but there is emerging research it can be used for a range of neurodegenerative diseases, including stroke, multiple sclerosis, Alzheimer’s and even conditions like chronic fatigue syndrome. This research into use of astaxanthin suggests that even if it cannot be used as a topical anti-microbial (due to high dosage), it may exert its beneficial effect by altering the composition of the gut microflora at lower dosage. Other elegant research has looked at how astaxanthin has been able to protect the myelin sheath in Multiple Sclerosis models in rats. This research strongly suggests that astaxanthin exerts its effect because they help reduce inflammation and oxidative stress. We can only hope that more research into the therapeutic effects of natural compounds like astaxanthin may lead towards wide-spread use of targeted dietary modifications. This could result in near term benefit for a range of people suffering immune mediated neurodegenerative conditions and that’s a win for all. Yadav, M., Ali, S., Shrode, R. L., Shahi, S. K., Jensen, S. N., Hoang, J., Cassidy, S., Olalde, H., Guseva, N., Paullus, M., Cherwin, C., Wang, K., Cho, T., Kamholz, J., & Mangalam, A. K. (2022). Multiple sclerosis patients have an altered gut mycobiome and increased fungal to bacterial richness. PloS one, 17(4), e0264556. https://doi.org/10.1371/journal.pone.0264556 Shah, S., Locca, A., Dorsett, Y., Cantoni, C., Ghezzi, L., Lin, Q., Bokoliya, S., Panier, H., Suther, C., Gormley, M., Liu, Y., Evans, E., Mikesell, R., Obert, K., Salter, A., Cross, A., Tarr, P., Lovett-Racke, A., Piccio, L. and Zhou, Y., 2021. Alterations of the gut mycobiome in patients with MS. EBioMedicine, 71, p.103557. https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(21)00350-9/fulltext

Imagine that at your workplace - you move to new offices and these offices are sited partially below ground level. Within three months of moving into the new offices, every person who works there has started to suffer from symptoms that consistent with exposure to a water damage buildings and are reacting to the microbes and moulds that are commonly found in these environments. When the symptoms became unbearable, the office staff started looking for answers. This week on The Mould Show, I'm going to be reviewing the research results that carefully examined each of those office workers to work out two things: Firstly, was the building contributing something toxic that the workers were being exposed to? And secondly, how could this be best measured by the medical doctors who were involved? This publication looks at whether or not immunosuppression and adverse events can be measured. And if so, how does one go about doing this? This publication appeared on the 21st of January 2022 in the Journal of Fungi: Toxic Indoor Air Is a Potential Risk of Causing Immuno Suppression and Morbidity-A Pilot Study. What the scientists did was examine both the patient (that is the occupants of the workplace), and they also looked at the building to see what type of toxins and microbes could be detected. The purpose of the research was how to prove causality between the symptoms experienced by the workers and exposure to the toxic indoor air. But the scientists weren't satisfied with just using microbiological technique to measure for mould, because it's well recognized that even though these tests are very sensitive and accurate to measure mould spore levels in the air - they can often miss the breakdown fragments of microbes that grow on water damaged buildings. And therefore, this very exciting research from Finland has implemented a new method to assess toxicity indoors, which looks at collecting condensed indoor air water vapour and test that. Now what does this mean? Well, essentially, they have devised and patented a method of rapidly collecting water vapor out of the air but again, how did they do this? The Finnish scientists used three toxicity test methods to see how the indoor air might be compromised. The first one was to use THP-1 macrophages. The next type of test they used to assess for toxicity in vitro wants to use baby hamster kidney cells or BHK-21 cells. These are commonly used to study viral infections, but they can also be used to determine the sensitivity to a drug or to a virus. the third type of toxicity assessment the Finnish scientists used was boar sperm. And this is a bio sensor-type test for detecting toxins in indoor dusts and bioaerosols. The reason it works is because sperm are highly dependent on mitochondria for energy, and therefore any drug that can be tested for how it might interfere with motility sheds light on interference with mitochondria. If we drill into one of the key tables in the Finnish research, we find that of course, various different toxins picked up in the mycotoxin screening panel, like Ochratoxin were present in each of the workers who worked in this new office location. But of extreme interest is a new biomarker called Mycophenolic acid, and this also was present in almost all of the individuals who worked in this particular office. Now, you need to remember that because large volumes of indoor air are inhaled every day, this air contains water vapor. And when the relative humidity indoors and temperature increases, the levels of mycotoxins that are inhaled will also increase. So this type of research is contributing cutting edge new knowledge about the different toxins that are being inhaled, along with the more common fungal particulates, like mould spores together with the PM2.5 and PM10 cell wall fragments from fungi. But what about all those people who are working in water damage building interiors? We know if they're being exposed to particulate matter, like mould spores and cell fragments, from typical indoor air quality tests like spore traps, biotape lifts or direct microbiology from the air or surfaces onto Petri plates. But many of the mycotoxins can also be measured in urine? Thanks to this breaking research, there are other, new biomarkers like mycophenolic acid – which is tested from the water vapour indoors. In turn, what do you think the contribution is to adverse health from mycophenolic acid exposure? The Finnish data shows that mycophenolic acid reduces immune function and the other types of in vitro tests showed that macrophages activity is reduced and that mitochondrial activity is increased, but also that bore sperm motility is interfered with. Vaali K, Tuomela M, Mannerström M, Heinonen T, Tuuminen T. Toxic Indoor Air Is a Potential Risk of Causing Immuno Suppression and Morbidity-A Pilot Study. J Fungi (Basel). 2022 Jan 21;8(2):104. doi: 10.3390/jof8020104. PMID: 35205859; PMCID: PMC8877819. https://pubmed.ncbi.nlm.nih.gov/35205859/

I'm often asked whether mould affects children's health? I thought this would be an appropriate topic to kick off the new year for The Mould Show in 2022. In approaching this topic, I'm going to review some of the key symptoms associated with exposure to mould and then provide you with an easy visual guide that you can use to not only remember the typical mould symptoms, but the causes and effects but that may be helpful when describing indoor air quality issues in your home or workplace. We all know that unexpected weather increasingly contributes to mould problems indoors in addition to water leaks and home dilapidation problems. In turn, most of us understand that moulds grow on wet surfaces and release their spores into the air. It’s important to remember that mycotoxin levels inside water damaged buildings are sometimes 1000-fold higher than the mould count. It's also known that 50% of fungal growth can be hidden and is missed by mould testing according to the EPA. To look at the health effects of mould on children, I’ll draw your attention to the first paper The authors review a study from Harvard University looking at 13,369 children aged between 8 and 12 years where they found that mould was growing in up to 50% of the homes and between 3 and 11% of children had asthma. By comparison, a Russian study showed that for 5951 children having mould in the home and water damage, there was a positive association with symptoms of asthma, dry cough wheezing and bronchitis. Another important paper in titled The Brain and Mycotoxins by Dr. Andrew Campbell. He talks about how mycotoxins can affect the brain and how research supports a connection with autism spectrum disorder, multiple sclerosis, and dementia and Alzheimer's. Dr. Campbell stresses the importance of talking with your medical practitioner about blood serum testing for mycotoxin antibodies using the ELISA test. He stresses that urine testing for mycotoxins does not mean the person is suffering from any disease or disorder linked to mould or mycotoxins. The third paper I want to talk about is examining the impact of mould contamination in early, gestational and postnatal periods. I will be reviewing a paper from Poland that looked at the association between mould exposure and IQ. To do this, we first need to define what the odds ratio is and how this is connected with the confidence interval, which simply means the span where 95% of the observation data points fall on either side of the population mean. The OR is a way to present the strength of association between risk factors/exposures and outcomes. If the OR is <1, odds are decreased for an outcome; OR >1 means the odds are increased for a given outcome. OR=1 Exposure does not affect odds of outcome OR>1 Exposure associated with higher odds of outcome OR<1 Exposure associated with lower odds of outcome The Polish research was looking at what the exposure effect for living with mould was on the cognitive development in children. They examined the cognitive function of 277 babies at 6 years of age. A survey was conducted to evaluate the extent of visible mould on indoor walls monitored at different intervals over the postnatal stages after birthing and up to 5 years. This was assessed using the Wechsler Intelligence Scale for children. They determined that where mould exposure to indoor moulds occurred for greater than two years. children scored significantly lower on the IQ scale with an odds ratio of 3.53 which more than tripled the risk of low IQ scoring. Put another way: “The odds of having a lower IQ is 3.4 times higher if the child experienced mould during early life for more than 2 years as opposed to not experiencing mould”. This paper demonstrates the harmful effects of early pre- and postnatal exposure to indoor moulds on children's cognitive development and emphasizes the importance of the living environment on human cognitive development. REFERENCES: Campbell AW, Watson P. Mold, Mycotoxins, and their Effects in Children. Altern Ther Health Med. 2021 Jan;27(1):8-10. PMID: 33609089. Campbell AW, Decena K. The Brain and Mycotoxins. Altern Ther Health Med. 2020 Nov;26(6):8-11. PMID: 33609092. Campbell AW. Molds and Mycotoxins: A Brief Review. Altern Ther Health Med. 2016 Jul;22(4):8-11. PMID: 27548484. Theoharides TC. Mold and Immunity. Clin Ther. 2018 Jun;40(6):882-884. doi: 10.1016/j.clinthera.2018.05.005. Epub 2018 May 30. PMID: 29859636. Spengler JD, Jaakkola JJ, Parise H, Katsnelson BA, Privalova LI, Kosheleva AA. Housing characteristics and children's respiratory health in the Russian Federation. Am J Public Health. 2004 Apr;94(4):657-62. doi: 10.2105/ajph.94.4.657. PMID: 15054021; PMCID: PMC1448314. Jedrychowski W, Maugeri U, Perera F, Stigter L, Jankowski J, Butscher M, Mroz E, Flak E, Skarupa A, Sowa A. Cognitive function of 6-year old children exposed to mold-contaminated homes in early postnatal period. Prospective birth cohort study in Poland. Physiol Behav. 2011 Oct 24;104(5):989-95. doi: 10.1016/j.physbeh.2011.06.019. Epub 2011 Jul 8. PMID: 21763705; PMCID: PMC3758954. Szumilas M. Explaining odds ratios [published correction appears in J Can Acad Child Adolesc Psychiatry. 2015 Winter;24(1):58]. J Can Acad Child Adolesc Psychiatry. 2010;19(3):227-229. Wong CT, Wais J, Crawford DA. Prenatal exposure to common environmental factors affects brain lipids and increases risk of developing autism spectrum disorders. Eur J Neurosci. 2015 Nov;42(10):2742-60. doi: 10.1111/ejn.13028. Epub 2015 Sep 19. PMID: 26215319.

Fungi grow everywhere, including the soil, in water and on plants on us, and in other organisms and of course inside our homes. Back in the 1990s people thought there were about 1.5M fungi on earth because only some of them had been described. However, more recent genetic sequencing tools put the total number of fungal species on Earth at over 5 Million. When we think about research on fungal diversity it’s a bit like the concept of the microbiome in our gut and similarly is referred to as the mycobiome. The purpose of today's talk is to discuss the relationship that we have with fungi in the built environment or the mycobiome of our homes. To do this, I want to focus attention on a groundbreaking pre-print paper that came out on the 16th of December 2021 on medRxiv. This looked at the relationship between specific types of fungi and how Species diversity can be used to predict the seriousness of influenza type infections like COVID-19 mortality. When you think about the over 5M fungal species that exist on the planet and juxtapose this against the approximate 2000 mushrooms species we might eat as food - there really are a lot of chance and probable possibilities for us to come into contact with these microorganisms in our everyday lives. This new paper that came out from the Lawrence Berkeley National Laboratory is quite an eye-opener because it looked at how fungal communities inside 1135 homes in the United States is connected with something called the Infection Fatality Ratio (IFR) which describes the number of deaths caused by COVID-19 per 1000 coronavirus infections. Their research showed that an increased fungal diversity especially for specific Species of indoor fungi versus outdoor fungi (Beta diversity) was associated with a reduced infection fatality ratio. Their hypothesis was premised on the known fact that (i) humans probably have an evolutionary adaptation to maintaining semi-stable close contact with microbes such as fungi without major adverse impact. As well, (ii) it’s known that early life exposure to certain types of bacteria, yeasts, and fungi actually stimulates the immune system. In their paper, they looked at whether there was a correlation between certain Species of fungi and adverse outcomes from COVID? And amazingly they found that “yes” there is! They found that something called the beta diversity assessed from a comparison between fungal spore types collected outdoors and then inside the home living environment was of fundamental importance. To understand this concept, I need to explain what beta diversity is because this is a basic principle needed to understand this publication. [This presentation and the references in the show notes below detail exactly how to do this]. However, the key result is that: high diversity of outdoor fungi when also present indoors is associated with a suppression effect for COVID-19 mortality. This means that collecting spore trap measurements from the outdoors and indoors is very important for predicting adverse events like mortality from COVID-19 and emphasizes the importance of the environment on human illness. Now it’s not just the raw numbers of fungi, but the overlap of which types are present outdoors and also found indoors which defines different aspects of Species richness and diversity. The research showed that at least four of the following seven fungal genera have a key role in suppressing coronavirus infections. These were: Alternaria, Aspergillus, Epicoccum, Eurotium, Toxicocladosporium and Wallemia as well as a novel Mycosphaerellaceae fungus. You could argue that simply airing out your property will naturally bring fresh outdoor air containing mould spores indoors. So, wouldn’t that automatically select for the correct beta diversity ratio that’s better for your health? On the surface, you'd be right to conclude this. However, I've personally done 1000s of indoor air quality inspections over the years and many homes have hidden mould problems that contribute to poor indoor air quality. This is often caused by water damage and dampness and in most of these cases, there is a skewed distribution of fungi indoors that’s very different to the outdoors. This publication is extremely important because it shows a correlation effect between bioaerosol counts especially mould spores and respiratory disease outcomes. The key takeaway here is that COVID-19 mortality is suppressed inside homes where the outdoor fungi occur indoors at very similar levels. When the skewness or difference between the outdoor: indoor diversity changes, or when the indoor fungi are significantly different to the outdoors, then COVID-19 mortality increases. These researchers found that fungal beta diversity was a much stronger correlate for adverse COVID-19 outcome as age. For example, older persons have worse COVID-19 outcomes, and this paper says that fungal beta diversity in the wrong direction is also bad for your health. The authors stress the method is unlikely to be restricted only to coronavirus but could extend to surveillance of other allergic and viral diseases. This research, therefore, underscores the importance of fungal biosurveillance in the built environment to improve public health outcomes. REFERENCES: The impact of environmental mycobiomes on geographic variation in COVID-19 mortality. December 16, 2021. Joshua Ladau, Katrina Abuabara, Angelica M. Walker, Marcin P. Joachimiak, Ishan Bansal, Yulun Wu, Elijah B. Hoffman, Chaincy Kuo, Nicola Falco, Jared Streich, Mark J. van der Laan, Haruko M. Wainwright, Eoin L. Brodie, Matthias Hess, Daniel Jacobson, James B. Brown medRxiv 2021.12.14.21267549; doi: https://doi.org/10.1101/2021.12.14.21267549 Blackwell M. The fungi: 1, 2, 3 ... 5.1 million species? Am J Bot. 2011 Mar;98(3):426-38. doi: 10.3732/ajb.1000298. Epub 2011 Mar 2. PMID: 21613136. Li, H., Tian, Y., Menolli, N., Ye, L., Karunarathna, S., & Perez‐Moreno, J. et al. (2021). Reviewing the world's edible mushroom species: A new evidence‐based classification system. Comprehensive Reviews In Food Science And Food Safety, 20(2), 1982-2014. doi: 10.1111/1541-4337.12708 Koenigsberg, A. (2021). How to Calculate Species Evenness. Retrieved 23 December 2021, from https://sciencing.com/calculate-species-evenness-2851.html Bezerra JDP, Sandoval-Denis M, Paiva LM, et al. New endophytic Toxicocladosporium species from cacti in Brazil, and description of Neocladosporium gen. nov. IMA Fungus. 2017;8(1):77-97. doi:10.5598/imafungus.2017.08.01.06 Sandoval-Denis M, Sutton DA, Martin-Vicente A, Cano-Lira JF, Wiederhold N, Guarro J, Gené J. Cladosporium Species Recovered from Clinical Samples in the United States. J Clin Microbiol. 2015 Sep;53(9):2990-3000. doi: 10.1128/JCM.01482-15. Epub 2015 Jul 15. PMID: 26179305; PMCID: PMC4540897. Videira, S., Groenewald, J., Nakashima, C., Braun, U., Barreto, R., de Wit, P. and Crous, P., 2017. Mycosphaerellaceae – Chaos or clarity?. Studies in Mycology, 87, pp.257-421. Baselga, A., 2015. What is Beta Diversity?. [online] Methods Blog. Available at: [Accessed 23 December 2021].