Orbicularis oris

Orbicularis Oris (or Orbicillium) is a genus of fungi with over 500 species worldwide. Most commonly known as the “black mold”, it grows in moist places such as basements, crawl spaces, attics and sewers. The fungus produces white spores which are released into air when touched by moisture. These spores are then inhaled and cause respiratory infections. People become infected if they come in contact with the spores while they are still airborne. The infection may spread from person to person through direct contact or indirectly by touching contaminated surfaces such as clothing, bedding, etc. Symptoms include fever, chills, headache, muscle aches and weakness along with breathing difficulties. The disease progresses rapidly and usually kills within 3 weeks after symptoms appear.

The fungus is found throughout the world, but especially in North America, Europe and Australia. There have been cases reported in Asia, Africa and South America. Orbicularis oris is not considered dangerous to humans unless it causes an outbreak.

However, it is possible for people to get sick from ingesting spores if they are inhaling them during coughs or sneezes.

In the United States there were several outbreaks of orbicularis oris between 2005 and 2008. The first reported case was in the month of July in a family living in a condominium in California. The family consisted of a mother and her three children ranging in age from 8 months to 3 years.

All four were diagnosed with the condition. While covering their faces doctors had told the family that it was not contagious, but they should stay inside their unit and avoid having contact with other people. Due to the fact that their disease appeared suddenly and without warning, the health department was called to investigate. While taking a mold sample from the house, they also collected several pieces of play equipment in the backyard belonging to the family. These samples were sent to a lab for testing.

A week later, twelve other children living in three separate houses in California came down with symptoms similar to those experienced by the four members of the first family. All of the children had been playing with a toy slide in their own backyards. The lab tests confirmed that this slide, like the other play equipment taken from the first family’s home, was contaminated with multiple strains of the fungus.

All thirteen children survived, but were kept in isolation for a period of six weeks while doctors waited to see if any further symptoms would appear. None did, and they were allowed to return home after receiving a clean bill of health. The infected slide was taken to a landfill.

After the first two outbreaks, mold was found in the carpets and wall-to-wall carpeting of all thirteen homes. In every case the fungus was found in areas where the children had been playing or napping within the past 48 hours. The fungus was not found in other parts of the house, such as kitchens or bathrooms.

In January of 2008 three employees at a steel factory in Ohio came down with orbicularis oris after using a piece of machinery which had been contaminated with the fungus. In this instance, the mold was traced back to the factory air conditioning system. All three workers survived and returned to work after a five week recovery period.

The last known case of the fungus infecting humans was in July of 2008 when a grocery store in Kentucky was found to be infested with it. Fifteen people who had been customers at the store within the past two weeks came down with the symptoms. Once again, every case involved people who had been in the store’s produce section.

The grocery store was closed for two weeks while a thorough cleaning took place. There have been no further cases since the store’s reopening.

In analyzing these six cases, health officials have determined that, in general, orbicularis oris is found in moldy areas in which vegetation is growing. In most cases it seems to prefer damp areas with a lot of foliage, such as the backyard play areas in the California cases and a grocery store’s produce section. Many types of mold and fungi thrive in these conditions, and it is possible that other types of mold may also cause orbicularis oris in humans.

More research will have to be done in this area.

The way the fungus spreads from one person to another is still somewhat of a mystery as well. It is believed that the mold may produce a toxic substance (or substances) which can be inhaled or perhaps even absorbed through the skin. In the case of the factory employees in Ohio, the fungus was spread through the air conditioner and probably entered their bodies through their lungs.

In the case of the Carlsbad residents, it is likely that the fungus spread through contact with another infected person’s saliva.

These cases also highlight the importance of heeding public health warnings. It is fortunate that their were no fatalities in any of these cases. Had the California residents refused to evacuate their homes, or had the factory employees ignored safety procedures, the results could have been very different.

So far orbicularis oris is not known to infect any other animals other than humans. Officials caution pet owners to be careful when letting their animals outside, especially in wooded or overgrown areas, as they may be at risk of coming into contact with the fungus.

The final mystery in all of this, is how a fungus came to spread from person to person in the first place. Fungi are not known to display this type of behavior, and it is unknown how the orbicularis oris fungus came to develop this trait.

If you think you may have symptoms of orbicularis oris, seek medical attention immediately.

No further cases have been reported since the last outbreak in 2008.

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Sources & references used in this article:

The orbicularis oris muscle: a functional approach to its repair in the cleft lip by PJ Nicolau – British journal of plastic surgery, 1983 – Elsevier

Associations between anterior temporal, masseter, and orbicularis oris muscle activity and craniofacial morphology in children by AA Lowe, K Takada – American journal of orthodontics, 1984 – Elsevier

The importance of accurate repair of the orbicularis oris muscle in the correction of unilateral cleft lip by CG Park, B Ha – Plastic and reconstructive surgery, 1995 – journals.lww.com

Anatomy of the orbicularis oris muscle in cleft lip by A De Mey, I Van Hoof, G De Roy, M Lejour – British journal of plastic surgery, 1989 – Elsevier

Enzyme-histochemical and morphological characteristics of muscle fibre types in the human buccinator and orbicularis oris by P Stål, PO Eriksson, A Eriksson, LE Thornell – Archives of Oral Biology, 1990 – Elsevier

Morphology of the mentalis muscle and its relationship with the orbicularis oris and incisivus labii inferioris muscles by MS Hur, HJ Kim, BY Choi, KS Hu… – Journal of Craniofacial …, 2013 – journals.lww.com