Doctors discovered that trigger for fatal case of hypersensitivity pneumonitis was likely to have been fungi living inside man’s bagpipes.
Wind musicians have be warned to clean their instruments after a man died from a lung disease triggered by fungi lurking in his bagpipes.
The piper developed a serious inflammation of the lungs, known as hypersensitivity pneumonitis, that worsened over a number of years, leaving him with a dry cough, breathlessness and curtailing the distance he could walk from 10 kilometres to just 20 metres. Eventually, in 2014, the 61-year old was admitted to hospital where he later died.
While the trigger for the disease was initially a mystery, a series of clues led doctors to discover that the cause was most likely a collection of fungi living inside the man’s bagpipes.
The case has led doctors to propose that “bagpipe lung” be added to the long list of alternative monikers for hypersensitivity pneumonitis, which is already known as “bird fancier’s lung”, “farmer’s lung” and even “hot tub lung” after the wide range of activities to which it has previously been linked.
“[Musicians] need to be aware that there are risks that instruments can become colonised with mould and fungi and this can be related to serious and potentially fatal lung disease,” said Dr Jenny King, first author of the study, of North Manchester general hospital.
She added that the warm, moist environment of wind instruments is an ideal breeding ground for such organisms. “Wind instrument hygiene is really important in preventing this and [musicians] should be stringent in cleaning their instruments regularly.”
Writing in the journal Thorax, King and colleagues from the University Hospital of South Manchester warn that wind players should disinfect their musical instruments regularly with a brush and detergent. “Physicians should be aware of this potential risk factor and promote wind instrument hygiene,” they add.
The case of the 61-year-old man initially baffled doctors, with common triggers of the lung disease, such as bird-keeping and household mould, ruled out.
However, a clue appeared after the patient was admitted to hospital in 2014. Examining his history, the medical team discovered that the man had spent three months in Australia in 2011, during which time his health bounced back, before once again deteriorating upon his return to the UK.
Close scrutiny of his habits offered a lead. During his trip to Australia the man had temporarily abandoned his daily custom of playing the bagpipes, but had returned to playing them every day once back in the UK.
An investigation of the bag, neck, stock and reed protector of the instrument yielded even stronger evidence that the bagpipes were at the root of the problem. “We isolated mould and fungi that are known to be associated with hypersensitivity pneumonitis and propose that was the likely cause of it,” said King. “It is likely [down to] spores from the fungi and mould that, when you inhale them, your body and your immune system react to them,” she said, adding that while not everyone would be susceptible to the spores, it is hard to predict who was likely to experience a reaction.
It is not the first time that bagpipes have been hailed a health hazard. In 2013 the Glasgow-based College of Piping issued a warning after expert piper John Shone fell seriously ill with symptoms of breathlessness and weakness. Eventually it was discovered that he was suffering from a fungal infection that was triggered by organisms lurking inside his bagpipes. “It was very much life-threatening,” Shone, a former competing piper, told the Guardian. “I was near death.”
Shone recovered with treatment but he says not enough is done to warn players of the dangers that could be lurking in their pipes. “In the leather bagpipes we use what was called a seasoning in the bag, and that seasoning in fact has [an] antiseptic property,” he said. Seasoning, he points out, is not used in bagpipes made from modern materials as they are already airtight; this necessitates regular cleaning, which modern bagpipes are designed to facilitate.
Robert Wallace, an award-winning professional bagpiper and editor of the Royal Scottish Pipe Band Association’s magazine, said that pipers should not panic.“It’s extremely rare,” he said of the incident. “However that doesn’t mean to say we should drop our guard.”
Since his brush with death Shone says he has bought a new set of pipes and is careful to disinfect them. But doctors say it is not only pipers who should heed the warning to clean their instruments, highlighting previous reports of a saxophone and a trombone player with symptoms of hypersensitivity pneumonitis. Both musicians recovered after cleaning their instruments.
Dr Tamara Everington of Hampshire Hospitals NHS Foundation Trust, who treated Shone, says that musicians should be aware of possible health implications of their instruments. “We spend a lot of time thinking about the technical aspects of the instrument, but we don’t spend enough time thinking about the impact on our own bodies,” she said. “If you think about them and address them early on then you have the chance of being able to play your instrument for many years and get great pleasure from it.”