麻豆传媒

Musicians who play wind instruments are at risk for a potentially fatal inflammatory lung condition that is being called "bagpipe lung," researchers suggested.

Thorax, British researchers described the case of a 61-year-old bagpipe player who died of the interstitial lung disease hypersensitivity pneumonitis (HP), which appeared to be caused by regularly breathing in mold and fungi which thrived in the moist interior of his musical instruments.

HP is triggered by repeated exposure to airborne bacteria, fungi or molds found in the environment. More than have been shown to cause the disease.

Farmers, bird and poultry handlers, veterinary workers, and grain processors have all been previously identified as having an increased risk for the interstitial lung disease. There have also been isolated reports of musicians developing the disorder, including and players, which resolved when players began routinely cleaning their instruments.

But the case is the first to link specific fungal contamination in a musical instrument to fatal HP.

"Clinicians need to be aware of this potential trigger for developing HP and wind instrument players need to be aware of the importance of regularly cleaning their instruments to minimize this risk," researcher , of the University Hospital of South Manchester (UHSM) in England, and colleagues, wrote.

The case patient was referred to the interstitial lung disease clinic at UHSM in April of 2014 with a 7-year history of dry cough and progressive dyspnea despite immunosuppressive therapy. The man had been diagnosed with HP based on high-resolution CT and biopsy findings from a referring hospital.

"He did not have any exposure to birds or pigeons. His house showed no evidence of mould or water damage, and he had no symptoms of connective tissue disease," the researchers wrote. "The precipitating trigger for his HP was unknown."

The man's symptoms were progressive, with the exception of a three-month period in 2011 when he resided temporarily in Australia, during which his condition improved greatly.

He was a lifelong nonsmoker who played the bagpipes daily, but he did not take his bagpipes to Australia. Upon returning to Britain, the man resumed his practice of playing his bagpipes daily, despite severe lung function restriction.

In September of 2014 he was admitted to the UHSM facility with deteriorating symptoms, and he was found to be afebrile, hypoxic and tachypneic.

Despite treatment, the patient continued to deteriorate, and he died in early October of 2014. Postmortem examination revealed diffuse alveolar damage consistent with acute respiratory distress syndrome and interstitial fibrosis, which was attributed to his history of chronic HP.

Prior to the man's death, samples were taken from his bagpipes which grew a number of fungi including Paecilomyces variotti, Fusarium oxysporum, Penicillium species, Rhodotorula mucilaginos, Trichosporon mucoides, pink yeast, and Exophiala dermatitidis.

"This is the first case report identifying fungal exposure, from a bagpipe player, as a potential trigger for the development of HP," Chaudhuri and colleagues wrote. "The clinical history of daily bagpipe-playing coupled with marked symptomatic improvement when this exposure was removed and the identification of multiple potential precipitating antigens isolated from the bagpipes make this the likely cause."

They concluded that wind instrument players need to be careful to cleaning their instruments regularly, and physicians should be aware of this potential risk factor for hypersensitivity pneumonitis.

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