Looking inside the bagpipes
Mystery writers received a dose of fodder from an unlikely source this week: the journal Thorax.
A case study discussed a 61-year-old Englishman with lung problems that led to a diagnosis of hypersensitivity pneumonitis. HP is an inflammatory lung disease caused by an inhaled antigen and can become fatal. Common causes include animal fur, contaminated metalworking fluid, bird droppings, hot tubs or ventilation systems. Woodworkers and wine makers, for example, are at a higher risk, although it's believed genetic or environmental factors such as smoking can make HP worse.
Since the man's diagnosis in 2009, physicians were baffled because they couldn't find the trigger of his HP. The man did not have exposure to animals or birds, there was no evidence of mold or water damage in his house, he had no connective tissue disease and he did not smoke.
The man died in 2014, but science progressed years later to discover the cause of the fatal illness: Bagpipes. It's the latest case of how a hobby you love can kill you (see also skiing, biking, running, hiking, or basically any other outdoor activity. It's a jungle out there.) I'm confident if the television show “House” were still on the air, “bagpipe lung” would be a pivotal case-of-the-week plot point.
The sad case of this man led scientists to discover that the bagpipes contained various types of fungi, including Fusarium oxysporum and Rhodotorula mucilaginosa. It's the reason, the article explains, why the man improved in condition when he went to Australia for three months and left the bagpipes behind.
As tragic as the death is, we can draw lessons from it to potentially help long-term care residents.
As much as we encourage independence for those living in units or rooms, we also have an obligation to notice what may be causing illness. Is there a humidifier gathering mold? What about a pet bird?
How well do you know your residents? Obviously you'd know if they had a love affair with bagpipes. But what about their other interests?
If there are any wind instruments being used in a facility, they need to be cleaned. There's more research needed on best practices, but the researchers recommend taking the instrument apart and letting it drip dry.
Even outside of work, it's a good idea to become ambassadors of wind instrument hygiene. Other interesting medical cases include adult saxophone and trumpet players coming down with pneumonia. Whether it's at your child's high school band concert or when the jazz trio stops by to play for residents, news coverage is your friend here. No one wants to be the Debbie Downer who looks for death in all places. But a causal, “Did you see the crazy stories about ‘bagpipe lung'?” could start a conversation where your child/friend/volunteer thinks, “Gosh, it has been a long time since I took apart and cleaned this trumpet.”
I don't think bagpipe lung will become the scourge of long-term care. But I do think we can take a moment to think about the hidden causes of germs and fungus in facilities, and ask how we can strengthen infection control practices.
In the meantime, you'll find me playing my cello.
Follow Elizabeth Newman @TigerELN.