Earlier today while working
through the day’s respiratory specimens, I came across the clinical information
supplied by the physician: “Chest infection, patient plays the bagpipes”. Not
being an activity I had ever considered might lead to infection; I thought it
was worth a quick search of the literature.
The results suggested a small but
extant risk of contracting a fungal lung infection from a badly cleaned pipe
bag. The scientific literature is sparse on the subject (there not being much
research grant money flowing around the bagpipe scene) but the odd occurrence
did seem to be newsworthy, prompting such as:
A
Warning To Clean Bagpipes from the New York times 18 March 2013: An
excellent article detailing the case of a 77 year old Glaswegian bagpipe player
diagnosed with pneumonia. the cause of which was only identified after
culturing Rhodoturula and Fusarium from the pipe bag. Until the
question of bagpipes arose, medical staff would have had no reason to suspect a
predisposition to fungal infection, only investigating further after the near
fatal failure of antibacterial therapy. In our laboratory we would also not
routinely culture for fungi unless requested or some predisposing factor is
apparent such as immune deficiency or instrumentation.
A previous case from 1978
discussed in The
Lancet involved a 60 year old piper
admitted to The Royal Prince Alfred Hospital with acute myeloblastic leukaemia.
Following treatment, material from the lungs of the patient was found to be
infected with Cryptococcus neoformans,
an identical strain to which was again cultured from his pipe bag. There seems
to have been a degree of controversy at the time over the question as to
whether he contracted C.neoformans
from the bagpipes, or whether he caught it elsewhere as a consequence of the
leukaemia and transferred it subsequently to the instrument. My own conjecture
is that when someone is looking for a comforting distraction in the event of
contracting a fungal pneumonia on top of acute myeloblastic leukaemia, I can’t
see them reaching for the bagpipes. It seems akin to jogging for relief of a
broken ankle. A possibility might be that the player did indeed transfer C.neoformans to the matrix of his pipe
bag after a short, transient period of carriage. The yeast thrived therein,
only by chance being able to infect the player opportunistically when his immune
system was damaged by the leukaemia.
The construction and care of
bagpipes has changed over the years. The traditional cow/sheepskin bag required
more regular maintenance than their more modern synthetic relatives. Synthetic
bags tend to be made from a fabric such as gortex which is breathable to allow
moisture from saliva to evaporate, but which may provide a matrix in which
fungi could thrive. The extra maintenance of the older type bag is thought by
pipers to have made these sorts of infections less likely, due to the
antimicrobial properties of the honey and herbs used to cure the material.
Personally, I would have thought this unlikely. The main antimicrobial property
of honey, when used historically in the dressing of infected wounds, comes from
its sugar concentration reducing water activity. In the small amounts used in
curing material, in a moist environment the honey is more likely act as a
source of food than an antimicrobial agent.
Added to this, the bagpipes are,
it would seem a temperamental instrument, as a consequence of which their
owners are reluctant to strip and clean them when they are working well, in
case this disturbs their equilibrium.
This is a rare route of
infection, however the message would appear to be to clean your bagpipes
regularly because there is a chance they could do to your lungs what they do to
my ears.
AA
