Clarinet Player Who Didn't Clean Instrument For 30 Years Develops 'Saxophone Lung,' An Allergic Reaction To The Fungi Inside

Clarinet mouthpiece
A clarinet player developed ‘saxophone lung,’ an allergic reaction from fungi build-up inside the instrument, after he left his instrument uncleaned for 30 years. James Eaton-Lee Njan, CC BY-SA 3.0

Musicians, it’s time to tune in: Those who play woodwind instruments, such as flutes, clarinets, and saxophones, and who don't clean their instruments are likely to develop ‘saxophone lung,’ according to a recent case study.

The rare disease, known as saxophone lung, typically develops from fungi build-up in a musician’s instrument. This was the case for an unidentified 68-year-old Dixie band player who had neglected to clean his clarinet for 30 years. The lack of maintenance left the Dixie band player susceptible to develop the allergic pulmonary disease.

The case was presented at the American College of Allergy, Asthma, and Immunology’s Annual Scientific Meeting in Baltimore, where researchers revealed that musicians who play woodwind instruments can develop saxophone lung from the continuously growing fungi in the instrument’s reed.

The Atlanta clarinet player reportedly had a one-year history of coughing and wheezing that was not responsive to inhaled corticosteroids, bronchodilators, or oral antibiotics. At first, doctors thought the man had allergic bronchopulmonary aspergillosis (ABPA), an immunologic pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus, NBC News reports. However, once the Atlanta man shared his clarinet practices, the medical experts began to speculate that he had another disease.

The woodwind player’s chest was a mess of blockages and mucus, and he even had a calcified lymph node — a scar in the chest resulting from a prior infection — once the x-rays came back. While a calcified lymph node is not harmful to a patient’s health, in rare cases, it could erode into an airway.

Researchers conducted chest imaging and tested for the fungus, which lead to evidence that the clarinet player was infected with different fungi. The tests showed he was allergic to Alternaria, a common allergen that causes opportunistic infections in people with weak immune systems, and Curvularia, a soil fungus usually found in tropical regions. The clarinet reed and the inside of the instrument were positive for another mold, Exophiala, a fungus that is usually found in decaying wood and soil.

"While both ABPA and Saxophone Lung present with persistent cough and wheeze due to localized mold allergy and are treated with systemic steroids, it is imperative for allergists to distinguish these clinical entities,” the researchers wrote.

Doctors prescribed the clarinet player more oral steroids to treat the lung inflammation, but it was only after he sterilized the instrument that he got any better.

“There was very impressive fungal growth on those,” said Dr. Marissa Shams from Emory University Adult Asthma, Allergy and Immunology Clinic, according to NBC News.  

In a similar study published in The International Journal of Environmental Health Research, researchers from Tufts University tested 20 instruments, including flutes, clarinets, trumpets, and saxophones. All of these instruments were found to have living bacteria, mold, and yeast, which survived for days when cultured, particularly in reeds and mouthpieces.

According to the University of Nevada, Las Vegas' Department of Music, alcohol wipes or Sterisol germicide solution should be used to sterilize the instruments.

For more information on musical instrument cleaning, click here

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