Saxophone Lung?

Subject: Saxophone Lung?
From: JohnInKansas
Date: 08 Nov 13 - 02:02 AM

Melody malady: Clarinet player develops 'saxophone lung' from fungus

JoNel Aleccia NBC News
08 November 2013

A 68-year-old clarinet player in Atlanta developed a year-long allergic chest reaction to fungus that grew in his instrument.

A Dixieland band player who didn't clean his clarinet for 30 years is recovering from a year-long allergic reaction caused by fungus that grew inside the reed instrument, experts said.

The 68-year-old unidentified Atlanta man came down with an intractable case of "saxophone lung," an actual condition familiar to germ experts — and to persnickety musicians.

But he didn't escape the notice of Dr. Marissa Shams and other researchers at the Emory University Adult Asthma, Allergy and Immunology Clinic, who planned to recount his ordeal at an annual scientific meeting in Baltimore Friday.

Saxophone lung is a rare type of hypersensitivity pneumonia, in which patients develop allergic pulmonary disease when they're exposed to fungi that invade instruments — and are never removed. Basically, the musicians have allergic reactions to the mold that won't let up, Shams said.

"He was playing very frequently, several nights a week," she said. "Basically he was kind of breathing in this fungus."

In the clarinet player's case, he complained of coughing and wheezing that lasted a year and didn't respond to any typical treatments, including inhalers, steroids and antibiotics. Doctors originally thought he had allergic bronchopulmonary aspergillosis, a different kind of fungal reaction — until they heard about the clarinet.
When they X-rayed the guy's chest, it was a mess of blockages and mucus and even a calcified lymph node, Shams said.

Tests showed the man was allergic to two fungi, Alternaria and Curvularia, while the clarinet reed and inside the instrument were positive for another mold, Exophilia.

"There was very impressive fungal growth on those," Shams said.
Doctors gave the man more oral steroids, but it was only after he sterilized the clarinet that he got any better.

"As we've been following him, he has substantially improved," she said.

Though the condition sounds strange, it's actually well known to musicians. In March, a 78-year-old English bagpipe player, John Shone, reported that he nearly died after contacting a fungal lung infection from his dirty instrument.

In 2011, researchers at Tufts University led by Dr. Stuart Levy tested 20 instruments and found that nasty germs — including the bug that causes tuberculosis — can live for a few hours up to several days on wind instruments such as clarinets, flutes and saxophones.

Researchers never did learn why the man didn't clean his clarinet, Shams said. But after they showed him the connection between the fungus and his illness, he started sterilizing regularly.

"We were happy to help him," Shams said. "This is not the typical allergy and asthma patient that we see in our clinic."

[Don't forget about your harmonicas and p'whistles too.]

John

Subject: RE: Saxophone Lung?
From: Roger the Skiffler
Date: 08 Nov 13 - 04:10 AM

So when kind friends suggest I put my kazoos in a vat of acid they're only thinking of my heallth?

RtS

Subject: RE: Saxophone Lung?
From: Jack Campin
Date: 08 Nov 13 - 06:45 AM

My wife treats environmental and food allergies and she's come across this. It had never occurred to her patient that her sax mouthpiece would ever need cleaning. It must have looked like something out of Fungus the Bogeyman.

Medical science also recognizes "saxophone penis" - try a google image search.

Subject: RE: Saxophone Lung?
From: GUEST,highlandman at work
Date: 08 Nov 13 - 09:37 AM

I've heard of it, too. Thing is, you can clean the bore of the instrument, but you can't really clean, much less sterilize, the reeds without wrecking them (at least bagpipe reeds). The frugal Scot in me wants them to last forever, but in the interest of sound quality and health, I guess I have to toss them.
-Glenn

Subject: RE: Saxophone Lung?
From: Jack Campin
Date: 08 Nov 13 - 10:28 AM

I store cane reeds (for clarinet and sax) in a medical sample bottle part filled with gin or vodka. The reeds last much longer and no germs. Probably not applicable to bagpipes since you don't want to keep pulling the reeds in and out of them.

Mostly I use synthetic reeds for clarinet and sax now - they start with no moistening so they're better if you do a lot of doubling, and they've improved a lot in the last 10 years. Fibracells give me the sort of cool flutey tone I like in a sax, and Legeres give me a warm and complex tone with a metal clarinet and a glass mouthpiece.

Subject: RE: Saxophone Lung?
From: JohnInKansas
Date: 08 Nov 13 - 11:10 AM

The reeds of course are potential places where mold can grow, but in a bagpipe and some other instruments the reeds themselves aren't "in your mouth" as they are with clarinets, oboes, and saxophones and the like. It seems unlikely to me that the reeds in any of the common instruments would be the main place where crud and corruption could flourish. It's likely the larger surfaces of the instrument that get moistened by the breath that passes through that would be where fungus would flourish, but any surface where moisture is present could contribute to the problem.

Conceptually, one might think that harmonicas would be the biggest threat, since you blow, which makes the innards wet, and also suck which draws the mold back in. Fortunately(?) the much smaller area on which the crud can grow seems to make the threat tolerable, and harmonicas may be easier to "sanitize" than some instruments with larger area(s) on which the mold can grow - or at least they might dry out sufficiently to inibit/slow the growth of the nasties between sessions.

I doubt that worrying just about the reeds will be any great help. It's the cleanliness of all the innards of the instrument exposed to the breath that needs to be of concern.

Maybe our bagpipers need a discussion on "how to clean your old bag" as much as they need to worry about just the reeds. (?) And maybe it's also just the pipers** who suck who are in real danger (?).

** probably applies to other instruments.

John

Subject: RE: Saxophone Lung?
From: Mr Red
Date: 09 Nov 13 - 10:19 AM

I have seen harp players immerse their gob iron in a glass of beer. Given the level of sugar and paucity of alcohol I doubt it serves to steralise, probably feeds the bacteria/viruses.

Subject: RE: Saxophone Lung?
From: Stringsinger
Date: 09 Nov 13 - 10:35 AM

Chances are that if this player was playing dixieland in Atlanta, it was in a smoky club. Over the years, tobacco smoke was probably the most likely culprit.

Subject: RE: Saxophone Lung?
From: Stringsinger
Date: 09 Nov 13 - 10:36 AM

Chances are that if this player was playing dixieland in Atlanta, it was in a smoky club. Over the years, tobacco smoke was probably the most likely culprit.

Subject: RE: Saxophone Lung?
From: GUEST,Jack Campin
Date: 09 Nov 13 - 12:38 PM

No - black mould. It's one of the commonest inhalant allergies, usually from household mildew (the mould gives off a specific volatile lung-damaging chemical, which is why people can get ill from mould in basements they never go into). A saliva-laden reed and mouthpiece is an ideal culture medium for it.

Subject: RE: Saxophone Lung?
From: JohnInKansas
Date: 09 Nov 13 - 10:39 PM

While the article reporting the incident isn't exactly a medical journal article it does present a sufficient argument to accept that the player's infection almost certainly was a fungus and its source most likely was his instrument.

It would have been helpful if it had described how the instrument was "sterilized." Many kinds of fungi withstand most of the methods of sterilization commonly used for common "bugs," and quite a few of the common methods would be extremely destructive to an instrument like a clarinet (or lots of others). Alcohol in particular may kill most bacteria, but is almost useless for molds (although I've never heard whether drunken mushrooms exhibit self-destructive behaviours).

Most keyed instruments can be at least partially disassembled so that parts with different materials/constructions could be separately treated, but this isn't a good thing to do on a frequent basis. (Reseating a used pad on a key that's been removed and put back is about like trying to put the bottle cap back on the Coca Cola. It's very likely to leak.)

Separate methods for routine/daily cleaning and for more serious periodic sanitizing might be a good idea(?).

About the only likely method that comes immediately to my mind would be a chlorine bleach solution, which is generally effective against most fungal types although some might require more than brief exposure. The chlorine content would not necessarily have to be much higher than what is used in many public water supplies at the point where the supply goes into the distribution plumbing (although perhaps a little higher than expected when it comes out at the taps). (????)

A swab dampened with a chlorine solution should be effective for daily use, and many clarinet players routinely use one anyway just on the pretense that it helps dry the slobbers out of the innards.

Anyone else got some better ideas? And ideas about which instruments different ones would work on?

John

Subject: RE: Saxophone Lung?
From: Fossil
Date: 10 Nov 13 - 02:27 AM

Thank goodness I'm a guitar player!

Subject: RE: Saxophone Lung?
From: JohnInKansas
Date: 10 Nov 13 - 03:24 AM

Just be careful not to sit too close to the bodhran.

Three deaths (that I saw reports on) have been reported in about the past year due to anthrax on (illegally?) imported goatskins used to make those.

John

Subject: RE: Saxophone Lung?
From: GUEST,Jack Campin
Date: 10 Nov 13 - 06:42 AM

Alcohol in particular may kill most bacteria, but is almost useless for molds

It doesn't need to kill them, just stop them from replicating. It dries the reed out and washes out the nutrients the moulds feed on.

The difference is visually obvious. Reeds kept in spirit don't go dark. And they last about ten times as long.

Subject: RE: Saxophone Lung?
From: Jack Campin
Date: 10 Nov 13 - 06:47 PM

I just read the Huffington Post story on this, which covers it MUCH better. (I presume they have scientifically literate journalists and NBC doesn't).

Crucially they identify the organism involved, which was NOT black mould (as I guessed, and as most doctors would guess).

Subject: RE: Saxophone Lung?
From: GUEST,.gargoyle
Date: 10 Nov 13 - 08:55 PM

It might BE very real.

Dialogue with a friend, within the past year, revealed father and son becoming ill after blasting on a bugle that had been dormant for two decades.

Sincerely,
Gargoyle

Blessed be the string players.

Subject: RE: Saxophone Lung?
From: JohnInKansas
Date: 10 Nov 13 - 09:25 PM

The MSNBC article named two different fungi that doctors confirmed produced allergic reactions in the patient, and a third that they found in the instrument. They didn't actually say whether anything was identified inside the patient.

While the reed gets wet during playing, and for a cane reed it needs to be wet to perform correctly, the entire inside of an instrument is likely to to be pretty damp. Clarinetists sometimes get a "wet finger," nearly always appearing first on the third finger on the left hand, from the condensate that runs down to there during a long performance, although this should be unusual for non-professional performers. There are no "open ring" finger points on a saxophone, so the similar wetness there wouldn't be detected as easily, although occasionally one or the other of the little "octave shift" pads may "spit at you" a little.

Drying, as with alcohol, may stop the growth of most molds, but doesn't necessarily kill them; and drying the reed between uses doesn't do anything about what's elsewhere on the enormously larger internal surfaces of the instrument. The van I brought from Seattle to Kansas showed no signs of the typical "Seattle suntan" for three years in Kansas before a "freak" (for Kansas) spell of weather with a three-day fog occured. On the second day, when I went out to the truck all of the external black rubber on the truck was GREEN from the mold that survived until it got a proper moisture boost and burst forth in all it's west coast glory. Drying doesn't kill many fungi.

The entire inner surface of almost any instrument may get sufficiently damp to support mold growth every time the instrument is played, and your condensed breath probably contains sufficient nutrients for growth even on an "inert" surface. And some molds can grow quite nicely on plastics, wood, leather pads, cork seals, and other materials, some of which don't obviously supply nutrients for them. Worrying about infection/reaction only from the reed seems somewhat inadequate if an allergic reaction is a concern.

The infrequent reports of "moldy instruments" affecting performers' health suggest that this isn't a problem most people will need to worry a lot about. (Moldy performers may be the bigger problem?) Awareness that it can happen should be encouraged, and knowing what corrective actions are most likely to be most effective with least harm to the instruments seem worth discussion.

John