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In an investigation worthy of Sherlock Holmes, a British doctor has cracked the case of a musician's unexplained illness. And he has done so twice.
In 2018, a then-58-year-old man came to Huzaifa Adamali's practice at North Bristol NHS Trust. The man reported a chronic dry cough and breathlessness, which was diagnosed as hypersensitivity pneumonitis. Inquiries into the usual pathogenic exposures—farming, hot tubs, feather duvets—turned up empty until the patient said he had to rush off to his tenor horn practice.
The pulmonologist knew from the literature that brass and wind instruments can, albeit rarely, be hotbeds for fungi and bacteria, a phenomenon known as the musical microbiome. Such microbes feast on a constant supply of musicians' "lovely spit," he tells Newscripts with a laugh.
Sure enough, testing at the national UK Health Security Agency Mycology Reference Laboratory revealed the horn was brimming with Purpureocillium lilacinum, a filamentous fungus known to cause pneumonitis. What's more, true to its name, the fungus had turned the instrument a violet hue.
Questions persisted: How did a soil-dwelling fungus get on the instrument? And why did cleaning it repeatedly with a decontaminant not kill the pathogen? The horn player eventually gave up his purple instrument and spent £4,000 (about $5,400) on a new one. His son's brass cornet, also fungus laden, cost an additional £3,000 ($4,000) to replace. The new horn plus a course of steroids seemed to resolve the man's so-called tenor horn lung, according to a 2019 study in the medical journal QJM (DOI: 10.1093/qjmed/hcz020).
Then, "Lo and behold, six months later, he comes back with the same symptoms," Adamali says. "Now my antenna was twitching—it's got to be in the water."
A recounting of the family's Sunday ritual proved him right. After a morning walk, they'd wash their family dog in the bathtub, drain it, refill, and then submerge both instruments in soapy water. So it was the pup who was tracking the fungus inside, a saga described in a QJM Letter to the Editor called "The Curious Incident of the Dog in the Bath Tub" (2023, DOI: 10.1093/qjmed/hcad221).
Rather than disturb the dog's routine, the man invested in a new steam cleaning tool for his horn that killed the fungus and has kept new infections at bay.
To Adamali, the circuitous experience shows how "you have to really think outside of the box" as a pulmonologist. Nowadays, when he meets a tough-to-diagnose patient, he says, "I invite myself into their home for a cup of tea."
Across the pond at the Massachusetts Institute of Technology, biology undergraduate Clara Zhu studies a different intersection of music and microbiomes. As a classically trained flutist, she was curious if music therapy—already a cost-effective approach for easing stress and chronic pain—could also improve gut health.
Zhu started her experiments as a high school student and continued them as an undergraduate. She exposed five laboratory mice to Mozart’s Flute Quartet in D Major for 12 h a day over 3 weeks. Probiotic bacteria in their gut called Lactobacillus salivarius flourished, fecal analysis revealed. Five control mice that listened to ambient noise and five more that listened to white noise did not experience similar spikes.
After being inoculated with salmonella, a major cause of foodborne illness in people, the Mozart-exposed mice lost less weight than the control animals, indicating they were less susceptible to illness. Cultured L. salivarius increases the acidity of growth media, which suggests the bacteria use pH to thwart salmonella.
For their last experiment, Zhu and colleagues placed each of the 15 mice alone in a square box. The Mozart mice scurried all around, while the control mice kept to the edges, a sign of anxiety, according to the study, published in March in the journal Microbiology Spectrum (2025, DOI: 10.1128/spectrum.02377-24). The team doesn't know how listening to Mozart stimulates L. salivarius, but they suspect a brain neurotransmitter such as dopamine plays a role as part of the gut-brain connection.
"We're in an age where antibiotic resistance is a big problem, and salmonella is very prevalent," Zhu tells Newscripts. "It's important for us to discover novel methods of treating such diseases."
Please send comments and suggestions to newscripts@acs.org.
The story was updated on June 20, 2025, to correct the first heading. The microbial source is fungal, not bacterial.
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