Fire breather's pneumonia

Fire breather's pneumonia

Fire breather's pneumonia, also known as fire breather's lung or fire-eater's lung, is a distinct type of exogenous lipoid pneumonia (chemical pneumonitis) that results from inhalation or aspiration of different types of hydrocarbons . Accidental inhalation of hydrocarbon fuels can occur during fire breathing, fire eating, or other fire performance, and may lead to pneumonitis. Symptoms can vary significantly among individuals, ranging from asymptomatic to severe, life-threatening disease . Onset usually occurs within hours, though symptoms may not appear for several days. Lipoid pneumonia is a rare condition, but is an occupational hazard of fire performers .

Causes

Fire breather’s pneumonia is caused by the entrance of hydrocarbon fuels into the bronchial tree, usually due to accidental aspiration or inhalation during a fire performance show. Fire breathing, or fire blowing, is the act of creating a plume of fire by blowing in a fine mist a mouthful of fuel over a source of ignition. Fire eating, or fire swallowing, is the act of putting a flaming object into the mouth and extinguishing it. In both disciplines, the performer holds their breath until the air is clear of vapors, so as to not inhale the hazardous fumes. However, improper technique or accident can lead to ingestion, inhalation, or aspiration of fine droplets or vapors. Fire breathing and fire eating are separate acts, but the terms are sometimes used interchangeably in the literature

Once inhaled, these fuels induce an inflammatory reaction in lung tissue. They are not metabolized by tissue enzymes, but undergo emulsification and become engulfed by macrophages which, with time, may disintegrate and release oily substances surrounded by fibrous tissue and giant cells .

Signs and symptoms

Fire breather’s pneumonia usually presents with certain non-specific symptoms, and may vary significantly among individuals. The most common symptoms include:

• Cough
• Dyspnea (shortness of breath)
• Chest pain
• Fever
• Weakness

Acute pneumonitis typically begins asymptomatic, with a worsening of symptoms over the course of hours or days. Patients may not recall a specific instance of aspiration.

Fuels

Fire breathing is typically performed with a high flash point fuel, such as lamp oil (liquid paraffin), while fire eating is performed with low flash point fuels, such as white gas or naphtha. Highly purified fuels are preferred by fire performers due to their minimized toxicity, but other, more dangerous fuels may sometimes be used, such as ethanol, isopropanol, kerosene, gasoline, or grill lighter fluid. All fuels run the risk of causing pneumonitis if inhaled.

Diagnosis

Exogenous lipid pneumonia is rare in the general population , but occupational accidents may not be uncommon in fire performers. Diagnosis is usually made on the basis of history of exposure to hydrocarbon fuels, symptoms, and radiological findings. Chest X-rays taken shortly after the accident may or may not be abnormal, but typically over time show infiltrates in the lower lobes of the lungs. High-resolution CT will frequently demonstrate abnormalities.