Spinal fungal infection in Covid-recovered patients: Know about the rare condition

“The pandemic has observed a steep rise in opportunistic infections in the post-Covid period. Mucormycosis or black fungus affecting the face, nasal-oral cavity and eyes has wreaked havoc in the past few months, requiring surgical and long-term medical treatment. But this is not the only fungal infection associated with Covid-19,” mentioned Dr Harshal Bamb, consultant and spine surgeon at Global Hospital, Mumbai.

He added that Aspergillosis sp and candida sp are common fungal co-infections observed during and after the Covid-19 infections. “Although spinal infections by fungus is a very rare occurrence; there are recent reports of such cases both in the country and abroad,” he added,

What is fungal spinal infection?

Many pathogens like bacteria, mycobacterium sp (tuberculous bacteria) and very rarely fungi affect the spinal disc and bone leading to infective spondylodiscitis and vertebral osteomyelitis. These infections, if not treated early and effectively, can lead to disastrous and permanent neurological problems and spinal deformities.

Fungal spinal infections are very rare with incidence less than 10 in a million (10 in 10,00,000), often presenting with non-specific signs and symptoms.

These infections are difficult to diagnose being commonly misdiagnosed and treated empirically as spinal tuberculosis which can have grave, life threatening consequences, said Dr Bamb. However, with the current practice of biopsy and microbiological study of every suspected spinal infection, accurate diagnosis and early treatment is often effectively started.

*Nonspecific symptoms- Low back pain and spasms, back pain on movements, resting pain, early fatigability, fever, weight loss etc
*Para spinal region swellings, spinal tenderness/ warmth, neurological issues.

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*Identification of the fungus in biopsy sample is the only confirmatory test.

*X-rays and MRI scans are often indicative but not diagnostic.

Why is spinal health important?

“Spinal issues are direct determinants of quality of life and disability. Even simpler acute spinal ailments often affect the patient’s ability to perform day to day activities pain-free and effectively. Spinal infections are major issues leading to serious long term and permanent sequelae. Spinal deformities and permanent neurological damages are fairly common in cases of difficult to diagnose and treat spinal infections,” he explained.

Post covid syndrome as an entity includes many variable signs and symptoms. Even a nonspecific back pain in the post covid period should be taken seriously. As we must remember -prevention has to take precedence; treatment is a difficult road to trudge.

What is the link with Covid-19?

Fungi are common inhabitants of human skin, nasal and respiratory tracts; but invasion into blood and important organs is almost a rarity. Fungal spinal infections are commonly opportunistic; meaning that they affect immunocompromised patients, such as solid organ recipients, patients with hematologic malignancies (cancers that affect the blood, bone marrow, and lymph nodes), those with severe neutropenia (lower-than-normal levels of neutrophils, a type of white blood cell), and those receiving high-dose steroids.

“Long term ICU management and steroid use is commonly needed in severe covid pneumonia which makes patients susceptible to invasive fungal infections. Various biological and pathological mechanisms have been postulated whereby Covid virus itself affects patient’s immunity leading to invasive fungal infections,” said Dr Bamb.

Re-use of health care equipment especially not adequately cleaned is also a described risk factor. With rising need and unavailability of resources,the re-use of gloves, intubation kits – tubes, ICU/oxygen assemblies, masks or PPE kits cannot be precluded. Most centres have taken great efforts and necessary precautions to maintain hygiene standards despite the huge adversity of a full blown pandemic.

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