“The pandemic has seen a sharp increase in opportunistic infections in the post-Covid period. Mucormycosis or the black fungus affecting the face, nasal-oral cavity and eyes has taken its toll in recent months, requiring long-term surgical and medical treatment. But that’s not the only fungal infection associated with Covid-19, ”said Dr Harshal Bamb, consultant and spine surgeon at Global Hospital in Mumbai.
He added that Aspergillosis sp and candida sp are common fungal co-infections seen during and after Covid-19 infections. “Although fungal infections of the spine are a very rare event; there are recent reports of such cases both at home and abroad, ”he added,
What is a fungal infection of the spine?
Many pathogens like bacteria, mycobacterium sp (tuberculous bacteria) and very rarely fungi affect the spinal cord and bones, resulting in infectious spondylodiscitis and spinal osteomyelitis. These infections, if not treated early and effectively, can lead to disastrous and permanent neurological problems and spinal deformities.
fungal infections of the spine are very rare with an incidence of less than 10 in a million (10 in 10,000,000), often presenting with nonspecific signs and symptoms.
These infections are difficult to diagnose being often misdiagnosed and treated empirically like spinal tuberculosis which can have serious and fatal consequences, Dr Bamb said. However, with the current practice of biopsy and microbiological study of each suspected spinal infection, accurate diagnosis and early treatment are often effectively implemented.
* Non-specific symptoms – Low back pain and spasms, back pain when moving, pain when resting, early fatigue, fever, weight loss, etc.
* Swelling of the paraspinal area, tenderness / heat of the spine, neurological problems.
* Identification of the fungus in the biopsy sample is the only confirmatory test.
* X-rays and MRIs are often indicative but not diagnostic.
Why is spine health important?
“Spine problems are direct determinants of quality of life and disability. Even the simplest acute spinal conditions often affect the patient’s ability to perform daily activities painlessly and efficiently. Spinal infections are major problems with serious permanent and long-term sequelae. Spine deformities and permanent neurological damage are quite common in spinal infections that are difficult to diagnose and treat, ”he explained.
Post-covid syndrome as a whole includes many varying signs and symptoms. Even nonspecific back pain in the post-covid period should be taken seriously. As we must remember, prevention must come first; treatment is a difficult path to take.
What is the link with Covid-19?
Fungi are common inhabitants of human skin, nasal passages and respiratory tract; but invasion of blood and important organs is almost a rarity. Fungal infections of the spine are usually opportunistic; which means that they affect immunocompromised patients, such as solid organ recipients, patients with hematologic malignancies (cancers affecting the blood, bone marrow and lymph nodes), those with severe neutropenia (rate of lower-than-normal neutrophils, a type of blood cell), and those receiving high-dose steroids.
“Long-term intensive care management and steroid use are generally required in severe covid pneumonia, which makes patients susceptible to invasive fungal infections. Various biological and pathological mechanisms have been postulated that the Covid virus itself affects the patient’s immunity, resulting in invasive fungal infections, ”said Dr Bamb.
The reuse of healthcare equipment, especially poorly cleaned, is also a risk factor described. With increasing needs and unavailability of resources, the reuse of gloves, intubation kits – tubes, ICU / oxygen sets, masks or PPE kits cannot be ruled out. Most of the centers have made great efforts and necessary precautions to maintain hygiene standards despite the enormous adversity of a pandemic.