City doctors have urged recovered Covid-19 patients to watch out for symptoms of fungal infections, which have been proven to be life-threatening by causing damage to the spine. Fungal spinal infections are very rare with the incidence of less than 10 in one lakh presenting with non-specific signs and symptoms.
The warning has come after a case presented itself in Pune, where a patient’s spinal-disc was infected, leading to severe bone damage. Doctors said they have not come across any other case yet. They have, however, stressed that long use of steroids can lead to such infections.
The recent discovery of this post-Covid symptom has raised serious concerns among the medical fraternity. Clinically termed as aspergillus osteomyelitis, the invasive infection is difficult to diagnose as it mimics spinal tuberculosis (TB). It has been earlier detected in oral cavities of Covid-recovered patients, and, in rare cases, in lungs. The infection affects individuals in immune-suppressive states.
A doctor said these infections are commonly misdiagnosed and treated empirically as spinal TB which can have life-threatening consequences. “However, with biopsy and microbiological study of every suspected spinal infection, accurate diagnosis and early treatment is often effectively started,” the doctor said, adding that long-term use of corticosteroids may increase the risk of opportunistic infections, depending on the underlying disease being treated and what other drugs are being used.
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.
Dr Manish Kothari, consultant (department of spine surgery) at Jaslok Hospital, said post-Covid fungal infections of the spine are usually destructive in nature due to proximity to the spinal cord and flexibility of the spine. In addition, antibiotic medications for these infections many a time do not fully penetrate into the infected part of the spine.
He said, “To make matters worse, initial symptoms may look like common back pain which may be missed by an untrained eye.” He added that timely diagnosis by appropriate clinical signs and relevant tests can save spinal cord compression and even paraplegia. “In severe cases, complete surgical clearance of the disease and reconstruction of the spine, followed by antibiotics gives the best chance for recovery,” he said.