I’m somewhat of an expert in spinal infections, unfortunately from both sides of the scalpel. About 10 years ago I had spinal surgery. The 1,300 skydives and years of mogul skiing wore out a disc – imagine that!
I had spinal surgery, a fusion, which made for a perfectly miserable six weeks. And then it got really interesting due to an infection inside the spine, which is never much fun. I had a second surgery to clean up the mess, then a couple of months of IV antibiotics through a port, like a cancer patient.
Life went on, but remind me not to do that again.
Spinal infections that have resulted in a national meningitis outbreak are in the news lately. They are being caused by an unusual culprit – fungus. Molds, yeast and fungus are the names for this group of slow growing organisms. They usually cause more trivial problems like athlete’s foot, ringworm, and that sort of thing.
Mold grows on cheese and you don’t call the biohazard team. They are not usually aggressive germs. But you have heard the expression: location, location, location to describe why a house is more valuable.
Some places are just more special than other places. Inside your spine is one of those very special places. It is not well defended and it’s filled with spinal fluid, which surrounds your brain (also pretty special).
How do fungi get in your spine? We (doctors) put them there; not intentionally of course.
Spinal injections of steroids are pretty common for pain control in elderly patients. These are called epidural blocks and involve injecting a small amount of fluid into your spine.
Great care is taken to avoid any skin germs getting into the spine. What we inject is supposed to also be completely sterile. Yet that is where the problem lies. The fluid that a doctor injects is often a mixture of a local anesthetic, a steroid, and sometimes other medications such as an enzyme.
These mixtures don’t come that way from the manufacturer because these medications might not have FDA approval or long-term stability when mixed. That is not to say mixing them is bad. Almost all spinal injections involve some sort of mixture.
There seems to be some fungi spores that got into the steroid/anesthetic mixture and went along for the ride when it was injected into the spine. Had the mixture been tainted with bacteria or viruses, the patient would be gravely sick within 24 hours. Fungi are much slower growing, so it sometime takes over a month for the infection to be noticeable.
When the infection finally occurs there are subtle or sometimes obvious signs of meningitis – headache, confusion, or even delirium occurs. Generalized weakness and nonspecific symptoms may also be the only clue. Treatment is antifungal medication, usually taken for a prolonged period.
Fungal meningitis is a disease with a very particular risk factor – spinal injection. If you haven’t had one in the last few months, relax and enjoy your day because there’s nothing to worry about.
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing Clinical Occupational Medicine for more than 25 years. Dr. B works in our Scottsdale, Arizona clinic.