After Cave Visit, This Man Developed Deadly, Bat-Related Lung Infection
Nate Rose visited a cave for his 40th birthday and ended up with permanent lung damage due to histoplasmosis, a bat-related fungal infection.
Courtesy Nate Rose
Histoplasmosis is a fungal infection you can get from inhaling tiny spores found in bird and bat poop. The good news is that most people who breathe in the spores won’t get sick and those who do generally have mild symptoms, including a nighttime fever, cough, and fatigue, that will resolve on their own, says Osita Onugha, MD, a thoracic surgeon and assistant professor of thoracic surgical oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California. “Fungal infections are rare and of those, histoplasmosis is one of the most rare. This isn’t something most people need to worry about unless they’re immune-compromised or spend a lot of time in enclosed places with bats or birds.”
“Histoplasmosis is commonly thought of as a disease of the lungs but it can target a wide variety of things in the body, causing scarring in places like the lining of the heart or the esophagus, in addition to the lungs,” he says. “It’s the scarring that causes most of the problems people experience.” When it spreads to other parts of the body, called disseminated histoplasmosis, it can be quite serious, causing severe symptoms, permanent disability, and even death.
Nate Rose, a 43-year-old father of five in Florida, was one of these who got the most severe form, after going on a caving trip. Here, he shares his harrowing experience.
Celebrating a milestone birthday in a cave
Forty is a milestone birthday so when mine came around in 2017, my friend Jared, who was also turning 40 that year, and I decided we needed to go on an adventure. You know, to prove that while we were getting older, we weren’t old.
We decided to visit the Rio Camuy cave system near Arecibo, Puerto Rico, and booked a trip that promised epic adventures, including rappelling down a sinkhole and hiking and swimming several miles through the caves and underground river. (Planning your own adventure trip? Make sure you get these essential immunizations.)
Excited and ready for anything, we flew into San Juan. Our tour guides picked us up the next day for a long bus ride to the caves with our group of about a dozen fellow adventurers.
At the cave site, we received a thorough safety briefing and were issued a hard hat with a headlamp, making us laugh because we looked like a bunch of coal miners.
We realized the hard hats weren’t just a fashion choice when the adventure started with a series of zip lines and rappelling 350 feet down into a sinkhole. The sinkhole gave us access to the underground river and the guide led us deeper into the inky black caves.
Swimming through underground rivers, scrambling over boulders, eating lunch in the middle of a cavern of stalactites and stalagmites was otherworldly. Occasionally we caught a glimpse of creatures that live in the caves, including blind crickets and scorpions.
The final stretch of the journey was floating down the river to another sinkhole exit. (P.S. Caves are one of the most dangerous places to swim so only go with an experienced guide.)
Our group was great and we all exchanged phone numbers and promised to stay in touch. The experience was so much fun that our plane hadn’t even left the runway before we had started planning a return trip.
Dealing with a dull headache and a stiff neck
About 10 days after arriving home I woke up with a dull ache at the back of my head that lasted for the rest of the next day. I wrote it off as a bad night’s sleep but the next day the ache intensified and my neck started to feel stiff.
By the third day, the pain came in waves that were so intense that I had to grab hold of something to steady myself and the neck stiffness got to the point where I couldn’t easily turn my head. (Neck stiffness is one of the signs your headache pain could be something serious.)
I made an appointment to see my doctor and explained my symptoms. None of my other vitals seemed out of whack, but the stiff neck led the doctor to suspect that I had meningitis. He sent me to the emergency room, where I checked myself in.
Unbeknownst to me, about this same time Jared had also started getting intense headaches but he didn’t have a sore neck. Like me, he initially attributed the headache to indigestion or poor sleep. When he heard that I had gone to the hospital, he called and made an appointment to see his physician.
An unknown diagnosis
At the hospital, the headaches were still coming in debilitating waves and I felt like my head and shoulders were welded together. They checked my vitals, took blood, asked for a urine sample, and after some time a doctor came to interrogate me.
I explained the symptoms, again, and added that I had been to Puerto Rico to go caving. A few more hours and several blood draws later, the doctor came back to tell me that they still weren’t exactly sure what was wrong. They wanted to rule out meningitis, so they were going to need to do a spinal tap or lumbar puncture.
One doctor explained that there is a small possibility that the procedure could go wrong and would leave me paralyzed. He also said that the procedure would make my head hurt.
It wasn’t a reassuring talk but since I didn’t think my head could possibly hurt any worse, I agreed. I had to sign so much paperwork, I wasn’t sure if I was agreeing to a medical procedure or buying a house.
They performed the spinal tap by inserting a long needle between the vertebrae in my back and neck to draw out spinal fluid. While they numbed the local area where the needle enters, I could still feel the pressure of the rod as it pushed through into my body.
I got extra lucky: The doctor missed the first time and had to come back with a second needle to try the process again. It was not fun but the worst was yet to come. (Here’s how one woman overcame her fear of needles.)
While I was waiting for results, Jared checked in the hospital. However, when he told his doctor that he’d been caving in Puerto Rico, his doctor asked follow-up questions, including “Were there bats?” Jared said yes and his doctor began to suspect histoplasmosis.
At the same time, some close friends were going through old episodes of the TV show House and found one where the patient gets histoplasmosis from bats in a cave and called to suggest that as a possibility to us.
Jared and I were both moved to rooms to stay overnight and put on heavy-duty painkillers.
Bat poop fungus in my lungs
On the second day at the hospital, the doctor came in and out a few times with promises to figure out what was wrong. I was sent for X-rays twice which revealed a dark section in my lungs that the doctor described as “patchy” and “crystalline.”
Those are not words you want to hear in relation to your lungs. At this point, Jared had already been tentatively diagnosed with histoplasmosis and told my doctor, who mentioned it for the first time to me.
Histoplasmosis is a fungal infection that forms on the inside of the lungs. This type of fungus commonly grows in the fecal matter of birds and bats. As the fungus grows, it releases spores into the air.
Under normal circumstances, the spores float harmlessly away but in compact areas where there isn’t a lot of airflow—like inside a cave—the spore concentration can get really high.
If humans breathe in the spores and the fungus grows inside the lungs, it can cause tuberculosis-like scarring. If left untreated, it can be fatal. (Blastomycosis is another potentially fatal fungal infection more people need to know about.)
Undergoing a lung biopsy
In order to confirm the diagnosis, I would have to get a lung biopsy, a process I can only describe as extremely traumatic. To get the lung biopsy, I laid face down in a CT scanner. The technician used three long metal tubes to pierce through my back, between my ribs, right up to the backside edge of the lung.
Each time a tube was installed, I was slid into the CT scanner so the tech could make sure the needle placement was correct. Once all three tubes were in place, the tech took biopsy samples.
To do this, the tech slid a large needle down the center of each tube. On the end of the needle was a small hook used to grab a chunk of lung material.
Envision your lungs are big balloons, but the balloons are coated on the inside with a thick layer of blood. Now, poke a crochet hook into the balloon and quickly yank it out. You can imagine what happens—the balloon collapses and all of the blood sheds from the surface of the lung, filling the cavity with blood and fluid.
Having my lungs popped like a balloon was a kind of torture I’d never imagined was possible.
My first overwhelming instinct was to cough but they told me not to because that just pushes all of that blood up and the lung collapses. You’re supposed to inhale in to keep the lung inflated, but I couldn’t.
The lung prick felt like a kick right into my lungs. I coughed. And that caused my windpipe to fill with blood, which made me gag and then vomit copious amounts of blood into the otherwise sterile white CT scanner.
And because I was barfing, I was struggling to breathe and re-inflate my lung. The attending nurse who had been as cool as a cucumber during the pre-op panicked and shouted at the tech to get the doctor.
An official histoplasmosis diagnosis
He said I’d be fine, and after catching my breath, he popped my lung again. Twice! Each time, more gagging and suffocating and vomiting. After the procedure, they helped me up and had me stand against a wall, breathing deeply.
They were concerned that my lung would collapse again. After it seemed as if I was stable enough to breathe on my own, I was wheeled back to my room. I went back again for more X-rays to make sure my lungs hadn’t re-collapsed and were recovering from the biopsy. (Learn more about respiratory conditions.)
I was in so much pain, from both the disease and the treatment, that I kinda lost track of time. At some point, the doctor finally came back into my room to confirm that I did indeed have histoplasmosis. It was the day of my 40th birthday. Happy birthday to me.
Courtesy Nate Rose
A long and painful recovery
Even though I had a diagnosis, I couldn’t go home yet. Apparently, there aren’t enough infectious disease specialists in South Florida so I had to wait for the specialist to “be in our area” to see me.
I spent another day in the hospital, enduring the excruciating headaches. I just really wanted to go home. Finally, the specialist arrived and prescribed an oral antifungal medication.
Unfortunately, it wasn’t as easy as popping a pill; the recovery was long and painful. The headaches cleared after about a week but I had to take the medication for four months.
I had regular checkups and blood draws during that period. I learned that the medication can arrest the progression of the fungus but it can’t undo the damage that had already occurred. As a result, I was also given daily breathing exercises as physical therapy for my lungs. (Try these exercises to build healthier lungs.)
Shortly after returning from the hospital, Jared and his family were over for dinner. We talked about the crazy turn of events and then we remembered the rest of our adventure group.
We reached out over text and learned that almost all of them had suffered varying degrees of the same symptoms, but none of the others had been diagnosed correctly.
Some were given flu medication and others tested for allergies. Histoplasmosis is fatal if untreated and death can occur in some patients even when medical treatment is received, so it was a good thing we had all shared numbers on the trip.
Living with permanent lung damage
Two months after being released from the hospital, in a follow-up appointment, the doctor showed me an X-ray of my lungs. There was a hazy patch. Turns out I suffered some permanent lung damage and scarring.
My body has compensated well and I don’t notice much difference in my daily life. I still hike and scuba dive and do all of the other physical activities I did before.
But sometimes when I go running I feel like I have to push a lot harder to keep my old pace. Like I just can’t get that second wind. Maybe it’s because of the lung damage. Or maybe it’s just because I really am old.