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17 May 2021 | Story André Damons | Photo Supplied
Scanning electron micrographs of Candida albicans (the large yeast cells) and Pseudomonas aeruginosa (the smaller bacterial cells). These are both opportunistic pathogens, that often co-occur in infections.

COVID-19 patients with severe symptoms who end up in intensive care units in hospitals are at risk of contracting an invasive fungal infection that might influence their outcomes and hamper treatment efforts. These fungal co-infections in COVID-19 patients on ventilators may contribute to the high mortality rate of these patients.

Prof Carlien Pohl-Albertyn and Dr Obinna Ezeokoli from the Pathogenic Yeast Research Group in the Department of Microbiology and Biochemistry, Faculty of Natural and Agricultural Sciences at the University of the Free State (UFS), have recently published an article on the incidence of fungal infection in COVID-19 patients. They are also in the process of publishing another article on the potential risk factors of COVID-19 treatment for getting fungal infections.

Severe COVID-19 causes changes in the immune system

Prof Pohl-Albertyn, who is the NRF SARChI Research Chair in Pathogenic Yeasts, says there are several reasons why COVID-19 patients who end up with severe symptoms in intensive care units (ICUs) are at risk of fungal infections. 
“Severe COVID-19 causes changes in the immune system, such as increased release of cytokines (molecules involved in inflammation) and a decrease in certain white blood cells (which help to fight other infections). These changes might make patients more susceptible to invasive fungal infections. Severe SARS CoV-2 infection also damages the lung tissue, making it easier for inhaled fungi (such as Aspergillus species, Cryptococus neoformans, and mucoralean fungi) to cause invasive infections,” explains Prof Pohl-Albertyn.

Many of the patients with severe COVID-19, continues Prof Pohl-Albertyn, have other co-morbidities (including diabetes) that make them more susceptible to fungal infections. Patients with severe COVID-19 in ICUs are often ventilated and have central venous catheters as well as urinary catheters. These are also risk factors for fungal infections.
“Some drugs, such as corticosteroids used to treat the symptoms of severe COVID-19, may increase the risk of fungal infection – although the link between these drugs and fungal infection in COVID-19 has not been well studied yet. Some patients may be given broad-spectrum antibiotics to treat or prevent bacterial co-infection. These antibiotics could also kill the ‘good bacteria’ that help to keep the fungi in and on your body in check. If they are removed, the fungi that colonise the patients may overgrow and cause infection,” says Prof Pohl-Albertyn.

Any systemic fungal infection can be deadly

According to her, any systemic fungal infection can be deadly, so in patients with COVID-19 it is definitely cause for concern. In a recent study done on the tissue of patients who died from COVID-19 after long-term treatment, fungal infections were a constant finding in these patients, even though the infection was not detected while they were alive. One of the problems is that patients with severe COVID-19 are not routinely tested for fungal co-infection.

In their recent article published in the South African Medical Journal, Prof Pohl-Albertyn and Dr Ezeokoli write that the incidence of severe infection and mortality in COVID-19 is thought to be due in part to a lack of natural immunity and to viral replication in the lower respiratory tract, as well as superinfections, secondary infections, or co-infections (these terms are often used interchangeably), leading to severe lung injury and acute respiratory distress syndrome (ARDS).
“Co-infections with respiratory viruses (other than SARS-CoV-2), bacteria, and fungi have been reported in COVID-19 patients all over the world, and secondary infections have been identified as one of the predictors of a fatal outcome in COVID-19 cases. An earlier report from China suggests that the mortality rate for COVID-19 patients on ventilators in intensive care units (ICUs) is ~60%, and further indicated that invasive fungal co-infections may contribute to this high mortality. 

A South African perspective 

The researchers also report that studies conducted before the current COVID-19 pandemic have shown that fungal infections are highly prevalent in the South African population, partly owing to the high incidence of HIV.

According to their article, it was observed that the Candida carrier rate is higher in the South African population than elsewhere and that HIV-positive patients carry more, and a greater variety of pathogenic yeasts compared to HIV-negative subjects. Similarly, cryptococcal meningitis, caused by the Cryptococcus neoformans species complex, is one of the leading causes of HIV-related deaths in South Africa, with >135 900 deaths estimated for sub-Saharan Africa in 2014. 
Other fungal infections, including invasive aspergillosis, Pneumocystis pneumonia, and endemic mycoses, are also prevalent in South Africa. “Given the high prevalence of HIV/AIDS in South Africa as well as the high number of persons undergoing immunosuppressive therapies for other illnesses, co-infections with opportunistic fungal species may be affecting the current COVID-19 disease statistics in South Africa.” 

A serious fungal infection has the ability to kill you, and yet few people – especially those with a weakened immune system – are aware of this lurking danger. Just like bacteria, these minute life forms are becoming resistant to the handful of treatment options.

Prof Pohl-Albertyn and her team at the university are studying this neglected field, which annually claims the lives of 1,7 million people worldwide. It is estimated that more than 3,2 million South Africans are afflicted by fungal diseases each year.

News Archive

Moshoeshoe - lessons from an African icon - by Prof Frederick Fourie
2004-11-03

(The full text of the article that appeared in City Press and Sunday Independent)

Our understanding of history informs our understanding of the present. No wonder the contestation over historical figures in South Africa’s past is so fierce and so divisive.
The question is: could it be any other way? I would like to think that it could; that black and white South Africans, across linguistic, cultural, religious and other divides, can develop a shared appreciation of our history – at least with certain periods and personalities as a starting point.

One such personality whose legacy I believe offers a possible platform for unifying our still divided country is King Moshoeshoe, who lived from 1786 to 1870, and is acknowledged as the founder of the Basotho.

King Moshoeshoe is the topic of a documentary that has been commissioned by the University of the Free State as part of its Centenary celebrations this year. It is part of a larger project to honour and research the legacy of Moshoeshoe. The documentary will be screened on SABC 2 at 21:00 on November 4th.

Moshoeshoe rose to prominence at a time of great upheaval and conflict in South Africa – the 19th century, a time when British colonialism was entrenching itself, when the Boer trekkers were migrating from the Cape and when numerous indigenous chiefdoms and groupings were engaged in territorial conquests. It was the time of the Difaqane, a period when society in the central parts of the later South Africa and Lesotho was fractured, destabilised and caught in a cycle of violence and aggression.

In this period Moshoeshoe displayed a unique and innovative model of leadership that resulted in reconciliation, peace and stability in the area that later became Lesotho and Free State. It made him stand out from many of his contemporaries and also caught the attention of his colonial adversaries.

Such an evaluation is not a judgment about which model of leadership is right and which is wrong, or which leader was better than another; but merely an attempt to explore what we can learn from a particular exemplar.
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Historians point to the many progressive leadership qualities displayed by Moshoeshoe which he used effectively in establishing the Basotho nation and in defending it.
First, there is his humanism and sense of justice worthy of any great statesman. Confronted by a situation in which cannibals murdered and devoured his grandfather, Moshoeshoe chose not to take revenge. Instead he opted to rehabilitate them and feed them as he believed hunger drove them to cannibalism.

Secondly, there is his skilful alliance-building with his contemporaries such as Shaka in an attempt to neutralize those rivals who were intent on attacking his followers. This is also displayed in the way he sought the protection of the British to keep the Boer forces at bay.
Thirdly, his emphasis on peaceful options is also seen in his defensive military strategy which saw him retreat to a mountain fortress to be able to protect and build a burgeoning nation in the face of the many forces threatening its survival.

Fourthly, there is his remarkable inclusivity and tolerance for diversity which saw him unite disparate groups of refugees from the violence and hunger that displaced them and then weld them into the Basotho nation. He also engaged with French missionaries, inviting them to stay with him and advise him on Western thought, technology and religion.
These are but some of the qualities which belie the notion that all 19th century African leaders were merely marauders and conquerors that gained their ascendancy through violence. Instead Moshoeshoe is a prime example of the human-centred, democratic and pluralist roots of South African, indeed African society.

The Moshoeshoe project that we have initiated (of which the documentary, called “The Renaissance King”, forms but one part) derives from our location as a university in the Free State, a province with a particular history and a particular political culture that developed as a result of this very model of leadership. This province has benefited tremendously from leaders such as Moshoeshoe and president MT Steyn, both of whom many observers credit with establishing a climate of tolerance, respect for diversity of opinion, political accommodation and peaceful methods of pursuing political objectives in the province. Their legacy is real – and Moshoeshoe’s role can not be overstated.
In addition the project derives from the University of the Free State being a site of higher learning in a broader geo-political sense. As a university in Africa we are called upon to understand and critically engage with this history, this context and this legacy.
Besides the documentary, the UFS is also planning to establish an annual Moshoeshoe memorial lecture which will focus on and interrogate models of African leadership, nation-building, reconciliation, diversity management and political tolerance.

In tackling such projects, there may be a temptation to engage in myth-making. It is a trap we must be wary of, especially as an institution of higher learning. We need to ask critical questions about some aspects of Moshoeshoe’s leadership but of current political leadership as well. Thus there is a need for rigorous academic research into aspects of the Moshoeshoe legacy in particular but also into these above-mentioned issues.
While the documentary was commissioned to coincide with the University of the Free State’s centenary and our country’s ten years of democracy, it is a project that has a much wider significance. It is an attempt to get people talking about our past and about our future, as a campus, as a province and as a country – even as a continent, given the NEPAD initiatives to promote democracy and good governance.

The project therefore has particular relevance for the continued transformation of institutions such as universities and the transformation of our society. Hopefully it will assist those who are confronted by the question how to bring about new institutional cultures or even a national political culture that is truly inclusive, tolerant, democratic, non-sexist, non-racial, multilingual and multicultural.

I believe that the Moshoeshoe model of leadership can be emulated and provide some point of convergence. A fractured society such as ours needs points of convergence, icons and heroes which we can share. Moshoeshoe is one such an African icon – in a world with too few of them.

Prof Frederick Fourie is the Rector and Vice-Chancellor of the University of the Free State

* The documentary on “Moshoeshoe: The Renaissance King” will be screened on SABC2 on 4 November 2004 at 21:00.

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