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First case of rare and deadly fungus in sub-Saharan Africa identified

28 August 2025 | Story André Damons | Photo André Damons

Dr Bonita van der Westhuizen, Senior lecturer and Pathologist in the UFS Department of Medical Microbiology, identified the first case of S. oblongispora mucormycosis in sub-Saharan Africa and among HIV-positive patients.

Medical staff at the University of the Free State (UFS) and the National Health Laboratory Service (NHLS) at the Universitas Academic Hospital have identified the first case of S. oblongispora mucormycosis in sub-Saharan Africa and among HIV-positive patients.

This discovery was made when a 32-year-old male patient was admitted to the Universitas Academic Hospital with right-sided facial swelling. The patient was HIV-positive, with a CD4 count of 50 cells/µl, and on antiretroviral therapy (ART), together with trimethoprim–sulfamethoxazole (TMX) prophylaxis. Additionally, he had hypertension for which he was also receiving treatment. The patient’s facial swelling rapidly progressed, with extension of redness and swelling observed daily.

Four days after admission, he underwent computerised tomography (CT) scan, and tissue biopsies were collected. The patient died three days later.

A significant discovery

Dr Bonita van der Westhuizen, Senior lecturer and Pathologist in the UFS Department of Medical Microbiology, who identified this rare fungus said this discovery is significant because it highlights the presence of this fungal pathogen in a region where it may have been previously unrecognised or underreported. It now raises awareness about the diversity of fungal infections affecting immunocompromised populations and underscores the need for improved diagnostics, surveillance, and treatment strategies in the region.

Dr Van der Westhuizen says though it is unclear where the deceased might have picked up this infection, moulds are ubiquitous in the environment. Patients usually get infected by inhalation of spores or traumatic implantation.

Together with colleagues Drs Liska Budding and Christie Esterhuysen, both from the UFS Department of Anatomical Pathology and the NHLS, and Prof Samantha Potgieter, Infectious disease expert in the UFS Department of Internal Medicine, Dr Van der Westhuizen published the case earlier this month (August) in the Journal Case Reports in Pathology.

Progresses rapidly

“Mucormycosis, which is caused by fungi in the order Mucorales, progresses rapidly due to a combination of factors related to the fungus, the host, and external influences. Mucorales fungi are known for their fast growth and ability to invade blood vessels. This allows the infection to spread quickly through the body, potentially reaching vital organs,” she says.

These fungi, Dr Van der Westhuizen explains, can resist being killed by immune cells, allowing them to establish infection. Some Mucorales fungi can produce toxins that disrupt blood vessels, further aiding the spread of the infection. Additionally, certain host conditions weaken the body's defences, allowing the infection to spread quickly.

“External factors that may play a role are traumatic injuries, endothelial damage and rarely hospital acquired infections. In essence, the aggressive nature of Mucorales fungi combined with weakened host defences and external factors creates a perfect storm for rapid disease progression in susceptible individuals.

“The Mucorales as a group normally infects patients with underlying risk factors including factors including diabetes mellitus, malignancies, transplant recipients, and current or past COVID-19 infection, however, this organism in particular, usually infects immunocompetent patients after traumatic inoculation,” says Dr Van der Westhuizen.

It is important to note, she continues, that all available data comes from research done in tropical regions. There is no data on this organism in sub-Saharan Africa which means it is still unknown what role this pathogen plays in our local patient population. The diagnostic complexities and rapid disease progression may contribute to the paucity of data in developing countries.

This infection can be treated with available antifungal agents, as well as surgical debridement of infected tissue. The challenge, however, is the rapid disease onset and progression to death. There is only a tiny window to help the patient. That is why clinical suspicion is so important, as immediate aggressive surgical debridement with antifungal agents is the only way to improve patient outcome. Unfortunately, this infection still has a high mortality rate, despite therapy.

Fungal diagnostics is complex

An invasive fungal infection (IFI) was not suspected in this patient, and he received neither antifungal therapy nor surgical interventions. His cause of death, likely the IFI, was only identified after he passed away and because of a combination of different testing platforms was used to identify this infection. Says Dr Van der Westhuizen: “This is unfortunately the case with mould infections as most readily available diagnostic methods lack sensitivity and these pathogens take long to grow in the laboratory. Fungal diagnostics is a specialised field that requires expertise. However, if clinicians are aware of these infections and they have an increased index of suspicion, appropriate therapy can be initiated even before the results are available.

“If clinicians suspect this type of infection early and they involve the infectious diseases physicians, microbiology and histopathology for support and advice, they will be guided to collect the most appropriate samples to ensure that an accurate diagnosis is made.”

There is a possibility that these infections had been missed before and even still today. Fungal diagnostics is a very complex field for various reasons. There is no highly sensitive stand-alone test to make a rapid diagnosis available. As newer methods are being developed and molecular diagnostics are advancing, fungal diagnostics are improving. A combination of testing platforms is still required to improve the sensitivity of diagnosing these infections.

Her hope for this research, says Dr Van der Westhuizen, who will now also embark further research into local fungal species for her PhD, their epidemiology, diagnostics, and their impact on vulnerable populations, ultimately contributing to better clinical care and health outcomes, is to advance understanding and awareness of Invasive mould infections specifically S. oblongispora, in sub-Saharan Africa and among HIV patients. She aims to improve early diagnosis, treatment strategies, and clinical outcomes, as well as to highlight the importance of monitoring fungal infections in immunocompromised populations. Additionally, her goal includes encouraging further research and collaboration in this area to better address fungal infections in the region.

News Archive

Professor launches his book, opposition parties attend

2011-03-22

Prof. Hussein Solomon
Photo: Stephen Collett

“We are good in opposing people, but we’re less good in opposing ideas.” This was how Prof. Jonathan Jansen, Vice-Chancellor and Rector of the University of the Free State (UFS) introduced the book launch of Against all Odds: Opposition Politics in Southern Africa.

The event was hosted in collaboration with the publisher under the title: Are opposition parties in South Africa in a crisis? This formed part of a series of dialogue sessions, organised by the Centre for Africa Studies, in the run up to the local elections.

Amongst those interested who attended the evening in the Senate Hall of the CR Swart Building on the Main Campus were various politicians, students, staff en a panel consisting of academics and the respective provincial representatives of the ANC and DA.

Dr Mcebisi Ndletyana from the Human Sciences Research Council (HSRC), acted as arbiter.

Proff. Hussein Solomon, author of Against all Odds: Opposition Politics in Southern Africa, also lecturer at the UFS, as well as Dirk Kotzé, Head of the Department of Political Science at Unisa, delivered enriching lectures on the stance and positioning of opposition parties.

Prof. Hussein, who spoke first, circumscribed the context of the political climate in the country, based on his book. “The problem that political science encounters is that everybody becomes experts on the internet, while they have no experience of what is happening in South Africa.” He said that when political parties in the country are under discussion, voters often allow myths and/or stereotyping to influence their concept of it. ‘’If there are no opposition parties, there is no democracy and people are deprived of their vote.”

Prof. Kotzé stated in his speech that it was not only opposition parties who had to make the government watch its step, but also the status that the country acquired, amongst others, from its connections, i.e. collaborative agreements such as BRICSA and the country’s inclusion in the G20. He left the audience with a question about how they were going to become involved in politics, and with his rhetoric question referred to options like social networks and movements.

Mr Sibongile Besani, the ANC'S secretary in the Free State, said the DA grew due to it’s swallowing of other parties; something he claims is taking the country backwards. He also described the use of personalities by opposition parties as means of association a weakness. He added that voters will continue voting for the ANC because they can associate themselves with the party’s vision.

In contrast, Mr Roy Jankielsohn, provincial leader of the DA, said voters and parties unite under their core vision for the country as like in the case of the ANC during the liberation struggles.

During the question-and-answer session, which followed after Mr Jankielson’s speech, Prof. Kwandiwe Kondlo, upon completion and summary of the discussions, stated firmly that the opposition parties are in a crisis. “The start of the solution is to recognise the problem. That is why our democracy finds itself in the state in which it is; because the opposition does not fulfil the role that they are supposed to fulfil.“ Prof. Kondlo is the head of the Centre of Africa Studies at the UFS.

He concluded by stating that the economic basis in the country was not transformed. “We cannot say that people determine their futures if they posses nothing. Opposition parties must start to communicate at this level in order to table something new. Our democracy must become more inclusive at political and material level.”

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