A Free State medical team has identified a rare fungal infection in an HIV+ patient that has never been seen before in South Africa, reports Daily Maverick.
The doctors and microbiologists at the University of the Free State and the National Health Laboratory Service positively identified the first-of-its-kind fungal infection for sub-Saharan Africa in a patient at the Universitas Hospital in Bloemfontein.
They said it was the first known infection of a patient with the fungus known as S. oblongispora mucormycosis in sub-Saharan Africa and among HIV-positive patients. It does not spread between humans.
The 32-year-old male patient had been admitted to the hospital after the right side of his face started swelling – he also had a critically low CD4 count, despite being on antiretroviral therapy.
The patient was HIV-positive, with a CD4 count of 50 cells/µl, and on antiretroviral therapy (ART) as well as a broad spectrum antibiotic.
The WHO describes Mucormycosis (previously called zygomycosis) as a rare but serious infection caused by a group of fungi called mucormycetes. It is not contagious.
Where does it come from?
Spores of these ubiquitous fungi (commonly found in soil, fallen leaves, compost, animal dung and air) can be inhaled and then infect the lungs, sinuses, and extend into the brain and eyes. Less often, infection may develop when the spores enter the body through a cut or an open wound.
Who is at risk?
• Immunocompromised people, or patients already infected with other diseases, and
• People with HIV, diabetes and organ recipients.
While the Free State case was an example of a rhino-orbital infection, the fungus can also attack the brain, lungs and digestive organs.
The team that attended to the Bloemfontein patient said his face had continued to swell. They did a CT scan and collected tissue biopsies, but were unable to help him in time and he died a week after admission.
Rare
Dr Bonita van der Westhuizen, a senior lecturer and pathologist in the University of the Free State Department of Medical Microbiology, who identified the rare fungus, said it was previously unrecognised or under-reported in South Africa and sub-Saharan Africa.
“This now raises awareness about the diversity of fungal infections affecting immunocompromised populations, and underscores the need for improved diagnostics, surveillance and treatment strategies,” she said.
Although it was unclear where the man might have picked up the infection, moulds were ubiquitous in the environment, she added. Patients usually got infected through the inhalation of spores, or through trauma.
The rest of the team, Dr Liska Budding and Dr Christie Esterhuysen from the university’s Department of Anatomical Pathology and the NHLS, and Professor Samantha Potgieter, an infectious disease expert at the university’s Department of Internal Medicine, and Van der Westhuizen published the case last month in the journal Case Reports in Pathology.
South African first
They wrote: “These fungi do not typically cause infections in immunocompetent individuals apart from the other risk groups.” They added that current or past Covid-19 infection could also create an infection risk, and that mucorales have also been linked to outbreaks in healthcare settings and after natural disasters.
They wrote that the infection had rapidly progressed and they were unable to save the patient.
“Due to his rapid deterioration, he neither underwent surgical intervention nor received any antifungal therapy … This is the first case of S. oblongispora infection described in sub-Saharan Africa and in the setting of HIV,” they noted.
“Infection by this fungus accounts for approximately 3% of human mucormycosis cases. S. oblongispora-associated rhinosinusitis is extremely uncommon and has been associated with rapid progression with high morbidity and mortality.
“A combination of different testing platforms was required to make a diagnosis. This case emphasises the challenge of diagnosing invasive mould infections timeously,” they added.
Progresses rapidly
“Mucormycosis progresses rapidly, due to a combination of factors related to the fungus, the host, and external influences. These fungi are known for their fast growth and ability to invade blood vessels, allowing the infection to spread quickly, potentially reaching vital organs,” Van der Westhuizen said.
The fungi can resist being killed by immune cells, allowing them to establish infection. Some can produce toxins that disrupt blood vessels, further aiding the spread of the infection.
“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,” Van der Westhuizen said.
There were no existing data on this fungus in sub-Saharan Africa.
While the infection could be treated through surgery and available anti-fungal medicine, treatment was made difficult due to the rapid disease onset and progression to death, she said.
“There is only a tiny window to help the patient. That is why clinical suspicion is so important …Unfortunately, this infection still has a high mortality rate, despite therapy.”
She added that the team was only able to identify the patient’s cause of death after he had died as they needed a combination of different testing platforms to do so.
“This is unfortunately the case with mould infections as most readily available diagnostic methods lack sensitivity and these pathogens take a long time to grow in the lab.”
Study details
Saksenaea oblongispora Rhinosinusitis in Advanced HIV: A Rare and Lethal Mucormycosis
Bonita van der Westhuizen, Liska Budding, Christie Esterhuysen, Samantha Potgieter.
Published in Case Reports in Pathology on 18 August 2025
Abstract
Mucormycosis is a severe invasive infection caused by the Mucorales fungi. The most frequently implicated genera are Rhizopus species, Mucor species, and Lichtheimia species. These fungi do not typically cause infections in immunocompetent individuals. Risk factors include diabetes mellitus, malignancies, transplant recipients, and current or past COVID-19 infection. Mucorales have also been linked to outbreaks in healthcare settings and following natural disasters. We describe a case of rapidly progressing rhinosinusitis in a patient with advanced HIV infection due to Saksenaea oblongispora, a rare cause of mucormycosis that, in contrast to the other Mucorales, primarily affects immunocompetent hosts following traumatic inoculation. A 32-year-old male patient presented with right-sided facial swelling. His clinical condition deteriorated rapidly. Biopsies and computerized tomography (CT) of the brain and sinuses were performed. Tuberculosis and bacterial workups were negative. Histological examination showed thick-walled angioinvasive fungal elements. Fungal cultures were positive. Molecular testing identified the organism as S. oblongispora. Due to his rapid deterioration, he neither underwent surgical intervention nor received any antifungal therapy and subsequently demised. This is the first case of S. oblongispora infection described in sub-Saharan Africa and in the setting of HIV. Infection by this fungus accounts for approximately 3% of human mucormycosis cases. S. oblongispora-associated rhinosinusitis is extremely uncommon and has been associated with rapid progression with high morbidity and mortality. A combination of different testing platforms was required to make a diagnosis. This case emphasises the challenge of diagnosing invasive mold infections timeously. A high index of suspicion, combined with a multidisciplinary diagnostic and treatment approach, is essential for the management of these infections.
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