Johannesburg - Local researchers have discovered a new fungus that causes a potentially deadly disease in HIV-positive South Africans.
The study – titled A Dimorphic Fungus Causing Disseminated Infection in South Africa – was led by Chris Kenyon from Groote Schuur Hospital in Cape Town and Dr Nelesh Govender from the National Institute of Communicable Diseases (NICD), and was published on Thursday in the New England Journal of Medicine, a widely read and influential medical periodical.
From July 2008 to July 2011, the researchers and their team conducted an enhanced surveillance to identify the cause of systemic, dimorphic fungal (fungi that can exist as mould or yeast) infections in patients at Groote Schuur and other hospitals affiliated with the University of Cape Town.
The infection was caused by a newly described, but unnamed, opportunistic fungus in the type Emmonsia, and was fatal in three patients.
It was probably acquired after inhalation of fungal spores from the environment.
However, how it got into the body and how the immune system responded to it still needed to be researched.
“No person-to-person transmission occurs with this infection and, fortunately, it can be treated successfully in most cases,” the NICD said.
Researchers collected clinical and laboratory data on 13 patients – who were aged between 29 and 38 – and had disseminated Emmonsia disease and other dimorphic fungal infections.
Eight of the patients were men and all 13 presented with “evidence of clinically advanced HIV disease and with very low CD4 counts”. They were also anaemic and had widespread skin lesions.
The NICD said that until antiretroviral treatment was started and recovery of the immune system occurred, many HIV-infected patients were at risk of bacterial, viral and fungal infections.
“Once the diagnosis had been made, most patients experienced dramatic and rapid responses to anti-fungal treatment. In most patients, the skin lesions healed almost completely, they gained weight and their lungs recovered.”
According to the study, five patients were on antiretroviral treatment – two had virologic and immunologic failure; the other three – who had presented at four, seven, and 11 weeks after starting antiretrovirals – had a more pronounced inflammatory infiltrate in the dermis than the patients not receiving antiretrovirals.
Govender said on Friday: “So far, it (the fungus) has only been discovered in South Africa, but the most important way to prevent it is to get diagnosed for HIV early. It’s a great honour for us for our study to be published in this very prestigious journal, but it’s also an important discovery because it will impact on how patients are treated and also how doctors diagnose patients with suspected opportunistic infections more carefully.” - The Star