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Summary Candida albicans is a commensal of the urogenital tract and the predominant cause of vulvovaginal candidiasis (VVC). Factors that increase circulatory estrogen levels such as pregnancy, the use of oral contraceptives, and hormone replacement therapy predispose women to VVC, but the reasons for this are largely unknown. Here, we investigate how adaptation of C. albicans to estrogen impacts the fungal host-pathogen interaction. Estrogen promotes fungal virulence by enabling C. albicans to avoid the actions of the innate immune system. Estrogen-induced innate immune evasion is mediated via inhibition of opsonophagocytosis through enhanced acquisition of the human complement regulatory protein, Factor H, on the fungal cell surface. Estrogen-induced accumulation of Factor H is dependent on the fungal cell surface protein Gpd2. The discovery of this hormone-sensing pathway might pave the way in explaining gender biases associated with fungal infections and may provide an alternative approach to improving women's health., Graphical abstract, Highlights • Estrogen promotes the virulence of Candida albicans by reducing phagocytosis • Estrogen-adapted C. albicans binds more Factor H on its cell surface • Estrogen-induced innate immune evasion of C. albicans is dependent on Gpd2 • Overexpression of GPD2 promotes the virulence of C. albicans, Women with high estrogen levels have an increased risk of developing genital thrush caused by Candida albicans. Kumwenda et al. show that C. albicans grown in estrogen is not recognized and killed efficiently by white blood cells. This reduced immune recognition could enable C. albicans to proliferate and cause infection.

Objective The aim of this study was to characterize Covid-19 cases and explore risk factors associated with mortality among hypertensive patients with COVID-19 country-wide. Methods We used a retrospective case control study design to provide a detailed account of cases and explore risk factors associated with mortality among hypertensive patients with COVID-19 country-wide. A total of 441 patients were included in the study in the ratio of one case to two controls (1:2), matched by age. Results Deaths due to Covid-19 varied with hypertensive condition with more deaths registered in hypertensive patients. Clinical signs and symptoms in Covid-19 patients varied greatly between hypertensive and non-hypertensive patients, with a leaning favouring the latter. The risk of death due to Covid-19 among hypertensive patients increased with age and meaningfully associated with underlining comorbidities such as HIV, TB, cardiovascular, and liver disease. Conclusion Our study reveals predictive factors for mortality in COVID-19 hypertensive patients that can be used by policy makers and health care practioners to identify those at a higher risk and determine proper treatment approach to achieve best possible clinical outcomes.