In Vivo Microevolutionary Analysis of a Fatal Case of Rhinofacial and Disseminated Mycosis Due to Azole-Drug-Resistant Candida Species

Ten Candida species strains were isolated from the first known fatal case of rhinofacial and rhino–orbital–cerebral candidiasis. Among them, five parapsilosis complex during early stage hospitalization, while tropicalis in later stages disease. Using whole-genome sequencing, we distinguished C. as four metapsilosis one strain. Antifungal susceptibility testing showed that susceptible to all antifungal drugs, had high minimum inhibitory concentrations azoles, whereas antifungal-drug resistance gene analysis revealed causes azole such strains. For time, analyzed microevolutionary characteristics pathogenic fungi human hosts inferred infection time parallel evolution Molecular clock azole-resistant occurred round therapy, followed by divergence via vivo. The presence/absence variations indicated a potential decrease virulence genomes following drug treatment, despite absence observed clinical improvement conditions patient. These results suggest genomic could serve an auxiliary tool guiding diagnosis treatment.