Microevolution of Candida albicans Isolate from a Patient with Mucocutaneous Candidiasis and HIV Infection

Candidiasis is the most common opportunistic fungal infection in HIV patients, and its presence is ascribed mainly to the persistence of the original infecting strain. The latter might acquire genetic variations during interaction with the host, reflecting the adaptation of the strain. Here, we report the case of a 32-year-old man complaining of asthenia, irregular hyperpyrexia, and dry cough, who was admitted to the emergency unit. Laboratory examination showed positivity for HIV. Dark violet macular lesions and ulcerated lesions with verrucous erosion were observed at the tip of the nose, whereas an ulcer without exudates was noted in the pubic region. Candida albicans was recovered from the skin by scraping these lesions. Cultures from the bronchoalveolar lavage (BAL) were negative for bacteria and opportunistic fungi but were positive for Candida albicans. The isolates from the skin and BAL were typed by PCR-RFLP and Candida albicans was identified. Analysis by microsatellite length polymorphisms, established that the pubic isolate was a genetic variant of the isolate from the nose and mouth. This suggested a microevolutionary event. Despite clinical support, the patient died of multiple organ failure.