UNUSUAL CASE OF CANDIDA-LUSITANIAE INFECTION IN A SEVERELY IMMUNOCOMPROMISED PATIENT - MULTIPLE LOCALIZATIONS OF A SINGLE INFECTIVE STRAIN DOCUMENTED BY RESTRICTION-ENDONUCLEASE ANALYSIS

We describe a complex Candida lusitaniae infection in a splenectomized patient with homozygote drepanocytemia. The diagnosis was established on the basis of mycological and histopathologic evidence. Combination of amphotericin B and flucytosine eventually allowed the specimens to be sterilized and the treatment to succeed, thus confirming the diagn osis. Three infective strains of C, lusitaniae were recovered over the course of the infection from buccal lesions, a bronchoalveolar lavage and epidermic lesions at the edge of the lower lip. These isolates we re susceptible in vitro to amphotericin B, flucytosine and fluconazole , with minimum inhibitory concentrations, as determined with the Natio nal Committee for Clinical Laboratory Standards reference macrodilutio n method, of 0.5, 0.03 and 1 mu g/ml, respectively. Restriction endonu clease analysis of total DNA was used to type the three isolates. In a ddition, four unrelated control strains were studied. By means of EcoR I and HinfI, restriction patterns of the infectious isolates were foun d to be identical (100 % similitude according to Jaccard's coefficient ). In contrast, the four control strains generated four different patt erns. These findings confirm the hypothesis that the Candida lusitania e strain spread from a buccal lesion to the upper respiratory tract an d to the face as suggested from the case analysis.