Spinola, mBio 5:e01081-13, 2014, http://dx.doi.org/10.1128/mBio.01081-13) suggested that H. ducreyi encounters growth conditions in human lesions resembling those found in stationary phase. However, how H. ducreyi transcriptionally responds to stress during human infection is unknown. Here, we determined the H. ducreyi transcriptome in biopsy specimens of human lesions and compared it to the transcriptomes of bacteria grown to mid-log, transition, and stationary phases. Multidimensional scaling showed that the in vivo transcriptome is distinct from those of in vitro growth. Compared to the inoculum (mid-log-phase bacteria), H. ducreyi harvested from pustules differentially expressed ϳ93 genes, of which 62 were upregulated. The upregulated genes encode homologs of proteins involved in nutrient transport, alternative carbon pathways (L-ascorbate utilization and metabolism), growth arrest response, heat shock response, DNA recombination, and anaerobiosis. H. ducreyi upregulated few genes (hgbA, flp-tad, and lspB-lspA2) encoding virulence determinants required for human infection. Most genes regulated by CpxRA, RpoE, Hfq, (p)ppGpp, and DksA, which control the expression of virulence determinants and adaptation to a variety of stresses, were not differentially expressed in vivo, suggesting that these systems are cycling on and off during infection. Taken together, these data suggest that the in vivo transcriptome is distinct from those of in vitro growth and that adaptation to nutrient stress and anaerobiosis is crucial for H. ducreyi survival in humans.T he Gram-negative bacterium Haemophilus ducreyi is the causative agent of the sexually transmitted disease chancroid. Chancroid facilitates the acquisition and transmission of human immunodeficiency virus type 1 (1). Although the global prevalence of chancroid has declined due to syndromic management of genital ulcer disease, the disease is still prevalent in several regions of Africa, Latin America, and Asia (2). In addition to causing chancroid, H. ducreyi now is recognized as a leading cause of nonsexually transmitted cutaneous ulcers in children in regions of the South Pacific islands and equatorial Africa where yaws is endemic (3-5). Strains that cause cutaneous ulcers are almost genetically identical to the genital ulcer strain 35000HP and likely evolved from the 35000HP lineage ϳ180,000 years ago (6, 7).The molecular pathogenesis of H. ducreyi 35000HP has been extensively characterized in a human challenge model (8). In this model, H. ducreyi is inoculated into the skin of healthy adults via puncture wounds made by an allergy-testing device. Within 24 h of inoculation, collagen and fibrin are deposited in the wounds; polymorphonuclear leukocytes (PMNs) and macrophages traffic onto collagen and fibrin, forming micropustules (9, 10). By 48 h, the micropustules coalesce to form an abscess, which eventually ulcerates through the epidermis (9, 10). In the abscess, H. ducreyi is found in aggregates and colocalizes with PMNs and macrophages, which fail to ingest the ...