A Case of Septic Shock due to Kodamaea Ohmeri

A Case of Septic Shock due to Kodamaea Ohmeri | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A Case of Septic Shock due to Kodamaea Ohmeri Min-nan Mao, Yu-fang Cao, Ying-ai Zhang, Ting Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4009218/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Kodamaea ohmeri is an emerging rare fungal pathogen that often infects patients with weakened immunity. Herein, we report a case of a patient with normal immune function infected with K.ohmeri. The patient presented with fever, shortness of breath and lethargic (accompanied by septic shock in one episodes) within two weeks. Chest roentgenography showed massive right-side pleural effusion and atelectasis, and left-side pneumonia. Thoracentesis yielded pleural effusion containing a nucleated cell count of more than 600·10 6 ·L -1 . An bronchoalveolar lavage fluid culture grew K.ohmeri. According to the result of drug sensitivity, voriconazole was used for anti-fungal treatment.The patient died after medical treatment. Early and accurate identification of K. ohmeri is critical to determining treatment options. Septic shock caused by severe fungal pneumonia requires early, aggressive and multidisciplinary treatment. Case report Kodamaea ohmeri Septic shock Figures Figure 1 INTRODUCTION K.ohmeri, formerly known as Pichia ohmeri, belongs to the ascomyceaceae and yeasts.It is a heteromorphous form of Candida guilliermondii, which is often mistaken for Candida and belongs to the same family as Candida. Kodamaea ohmer was first identified from pleural effusion in 1984, and since then an increasing number of infections have been reported in the publications. Here, we report a rare case of severe infection here. CASE A 81-year-old male patient presented to the Department of Respiratory Diseases of our institution with cough, sputum (the sputum was yellowish-white sticky and easily coughed up), recurrent fever (up to 38°C and irregular), irritability, poor appetite and fatigue. He was initially diagnosed with severe pneumonia, septic shock, and gastrointestinal bleeding requiring transfer to Respiratory Intensive Care Unit. He was treated with broad-spectrum antibiotics, high-flow nasal cannula, and symptomatic treatments such as relieving cough and reducing phlegm, controlling blood pressure, suppressing gastric acid and protecting gastric mucosa before transfer. The patient denied having any other medical or surgical history but he have been prescribed medication for hypertension 20 years and the previous highest blood pressure was 160/100 mmHg. Vital signs were notable for a pulse of 118 beats·min -1 , a respiratory rate of 26 breaths·min -1 , a blood pressure of 126/68 mmHg, and pulse oximetry of 65% with mask oxygen inhalation(flow rate of oxygen was 5L·min -1 ). The patient was fatigued and lethargic on arrival to the respiratory intensive care unit (Glasgow Coma Score was 13 points). Physical examination showed increased respiratory effort with bilateral wheezing. The patient’s skin was yellow, and dry without rash and ulcer. Auscultation of the lungs suggested weak breathing sounds in the right-side lung, dry and wet rales could be heard in bilateral lungs. Auscultation of the abdomen revealed a normal active bowel sound with slight tenderness. Mild depressed oedema in both lower limbs. Routine laboratory testing was sent (Table 1). Initial chest x-ray showed massive right-side pleural effusion and atelectasis, and left-side pneumonia. The same situation was seen on computed tomography(CT) of the chest (Figure 1). Fibreoptic bronchoscopy indicated a small amount of yellowish-white secretion from the upper and lower lobes of the left lung, a small amount of yellowish-white secretion from the right lung's upper lobe, and a large amount of yellowish-white, mucoid secretion from the middle and lower lobes. The patient was started on moxifloxacin and meropenem based on our differential diagnosis, which included bacterial pneumonia, viral pneumonia, fungal pneumonia, aspiration pneumonitis. And He required vasopressor support for hypotension. Pleural puncture was performed on the right chest and pleural effusion was evacuated. Due to hypoxic respiratory failure, he required endotracheal intubation and mechanical ventilation for a total of 7 days. Once his disease progressed to respiratory failure, he underwent bronchoscopy, with multiple cultures of his bronchial washings. His blood and urine was additionally cultured for bacterial and fungal pathogens. Fluorescent staining of sputum bacteria reveals spores and pseudohyphae, which are suspected to be yeasts. Fungal spores, similar to Candida albicans, were detected in bronchoalveolar lavage fluid by fluorescent staining and the final culture result was K.ohmeri. Antibiotics were changed to voriconazole and meropenem according to the results of bronchoalveolar lavage fluid culture and drug sensitivity, and blood cultures and urine tests were negative for other pathogens. Esomeprazole and somatostatin were used to treat gastrointestinal bleeding. At the same time, some support treatment such as liver protection, plasma infusion to improve coagulation function, transfusion of suspended red blood cells to improve moderate anemia, fog to relieve spasm, and maintain internal environment balance was given. Unfortunately, he developed severe respiratory and circulatory failure on day 7 of voriconazole and eventually died. DISCUSSION K.ohmeri is considered to be an emerging and rare fungal pathogen that can cause invasive infections such as peritonitis, endocarditis, urinary tract infection, ear infection, cellulitis, fungemia, tinea onychomycosis, pneumonia, keratitis, oral diseases, and disseminated infections, with high mortality rates due to fungal bacteraemia, especially in children [1-3] 。Molecular epidemiological information on K. ohmeri isolates is currently unavailable, and studies have speculated that their wide range of infection types may be related to the underlying genomic diversity that allows K. ohmeri to adapt to a variety of human sites and tissues [4] . This microbe has been found in patients around the world, with nearly 70% of infections occurring in Asia (especially East and Southeast Asia), but its regional and ethnic heterogeneity is unknown due to the low number of reported cases. Infection often occurs in immunocompromised patients, such as diabetes or chronic renal failure, hematological or solid malignancies,patients with immunosuppression due to neutropenia after chemotherapy, immunosuppressive therapy, long-term parenteral nutrition, or intravenous drug use [5] . It can also occur in patients with long-term placement of central venous catheters, prolonged ICU stay, use of broad-spectrum antibiotics, drug abuse, and artificial valve replacement. However, in patients with normal immune function, K. ohmeri infection is rarely reported, and no serious life-threatening infection caused by K. ohmeri has been reported. The clinical characteristics of this patient are repeated fever, obvious shortness of breath, large amount of sputum, and even respiratory distress, reduced consciousness level, serious liver function damage, abnormal coagulation function, gastrointestinal bleeding, severe anemia, low thrombocytopenia and other clinical manifestations.According to the clinical practice guidelines for the management of candidiasis from the Infectious Diseases Society of America, echinocin is recommended as initial treatment, Fluconazole can also be used as an alternative therapy for non-critically ill patients who have not previously been exposed to azole drugs, but the incidence of resistance has increased in recent years. Other studies have shown that in addition to fluconazole, amphotericin B, 5-flucytosine, fluconazole, itraconazole, voriconazole, posaconazole, micafungin, Eight antifungal drugs, including caspofungin, successfully treat most K. ohmeri infections [6] . However, in our case, voriconazole selected as first-line therapy based on susceptibility results was not effective. To prevent the spread of K. ohmeri in hospitals, early identification of this genus of Candida, enhanced personal protective measures, environmental cleaning, and patient removal colonization may be required [7] . Abbreviations Kodamaea ohmeri, K.ohmeri; Computed Tomography, CT Declarations Ethics Statement: The studies involving human participants were reviewed and approved by the Ethical Committee of Haikou Affiliated of Central South University Xiangya School of Medicine. Consent for publication: The participant provided his written informed consent for publication. Availability of data and materials: Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. Conflict of Interest: The authors declare that they have no competing interests. Statement of Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Authors' contributions: The original manuscript was written by M-NM, reviewed and edited by M-NM, Y-FC, YA-Z and TW. All authors read and approved the final manuscript. Acknowledgements: The authors would like to thank Xiao-bin Wei of clinical laboratory of Haikou People’s Hospital for helpful discussions on topics related to this work. REFERENCES WILCOCK J N, GALLAGHER A J, WENGENACK N L, et al. Candida guilliermondii/K.ohmeri Endocarditis [J]. Mycopathologia, 2023. LI Z M, KUANG Y K, ZHENG Y F, et al. Gut-derived fungemia due to K.ohmeri combined with invasive pulmonary aspergillosis: a case report [J]. BMC Infect Dis, 2022, 22(1): 903. ALAM M M, BIPLOB J A, SATHI F A, et al. Ear Infections by Non albicans Candida Species with Isolation of Rare Drug Resistant Species in a Tertiary Care Hospital of Bangladesh [J]. Mymensingh Med J, 2023, 32(3): 644-8. SATHI F A, AUNG M S, PAUL S K, et al. Clonal Diversity of Candida auris, Candida blankii, and K.ohmeri Isolated from Septicemia and Otomycosis in Bangladesh as Determined by Multilocus Sequence Typing [J]. J Fungi (Basel), 2023, 9(6). CHEW K L, ACHIK R, OSMAN N H, et al. Genome Sequence of a Clinical Blood Isolate of K.ohmeri [J]. Microbiol Resour Announc, 2022, 11(12): e0084322. ZHOU M, YU S, KUDINHA T, et al. Identification and antifungal susceptibility profiles of K.ohmeri based on a seven-year multicenter surveillance study [J]. Infect Drug Resist, 2019, 12: 1657-64. SATHI F A, PAUL S K, AHMED S, et al. Prevalence and Antifungal Susceptibility of Clinically Relevant Candida Species, Identification of Candida auris and K.ohmeri in Bangladesh [J]. Trop Med Infect Dis, 2022, 7(9). Table Table 1. Laboratory values on patient presentation Test Value Leukocytes(10 9 ·L -1 ) 26.22 Neutrophils ratio(%) 91.5 Lymphocytes ratio(%) 4.5 C-reactive protein(mg·L -1 ) 140.12 Procalcitonin(ng·ml -1 ) 16.20 Hypersensitive C-reactive protein(mg·L -1 ) 264.2 Oxygenation index 155 D-glucan(pg·ml -1 ) < 31.25 Pleural Effusion Appearance red turbid fluid Mucin + Erythrocytes full visual field Leucocytes(HP -1 ) 5-8 Nucleated cell(10 6 ·L -1 ) 647 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4009218","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":276686441,"identity":"78a34b6c-78e5-41f2-abb7-88ff1a2b579d","order_by":0,"name":"Min-nan Mao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYDACZhiDvQFIFDAwSBCvhecAA8MBA2K0wIFEApFadNt5jz34uWObPL/k42PSHwxs5CQbmB8+uoFHi9lhvnTD3jO3DWfOTkuTOGCQZizNwGZsnINXC4+ZBG/bbcYNt3PMgFoOJ85j4GGTJqRF8m/bbfsNN8+QoEUaaEvihhs8EC2zidIi23Y7eWZPWrLFGaBfJJsJ+eX8GTPJt223bfvZDx+8UVFhIydxvPnhY3xasABmwkpGwSgYBaNgFBAAAH14R+6Lu96aAAAAAElFTkSuQmCC","orcid":"","institution":"Haikou Affiliated of Central South University Xiangya School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Min-nan","middleName":"","lastName":"Mao","suffix":""},{"id":276686442,"identity":"dffac2d0-0b34-4f52-90ba-8c2836a263fb","order_by":1,"name":"Yu-fang Cao","email":"","orcid":"","institution":"Haikou Affiliated of Central South University Xiangya School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Yu-fang","middleName":"","lastName":"Cao","suffix":""},{"id":276686443,"identity":"454dbf1f-36e7-4003-b166-e2cb0f18fe0c","order_by":2,"name":"Ying-ai Zhang","email":"","orcid":"","institution":"Haikou Affiliated of Central South University Xiangya School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ying-ai","middleName":"","lastName":"Zhang","suffix":""},{"id":276686444,"identity":"248fa06a-b013-49fc-a905-206c6ea5a4f8","order_by":3,"name":"Ting Wang","email":"","orcid":"","institution":"Haikou Affiliated of Central South University Xiangya School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ting","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2024-03-03 16:32:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4009218/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4009218/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52447914,"identity":"ea281f38-0f80-4946-a4ae-333b9aee747a","added_by":"auto","created_at":"2024-03-11 18:32:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":451294,"visible":true,"origin":"","legend":"\u003cp\u003eThe chest CT images of the patient we reported. Chest CT of right lobe showed ground-glass opacity and consolidation, moderate pleural fluid accumulation and compressive pulmonary atelectasis were also presented. Images of the left lobe revealed a few fibrous and sclerotic foci.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4009218/v1/e8cd2d698f20f8965d1c36a9.png"},{"id":58730042,"identity":"51aba757-f35a-477c-ac85-45d4f370a300","added_by":"auto","created_at":"2024-06-20 10:59:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":658385,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4009218/v1/a8f66a0a-1146-4c64-935e-6b5a32bcf325.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Case of Septic Shock due to Kodamaea Ohmeri","fulltext":[{"header":"INTRODUCTION ","content":"\u003cp\u003eK.ohmeri, formerly known as Pichia ohmeri, belongs to the ascomyceaceae and yeasts.It is a heteromorphous form of Candida guilliermondii, which is often mistaken for Candida and belongs to the same family as Candida. Kodamaea ohmer was first identified from pleural effusion in 1984, and since then an increasing number of infections have been reported in the publications. Here, we report a rare case of severe infection here.\u003c/p\u003e"},{"header":"CASE","content":"\u003cp\u003eA 81-year-old male patient presented to the Department of Respiratory Diseases of our institution with cough, sputum (the sputum was yellowish-white sticky and easily coughed up), recurrent fever (up to 38\u0026deg;C and irregular), irritability, poor appetite and fatigue. He was initially diagnosed with severe pneumonia, septic shock, and gastrointestinal bleeding requiring transfer to Respiratory Intensive Care Unit. He was treated with broad-spectrum antibiotics, high-flow nasal cannula, and symptomatic treatments such as relieving cough and reducing phlegm, controlling blood pressure, suppressing gastric acid and protecting gastric mucosa before transfer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe patient denied having any other medical or surgical history but he have been prescribed medication for hypertension 20 years and the previous highest blood pressure was 160/100 mmHg.\u003c/p\u003e\n\u003cp\u003eVital signs were notable for a pulse of 118 beats\u0026middot;min\u003csup\u003e-1\u003c/sup\u003e, a respiratory rate of 26 breaths\u0026middot;min\u003csup\u003e-1\u003c/sup\u003e, a blood pressure of 126/68 mmHg, and pulse oximetry of 65% with mask oxygen inhalation(flow rate of oxygen was 5L\u0026middot;min\u003csup\u003e-1\u003c/sup\u003e). The patient was fatigued and lethargic on arrival to the respiratory intensive care unit (Glasgow Coma Score was 13 points). Physical examination showed increased respiratory effort with bilateral wheezing. The patient\u0026rsquo;s skin was yellow, and dry without rash and ulcer. Auscultation of the lungs suggested weak breathing sounds in the right-side lung, dry and wet rales could be heard in bilateral lungs. Auscultation of the abdomen revealed a normal active bowel sound with slight tenderness. Mild depressed oedema in both lower limbs.\u003c/p\u003e\n\u003cp\u003eRoutine laboratory testing was sent (Table\u0026ensp;1). Initial chest x-ray showed massive right-side pleural effusion and atelectasis, and left-side pneumonia. The same situation was seen on computed tomography(CT) of the chest (Figure 1). Fibreoptic bronchoscopy indicated a small amount of yellowish-white secretion from the upper and lower lobes of the left lung, a small amount of yellowish-white secretion from the right lung\u0026apos;s upper lobe, and a large amount of yellowish-white, mucoid secretion from the middle and lower lobes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe patient was started on moxifloxacin and meropenem based on our differential diagnosis, which included bacterial pneumonia, viral pneumonia, fungal pneumonia, aspiration pneumonitis. And He required vasopressor support for hypotension. Pleural puncture was performed on the right chest and pleural effusion was evacuated. Due to hypoxic respiratory failure, he required endotracheal intubation and mechanical ventilation for a total of 7 days. Once his disease progressed to respiratory failure, he underwent bronchoscopy, with multiple cultures of his bronchial washings. His blood and urine was additionally cultured for bacterial and fungal pathogens. Fluorescent staining of sputum bacteria reveals spores and pseudohyphae, which are suspected to be yeasts. Fungal spores, similar to Candida albicans, were detected in bronchoalveolar lavage fluid by fluorescent staining and the final culture result was K.ohmeri. Antibiotics were changed to voriconazole and meropenem according to the results of bronchoalveolar lavage fluid culture and drug sensitivity, and blood cultures and urine tests were negative for other pathogens. Esomeprazole and somatostatin were used to treat gastrointestinal bleeding. At the same time, some support treatment such as liver protection, plasma infusion to improve coagulation function, transfusion of suspended red blood cells to improve moderate anemia, fog to relieve spasm, and maintain internal environment balance was given. Unfortunately, he developed severe respiratory and circulatory failure on day 7 of voriconazole and eventually died.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eK.ohmeri is considered to be an emerging and rare fungal pathogen that can cause invasive infections such as peritonitis, endocarditis, urinary tract infection, ear infection, cellulitis, fungemia, tinea onychomycosis, pneumonia, keratitis, oral diseases, and disseminated infections, with high mortality rates due to fungal bacteraemia, especially in children\u003csup\u003e[1-3]\u003c/sup\u003e。Molecular epidemiological information on K. ohmeri isolates is currently unavailable, and studies have speculated that their wide range of infection types may be related to the underlying genomic diversity that allows K. ohmeri to adapt to a variety of human sites and tissues\u003csup\u003e[4]\u003c/sup\u003e. This microbe has been found in patients around the world, with nearly 70% of infections occurring in Asia (especially East and Southeast Asia), but its regional and ethnic heterogeneity is unknown due to the low number of reported cases.\u003c/p\u003e\n\u003cp\u003eInfection often occurs in immunocompromised patients, such as diabetes or chronic renal failure, hematological or solid malignancies,patients with immunosuppression due to neutropenia after chemotherapy, immunosuppressive therapy, long-term parenteral nutrition, or intravenous drug use\u003csup\u003e[5]\u003c/sup\u003e. It can also occur in patients with long-term placement of central venous catheters, prolonged ICU stay, use of broad-spectrum antibiotics, drug abuse, and artificial valve replacement. However, in patients with normal immune function, K. ohmeri infection is rarely reported, and no serious life-threatening infection caused by K. ohmeri has been reported.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe clinical characteristics of this patient are repeated fever, obvious shortness of breath, large amount of sputum, and even respiratory distress, reduced consciousness level, serious liver function damage, abnormal coagulation function, gastrointestinal bleeding, severe anemia, low thrombocytopenia and other clinical manifestations.According to the clinical practice guidelines for the management of candidiasis from the Infectious Diseases Society of America, echinocin is recommended as initial treatment, Fluconazole can also be used as an alternative therapy for non-critically ill patients who have not previously been exposed to azole drugs, but the incidence of resistance has increased in recent years. \u0026nbsp;Other studies have shown that in addition to fluconazole, amphotericin B, 5-flucytosine, fluconazole, itraconazole, voriconazole, posaconazole, micafungin, Eight antifungal drugs, including caspofungin, successfully treat most K. ohmeri infections\u003csup\u003e[6]\u003c/sup\u003e. However, in our case, voriconazole selected as first-line therapy based on susceptibility results was not effective. To prevent the spread of K. ohmeri in hospitals, early identification of this genus of Candida, enhanced personal protective measures, environmental cleaning, and patient removal colonization may be required\u003csup\u003e[7]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eKodamaea ohmeri, K.ohmeri; Computed Tomography, CT\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics Statement: The studies involving human participants were reviewed and approved by the Ethical Committee of Haikou Affiliated of Central South University Xiangya School of Medicine.\u003c/p\u003e\n\u003cp\u003eConsent for publication: The participant provided his written informed consent for publication.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003eConflict of Interest: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eStatement of Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions: The original manuscript was written by M-NM, reviewed and edited by M-NM, Y-FC, YA-Z and TW. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcknowledgements: The authors would like to thank Xiao-bin Wei of clinical laboratory of Haikou People’s Hospital for helpful discussions on topics related to this work.\u003c/p\u003e"},{"header":"REFERENCES","content":"\u003col\u003e\n\u003cli\u003eWILCOCK J N, GALLAGHER A J, WENGENACK N L, et al. Candida guilliermondii/K.ohmeri Endocarditis [J]. Mycopathologia, 2023.\u003c/li\u003e\n\u003cli\u003eLI Z M, KUANG Y K, ZHENG Y F, et al. Gut-derived fungemia due to K.ohmeri combined with invasive pulmonary aspergillosis: a case report [J]. BMC Infect Dis, 2022, 22(1): 903.\u003c/li\u003e\n\u003cli\u003eALAM M M, BIPLOB J A, SATHI F A, et al. Ear Infections by Non albicans Candida Species with Isolation of Rare Drug Resistant Species in a Tertiary Care Hospital of Bangladesh [J]. Mymensingh Med J, 2023, 32(3): 644-8.\u003c/li\u003e\n\u003cli\u003eSATHI F A, AUNG M S, PAUL S K, et al. Clonal Diversity of Candida auris, Candida blankii, and K.ohmeri Isolated from Septicemia and Otomycosis in Bangladesh as Determined by Multilocus Sequence Typing [J]. J Fungi (Basel), 2023, 9(6).\u003c/li\u003e\n\u003cli\u003eCHEW K L, ACHIK R, OSMAN N H, et al. Genome Sequence of a Clinical Blood Isolate of K.ohmeri [J]. Microbiol Resour Announc, 2022, 11(12): e0084322.\u003c/li\u003e\n\u003cli\u003eZHOU M, YU S, KUDINHA T, et al. Identification and antifungal susceptibility profiles of K.ohmeri based on a seven-year multicenter surveillance study [J]. Infect Drug Resist, 2019, 12: 1657-64.\u003c/li\u003e\n\u003cli\u003eSATHI F A, PAUL S K, AHMED S, et al. Prevalence and Antifungal Susceptibility of Clinically Relevant Candida Species, Identification of Candida auris and K.ohmeri in Bangladesh [J]. Trop Med Infect Dis, 2022, 7(9).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003eTable\u0026nbsp;1. Laboratory values on patient presentation\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"524\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003eValue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLeukocytes(10\u003csup\u003e9\u003c/sup\u003e\u0026middot;L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e26.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eNeutrophils ratio(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e91.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLymphocytes ratio(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eC-reactive protein(mg\u0026middot;L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e140.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eProcalcitonin(ng\u0026middot;ml\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e16.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eHypersensitive C-reactive protein(mg\u0026middot;L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e264.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eOxygenation index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.213740458015266%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eD-glucan(pg\u0026middot;ml\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 31.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.99236641221374%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003ePleural Effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.221374045801525%\" valign=\"top\"\u003e\n \u003cp\u003eAppearance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.786259541984734%\" valign=\"top\"\u003e\n \u003cp\u003ered turbid fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.17391304347826%\" valign=\"top\"\u003e\n \u003cp\u003eMucin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.82608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.17391304347826%\" valign=\"top\"\u003e\n \u003cp\u003eErythrocytes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.82608695652174%\" valign=\"top\"\u003e\n \u003cp\u003efull visual field\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.17391304347826%\" valign=\"top\"\u003e\n \u003cp\u003eLeucocytes(HP\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.82608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e5-8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.17391304347826%\" valign=\"top\"\u003e\n \u003cp\u003eNucleated cell(10\u003csup\u003e6\u003c/sup\u003e\u0026middot;L\u003csup\u003e-1\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"47.82608695652174%\" valign=\"top\"\u003e\n \u003cp\u003e647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Case report, Kodamaea ohmeri, Septic shock ","lastPublishedDoi":"10.21203/rs.3.rs-4009218/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4009218/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eKodamaea ohmeri is an emerging rare fungal pathogen that often infects patients with weakened immunity. Herein, we report a case of a patient with normal immune function infected with K.ohmeri. The patient presented with fever, shortness of breath and lethargic (accompanied by septic shock in one episodes)\u0026nbsp;within two weeks. Chest roentgenography showed massive right-side pleural effusion and atelectasis, and left-side pneumonia. Thoracentesis yielded pleural effusion containing a nucleated cell count of more than 600·10\u003csup\u003e6\u003c/sup\u003e·L\u003csup\u003e-1\u003c/sup\u003e. An bronchoalveolar lavage fluid culture grew K.ohmeri. According to the result of drug sensitivity, voriconazole was used for anti-fungal treatment.The patient died after medical treatment. Early and accurate identification of K. ohmeri is critical to determining treatment options. Septic shock caused by severe fungal pneumonia requires early, aggressive and multidisciplinary treatment.\u003c/p\u003e","manuscriptTitle":"A Case of Septic Shock due to Kodamaea Ohmeri","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-11 18:31:42","doi":"10.21203/rs.3.rs-4009218/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"08d39a3d-be34-4697-94f0-c581eb8f3a12","owner":[],"postedDate":"March 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-20T10:51:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-11 18:31:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4009218","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4009218","identity":"rs-4009218","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}