Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury. Ann Clin Microbiol Antimicrob 2006 Sep 08;5:21
Date
09/12/2006Pubmed ID
16961922Pubmed Central ID
PMC1592504DOI
10.1186/1476-0711-5-21Scopus ID
2-s2.0-33749571119 (requires institutional sign-in at Scopus site) 27 CitationsAbstract
BACKGROUND: Traumatic injuries occurring in agricultural settings are often associated with infections caused by unusual organisms. Such agents may be difficult to isolate, identify, and treat effectively.
CASE REPORT: A 4-year-old boy developed an extensive infection of his knee and distal femur following a barnyard pitchfork injury. Ultimately the primary infecting agent was determined to be Myceliophthora thermophila, a thermophilic melanized hyphomycete, rarely associated with human infection, found in animal excreta. Because of resistance to standard antifungal agents including amphotericin B and caspofungin, therapy was instituted with a prolonged course of terbinafine and voriconazole. Voriconazole blood levels demonstrated that the patient required a drug dosage (13.4 mg/kg) several fold greater than that recommended for adults in order to attain therapeutic blood levels.
CONCLUSION: Unusual pathogens should be sought following traumatic farm injuries. Pharmacokinetic studies may be of critical importance when utilizing antifungal therapy with agents for which little information exists regarding drug metabolism in children.
Author List
Destino L, Sutton DA, Helon AL, Havens PL, Thometz JG, Willoughby RE Jr, Chusid MJAuthors
John G. Thometz MD Professor in the Orthopaedic Surgery department at Medical College of WisconsinRodney E. Willoughby MD Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Child, PreschoolHumans
Knee Injuries
Male
Mitosporic Fungi
Mycoses
Osteomyelitis
Pyrimidines
Triazoles
Voriconazole
