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Case Reports
. 2006 Sep 8:5:21.
doi: 10.1186/1476-0711-5-21.

Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury

Lauren Destino  1 , Deanna A Sutton, Anna L Helon, Peter L Havens, John G Thometz, Rodney E Willoughby Jr, Michael J Chusid
Affiliations
Case Reports

Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury

Lauren Destino et al. Ann Clin Microbiol Antimicrob. .

Abstract

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.

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Figures

Figure 1
Figure 1
Conidia of Myceliophthora thermophila being produced from ampulliform swellings. Note both smooth, hyaline, immature conidia, and darker, more mature roughened conidia. Lactofuschin stain, approximately 1000×.
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