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Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury

Lauren Destino1, Deanna A Sutton, Anna L Helon

  • 1Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, USA. ldestino@mcw.edu

Annals of Clinical Microbiology and Antimicrobials
|September 12, 2006
PubMed
Abstract

Insights

Unusual fungal infections can occur after farm injuries. Pediatric patients may require higher antifungal drug doses than adults for effective treatment.

Area of Science:

  • Medical Mycology
  • Pediatric Infectious Diseases
  • Agricultural Medicine

Background:

  • Agricultural injuries pose risks of infection from uncommon microorganisms.
  • These unusual pathogens present diagnostic and therapeutic challenges.

Observation:

  • A pediatric case involving extensive knee and femur infection after a barnyard pitchfork injury.
  • The causative agent identified was Myceliophthora thermophila, a rare thermophilic fungus found in animal excreta.

Findings:

  • The infection showed resistance to standard antifungal medications like amphotericin B and caspofungin.
  • Treatment with terbinafine and voriconazole was initiated.
  • Pediatric voriconazole dosing required significantly higher levels (13.4 mg/kg) than standard adult recommendations to achieve therapeutic blood concentrations.

Implications:

  • Highlights the importance of considering unusual pathogens in agricultural trauma.
  • Emphasizes the critical role of pharmacokinetic studies for optimizing antifungal therapy in children, especially with limited pediatric data.

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