Severe osteomyelitis caused by Myceliophthora thermophila after a pitchfork injury

被引：21

作者：

Destino L. ^{[1
]}

Sutton D.A. ^{[2
]}

Helon A.L. ^{[3
]}

Havens P.L. ^{[1
]}

Thometz J.G. ^{[4
]}

Willoughby Jr. R.E. ^{[1
]}

Chusid M.J. ^{[1
]}

机构：

[1] Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI

[2] Fungus Testing Laboratory, Department of Pathology, University of Texas Health Sciences Center, San Antonio, TX

[3] Pharmacy Department, Children's Hospital of Wisconsin, Milwaukee, WI

[4] Department of Orthopedic Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI

来源：

Annals of Clinical Microbiology and Antimicrobials | / 5卷 / 1期

关键词：

Voriconazole; Distal Femur; Caspofungin; Terbinafine; Medial Femoral Condyle;

D O I：

10.1186/1476-0711-5-21

中图分类号：

学科分类号：

摘要：

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. © 2006 Destino et al; licensee BioMed Central Ltd.

引用

共 18 条

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