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Annals of Clinical Microbiology and Antimicrobials

, 5:21

First Online: 08 September 2006Received: 26 June 2006Accepted: 08 September 2006

Abstract

BackgroundTraumatic 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 reportA 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.

ConclusionUnusual 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.

Electronic supplementary materialThe online version of this article doi:10.1186-1476-0711-5-21 contains supplementary material, which is available to authorized users.

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