Pediatrics International (2014) 56, e21–e22
Stenotrophomonas maltophilia: Rare cause of meningitis Cátia Rodrigues Correia, Sara Tavares Ferreira and Paula Nunes Department of Pediatrics, São Francisco Xavier Hospital, Lisbon, Portugal Abstract
Stenotrophomonas maltophilia is a Gram-negative bacillus, which is an extremely rare cause of meningitis. To our knowledge, there are only five previous pediatrics cases. Here, we describe the case of a 4-year-old boy who developed meningitis associated with this organism, after several neurosurgical procedures and previous treatment with a broadspectrum antibiotic. He was treated successfully with a combination of trimethoprim–sulfamethoxazole, ceftazidime and levofloxacin. Stenotrophomonas maltophilia should be considered as a potential cause of meningitis, especially among severely debilitated or immunosuppressed patients. Antimicrobial therapy is complicated by the high resistance of the organism to multiple antibiotics.
Key words: levofloxacin, meningitis, Stenotrophomonas maltophilia.
Stenotrophomonas maltophilia is a ubiquitous, aerobic, nonfermentative, Gram-negative bacillus that is closely related to the Pseudomonas sp.1–4 This bacterium is found in several environments such as water, soil, plants, food and hospital settings.1,3 The risk factors for colonization and infection due to S. maltophilia include prolonged hospitalization requiring invasive procedures, previous exposure to broad-spectrum antibiotics, mechanical ventilation, and severe mucositis.1,5 Although this microorganism is considered an infrequent cause of meningitis, it has become a focus of interest not only due to increasing recognition of its pathogenic potential but also because of its marked antibiotic resistance.3,6,7 Here, we describe a case in which a child with multi-resistant S. maltophilia meningitis was treated successfully with a combination of trimethoprim–sulfamethoxazole (TMP-SMX), ceftazidime and levofloxacin.
Case report A 4-year-old boy, with a background of prenatal (35 weeks of gestation) diagnosis of hydrocephalus due to congenital stenosis of the Sylvius aqueduct was admitted to the emergency room. He had undergone placement of a ventricular–peritoneal shunt (VPS) at 2 months and at 4 years of age (7 months prior to the current admission). He was admitted to hospital with meningitis caused by Candida famata with active hydrocephalus, which required removal of VPS, placement of a temporary external ventricular drain (EVD) and further replacement of VPS. On admission he presented with a 4 day history of persistent vomiting and headaches. On examination he had a Glasgow coma score of 15 and no neurological alterations. Laboratory findings were as follows: white blood cell (WBC) count, 13 800/mm3; Correspondence: Cátia Rodrigues Correia, MD, Estrada do Forte do Alto do Duque, 1449-005 Lisboa, Portugal. Email: catiarcorreia @gmail.com Received 1 February 2014; accepted 4 March 2014.
© 2014 Japan Pediatric Society
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