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| CASE REPORTS |
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| Year : 1993 | Volume
: 39
| Issue : 3 | Page : 153-5 |
Meningitis due to Xanthomonas maltophilia.
T Girijaratnakumari, A Raja, R Ramani, B Antony, PG Shivananda
Dept of Microbiology, Kasturba Medical College, Manipal, Karnataka.
Correspondence Address:
T Girijaratnakumari
Dept of Microbiology, Kasturba Medical College, Manipal, Karnataka.
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0008051648 
During 1st week of post-operative period, a 28 year old female patient operated for left cerebellopontine angle tumor, continued to get fever. Lumbar puncture did not reveal any organisms. She responded to ciprofloxacin. Two months later, she was readmitted with signs and symptoms of meningitis. The CSF tapped on lumbar puncture grew Xanthomonas maltophilia, Gram negative bacilli, sensitive to various antibiotics, ciprofloxacin being one of them. The patient was given ciprofloxacin for 3 weeks. On follow up, a year later she was found to be asymptomatic.
Keywords: Adult, Case Report, Cerebellar Neoplasms, surgery,Cerebellopontine Angle, Ciprofloxacin, administration &dosage,Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Human, Meningitis, Bacterial, drug therapy,microbiology,Microbial Sensitivity Tests, Recurrence, Surgical Wound Infection, drug therapy,microbiology,Xanthomonas, drug effects,isolation &purification,
How to cite this article:
Girijaratnakumari T, Raja A, Ramani R, Antony B, Shivananda P G. Meningitis due to Xanthomonas maltophilia. J Postgrad Med 1993;39:153 |
Xanthomonas maltophilia  s an increasingly important cause of hospital acquired infection in patients who are receiving antimicrobial therapy and / or immunocompromised[1]. It has been isolated from many anatomic sites including respiratory tract secretions, urine, skin wounds and blood[2]. However isolation of Xanthomonas maltophilia from Cerebrospinal fluid (CSF) is rare. We report Xanthomonas maltophilia isolated from cerebrospinal fluid of a patient with meningitis.
A 28-year-old female patient who presented with clinical features of raised intracranial tension was investigated and found to have a left cerebeilo-pontine angle tumour for which she underwent surgery. A total removal was done and in the peri-operative period, she was on ampicillin, cloxacillin and dexamethasone for 72 hours. A routine therapeutic lumbar puncture done after 48 hours did not reveal any evidence of meningitis. As the patient continued to have fever, a lumbar puncture was repeated during the first week, which again failed to show any organism. She was treated with ciprofloxacin 500 mg twice/day for 2 weeks with which her temperature subsided and she was discharged. Retrospectively there was no evidence of any infective focus in the ear. Two months later, she was readmitted with signs and symptoms of meningitis. The clinical picture was suggestive of bacterial meningitis. Xanthochromic CSF tapped on lumbar puncture grew Xanthomonas maltophilia, which was identified as followed:
The CSF fluid (about 10 ml.) was centrifuged for 15 minutes at 1500 xg and the supernatent was decanted leaving about 0.5 ml sediment. After thorough mixing, a heaped drop of this sediment on slide stained with Gram's staining showed Gram negative bacilli. Later, the specimen was inoculated into chocolate agar, which was incubated at 37?C for 72 hrs in a candle jar. Simultaneously, the specimen was also inoculated into 5% sheep blood agar plate, MacConkey agar plate, which were incubated aerobically at 37?C for 72 hrs. The growth was observed after 72 hrs. in the form of small, yellow smooth colonies with entire margin both on chocolate agar and blood agar plates. The bright yellow pigment developed by these colonies was more prominent on nutrient agar and Sabouraud's agar. There was no growth on MacConkey agar at 37?C as well as at 42?C. A Gram's stain of the smear made from the colony detected Gram negative bacilli. As this isolated Gram negative bacillus was not a member of the Enterobacteriaceae and was also not Pseudomonas aeruginosa, the organism was proceeded for identification according to the procedure 3 given in the form of [Figure:2] and [Table:5] by Bhujwala[3]. According to the procedure, the isolated organism was identified as Xanthornonas species (11K - 1). The species identification as Xanthomonas maltophilia was done according to the method followed by Holmes et al[4].
The antibiotic sensitivity of the isolated Xanthomonas maltophilia was tested by the disc diffusion technique and the result was interpreted according to the Kirby - Bauer method[5]. The isolate was sensitive to erythromycin, gentamicin, sulphadiazine, ciproffoxacin, cefurbxime, netilmicin and amikacin. She was treated with ciprofloxacin 500 mg twice/day for 3 weeks and responded well. On follow up 3 months, 6 months and one year later she remained asymptomatic.
Xanthomonas mattophilia was predominantly isolated from respiratory tract secretions[6]. Isolation of Xanthomonas mattophilia from the CSF is rare. King[7] reported the isolation of Xanthornonas maltophilia from the CSF. Later, Holmes et al[4] in 1979 isolated 3 strains of Xanthornonas maltophilia from the CSI`. Most often, the infection due to Xanthomonas maltophilia is considered to be nosocomial in nature and a prolonged hospital stay and / or immunocompromised state of the patient can predispose for the infection. In view that the CSF findings prior to the isolation of the organism were normal, meningitis in this patient could be iatrogenic.
Nancy Khardori et al[6] reported that 57% of their Xanthomonas mattophilia strains were sensitive to ciprofloxacin as was seen in our case too. Patric et al[8] reported that all or a large proportion of the strains they examined were sensitive to one or more of streptomycin, kanamycin, gentamicin, erythromycin, tetracycline and chloramphenicol to which our strain was also sensitive.
Though meningitis due to Xanthomonas maltophilia is rare, one should consider the possibility wherever a patient does not respond to the routine broad spectrum antibiotics.
| :: References | |  |
| 1. |
Marshall WF, Keating MR, Anhalt JP, Steckelberg JM. Xanthomonas mattophilia. An emerging nosocomial pathogen. Mayo Clin Proceedings 1989; 64:1097-1104.  |
| 2. | Zuravieff JJ, YUVL. Infections caused by Pseudomonas maltophilia with emphasis on bacteremia: case reports and a review of the literature. Rev Infect Dis 1982; 4:1236-1246. |
| 3. | Bhujwala RA, Nonfermentative Gram negative bacilli (Non fermenters). A guide to identification. Indian Assoc Med Microbiol 1982. |
| 4. | Holmes B, Lapage SP, Easterling BG. Distribution in clinical material and identification of Pseudomonas maltophilia from the national collection of type cultures, Central Public health laboratory. Colindale, London NW 95 HT, UK: J Clin Pathol 1979; 32:66-72. |
| 5. | Bauer AW, Krby MMM, Sherris JC, Duck M. Antibiotic susceptibility testing by a standardized single disc method. Am J Clin Pathol 1966; 45:493-497. |
| 6. | Khardori N, Elting L, Wong E. Nosocomial infection due to Xanthomonas mattophilia (Pseudomonas maltophilia) in patients with cancer. Rev Infect Dis 1990; 12:16 |
| 7. | King EO. The identification of unusual pathogenic Gram negative Bacteria. Altanta, Georgia, USA: Communicable Disease Centre; 1967. |
| 8. | Patric S, Hindmarch JM, Hague RV, Harris DM. Meningitis caused by Pseudomonas maltophilia. J Clin Pathol 1975; 28:741-743.
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