To the Editor: Stenotrophomonas maltophilia is a gram-negative rod ubiquitous in the environment and a cause of serious infections in hospitalized patients [1]. We report a case of community-acquired (CA) S. maltophilia meningitis in a healthy infant.

A 9-mo-old healthy infant presented with fever, vomiting, and irritability for 3 d and a bulging fontanelle. This was preceded a wk ago by an episode of gastroenteritis. Lumbar puncture was done and IV ceftriaxone initiated. Hb was 7.5 g% and TLC was 8100/μL. The CSF showed 11,200 cells, 90% polymorphs, protein 272 mg%, and sugar 13 mg% (blood sugar 78). The fever resolved initially to reappear after 48 h. The CSF culture grew S. maltophilia, sensitive to ceftazidime, levofloxacin, and cotrimoxazole (VITEK 2). The isolate was considered a contaminant and LP repeated as fever was persisting. Repeat CSF showed 500 cells, 75% lymphocytes, protein 111 mg%, and sugar 55 mg% (blood sugar 80). Repeat CSF culture sent to a reference laboratory again grew S. maltophilia (MALDI TOF MS) with same sensitivity. Treatment was changed to intravenous cotrimoxazole and levofloxacin following which, fever resolved and CSF normalized. Antibiotics were stopped after 2 wk. The child is normal over a follow-up period of 18 mo.

CA infections due to S. maltophilia are uncommon and occur in those with comorbidities and the immunocompromised [1, 2]. There is only one published case of CA meningitis in a healthy term neonate [3]. Contaminated water seems to be the most likely source of infection in our case [4]. While this case is a rarity, it emphasizes the need for reconfirmation of diagnosis by repeat testing when rare or unusual pathogens are cultured and the patient is not improving despite appropriate empiric therapy. Occurrence of second rare infection in such a patient should also trigger investigation for an immunodeficiency disorder.