Mucocutaneous and Soft Tissue Infections Caused by Xanthomonas maltophilia: A New Spectrum

Abstract

Mucocutaneous and soft tissue infections caused by X. maltophilia are not uncommon, and X. maltophilia can cause metastatic nodular skin lesions that mimic disseminated fungal infections. It also causes serious morbidity and high mortality in patients with metastatic skin nodules and can cause superinfections in patients receiving broad-spectrum beta-lactam or quinolone antibiotics to which the organisms are susceptible when the infections develop. Catheter removal contributes to a favorable outcome in patients with catheter-associated cellulitis without bacteremia. Xanthomonas maltophilia infection should be added to the differential diagnosis of mucocutaneous or soft tissue infection in patients with cancer. Trimethoprim-sulfamethoxazole with or without ticarcillin-clavulanate is the current treatment of choice for culture-proven infections, but early empiric therapy may improve outcome.

Acral necrosis by Stenotrophomonas maltophilia

“…1 It is an important opportunistic nosocomial pathogen, associated with a significant mortality rate, especially in patients who are neutropenic, debilitated, immunocompromised, or on broad-spectrum antibiotics. 2,3,5 There are references suggesting the existence of an altered microenvironment in neoplastic tissue favourable for the multiplication of SM. Consequently, in the presence of SM infection, malignancy should be ruled out.…”

“…The most frequently described skin and soft tissue manifestations due to SM infection are subcutaneous nodules 2,7,8 and primary or metastatic cellulitis, which may manifest as ecthyma gangrenosum. 1,5 The latter is probably connected to the production of protease and elastase enzymes by the bacteria 9 and seen in malignant disease, especially in haematological patients.…”

“…1 Cotrimoxazole with or without ticarcillin-clavulanate is the current treatment of choice. 2 Other agents considered in documented studies are minocycline, doxycycline and quinolones. New generation quinolones (trovafloxacin, clinafloxacin, moxifloxacin, sparfloxacin) have an enhanced in vitro activity against SM and could become an alternative if clinical studies confirm these results.…”

“…1 It is implicated as an opportunistic pathogen in hospitalized, neutropenic patients or those on broad-spectrum antibiotics. 2,3 Rare cases of cutaneous infections in farmers have been reported, as it is a microorganism isolated from soil and agricultural plants. 4 To our knowledge, this is one of the first cases to describe distal necrosis of the fingers due to community acquired SM infection by an apparently healthy patient.…”

Septicemia Associated with Stenotrophomonas Maltophilia in a West African Dwarf Crocodile (Osteolaemus Tetraspis Subsp. Tetraspis)

“…18 Human patients considered at risk for S. maltophilia infections include the severely debilitated or immunosuppressed, those receiving antimicrobial and/or intravenous therapy, and individuals subjected to invasive surgical procedures. 2 A protease and elastase elaborated by S. maltophilia are believed to be important in the pathogenesis of infection.…”