open access

Vol 50, No 1 (2016)
Case reports
Submitted: 2015-06-02
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Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation

Sina Tok, Marian Christoph Neidert, Guido Bloemberg, Oguzkan Sürücü
DOI: 10.1016/j.pjnns.2015.11.005
·
Neurol Neurochir Pol 2016;50(1):63-68.

open access

Vol 50, No 1 (2016)
Case reports
Submitted: 2015-06-02

Abstract

Objective

Central nervous system (CNS) infections after cervical spine surgery are a rare but serious complication and may be caused by uncommon pathogens. We report the case of a 57-year-old male who developed slowly progressive mental confusion with headaches, increased daytime sleepiness and mild gait disturbance within the last 3 weeks. Six weeks prior to admission to our department, he underwent an atlantoaxial fusion by C1-C2 transarticular screw fixation for rheumatoid arthritis related C1-C2 multidirectional instability.

Methods

We analyzed clinical and neuroradiological findings.

Results

The findings were consistent with communicating hydrocephalus secondary to ventriculitis and the left C1-C2 screw was found to be misplaced with perforation of the dura. The situation was interpreted as implant related surgical site infection of the cerebrospinal fluid followed by ventriculitis and hydrocephalus. Bacterial broad range 16S rRNA gene PCR from the cerebrospinal fluid (CSF) followed by sequencing identified Aggregatibacter aphrophilus as the causative agent, while conventional cultures remained negative due to its fastidious growth. The patient was successfully treated with a lumbar drain and intravenous ceftriaxone.

Conclusions

To our knowledge, this is the first report of Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation.

Abstract

Objective

Central nervous system (CNS) infections after cervical spine surgery are a rare but serious complication and may be caused by uncommon pathogens. We report the case of a 57-year-old male who developed slowly progressive mental confusion with headaches, increased daytime sleepiness and mild gait disturbance within the last 3 weeks. Six weeks prior to admission to our department, he underwent an atlantoaxial fusion by C1-C2 transarticular screw fixation for rheumatoid arthritis related C1-C2 multidirectional instability.

Methods

We analyzed clinical and neuroradiological findings.

Results

The findings were consistent with communicating hydrocephalus secondary to ventriculitis and the left C1-C2 screw was found to be misplaced with perforation of the dura. The situation was interpreted as implant related surgical site infection of the cerebrospinal fluid followed by ventriculitis and hydrocephalus. Bacterial broad range 16S rRNA gene PCR from the cerebrospinal fluid (CSF) followed by sequencing identified Aggregatibacter aphrophilus as the causative agent, while conventional cultures remained negative due to its fastidious growth. The patient was successfully treated with a lumbar drain and intravenous ceftriaxone.

Conclusions

To our knowledge, this is the first report of Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation.

Get Citation

Keywords

CNS, CSF, IE, RA, NSAIDS, MRI, NECCT, GCS, MTX, SSI

About this article
Title

Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 50, No 1 (2016)

Pages

63-68

DOI

10.1016/j.pjnns.2015.11.005

Bibliographic record

Neurol Neurochir Pol 2016;50(1):63-68.

Keywords

CNS
CSF
IE
RA
NSAIDS
MRI
NECCT
GCS
MTX
SSI

Authors

Sina Tok
Marian Christoph Neidert
Guido Bloemberg
Oguzkan Sürücü

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