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Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation
Affiliations- University Hospital Zurich, Department of Neurosurgery, University of Zurich, Zurich, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
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Abstract
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.
MethodsWe analyzed clinical and neuroradiological findings.
ResultsThe 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.
ConclusionsTo our knowledge, this is the first report of Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation.
Abstract
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.
MethodsWe analyzed clinical and neuroradiological findings.
ResultsThe 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.
ConclusionsTo our knowledge, this is the first report of Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation.
Keywords
CNS, CSF, IE, RA, NSAIDS, MRI, NECCT, GCS, MTX, SSI
About this articleTitle
Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
63-68
Page views
336
Article views/downloads
871
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
