Aggregatibacter aphrophilus ventriculitis following C1-C2 transarticular screw fixation

作者：Tok Sina^*; Neidert Marian Christoph; Bloemberg Guido; Sueruecue Oguzkan

来源：Neurologia i Neurochirurgia Polska, 2016, 50(1): 63-68.

DOI：10.1016/j.pjnns.2015.11.005

• Atlantoaxial fusion
• C1-C2 transarticular screw fixation
• Aggregatibacter aphrophilus
• Ventriculitis
• HACEK

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.

• 出版日期2016
• 单位河北医科大学