title: 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.
authors: University Hospital Zurich, Department of Neurosurgery, University of Zurich, Zurich, Switzerland(1). Electronic address: sina.tok@kws.ch.
authors: Sina
authors: S
authors: Tok
authors: University Hospital Zurich, Department of Neurosurgery, University of Zurich, Zurich, Switzerland(1). Electronic address: marian.neidert@usz.ch.
authors: Marian Christoph
authors: MC
authors: Neidert
authors: Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland(2). Electronic address: bloemberg@imm.uzh.ch.
authors: Guido
authors: G
authors: Bloemberg
authors: University Hospital Zurich, Department of Neurosurgery, University of Zurich, Zurich, Switzerland(1). Electronic address: oguzkan.sueruecue@usz.ch.
authors: Oguzkan
authors: O
authors: Sürücü
mesh_terms: D064207:Aggregatibacter aphrophilus / Q000472:pathogenicity*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000601:surgery; D001174:Arthrodesis / Q000009:adverse effects*; D001863:Bone Screws; D058565:Cerebral Ventriculitis / Q000209:etiology* / Q000382:microbiology / Q000503:physiopathology; D002574:Cervical Vertebrae / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016871:Pasteurellaceae Infections / Q000209:etiology* / Q000503:physiopathology; D016459:Prosthesis-Related Infections / Q000150:complications*
keywords: Aggregatibacter aphrophilus; Atlantoaxial fusion; C1-C2 transarticular screw fixation; HACEK; Ventriculitis