Non-typhoidal Salmonella infections commonly manifest as enterocolitis, bacteremia, osteomyelitis, and meningitis. However, pleural involvement is rare. Our patient was a 65-year-old immunocompromised male with alcoholic cirrhosis. He presented with shortness of breath for five days and was found to have a large loculated pleural effusion on imaging. The patient underwent surgical decortication and was found to have exudative pleural fluid with pleural fluid cultures eventually growing Salmonella. The patient was treated with a prolonged course of intravenous antibiotic therapy. This case highlights the necessity of including Salmonella infection in the differential diagnosis of exudative pleural effusions, particularly in patients with aspiration risk and underlying immunosuppressive conditions.

Spontaneous cerebrospinal fluid (CSF) rhinorrhea originating from clival defects is an exceptionally rare condition, with only a limited number of cases reported, and its diagnosis is often challenging, potentially leading to delayed management and recurrent meningitis. We report 2 cases of spontaneous clival CSF leakage in male patients aged 76 and 64 years, both presenting with clear rhinorrhea associated with headaches; one case followed minor head trauma and was complicated by extensive pneumocephalus, while the second was marked by recurrent meningitis with an initially missed defect on imaging. High-resolution CT and MRI ultimately identified small clival breaches in both patients, who were successfully treated using an endoscopic endonasal transsphenoidal approach with multilayer skull base reconstruction. Postoperative outcomes were favorable, with no recurrence during follow-up. These cases highlight the diagnostic pitfalls of clival CSF leaks, underscore the importance of meticulous high-resolution imaging, and confirm that early endoscopic endonasal repair is a safe, minimally invasive, and effective therapeutic option.

Neurocysticercosis is a frequent parasitic infection of the central nervous system. While parenchymal forms are well recognized, meningitis due to cysticercus remains underdiagnosed. This systematic review assessed clinical features, diagnostics, treatment, and outcomes of neurocysticercosis-associated meningitis. Following PRISMA guidelines and PROSPERO registration, case reports, series, and cohorts describing meningitis attributed to neurocysticercosis were analyzed. Extracted data included demographics, presentation, imaging, cerebrospinal fluid (CSF) findings, diagnostics, therapy, and outcomes. A total of 48 published cases of neurocysticercosis-associated meningitis were analyzed. Headache was the most common presenting symptom (45 cases, 94%), followed by fever and vomiting (20 cases each, 42%), visual impairment or gait disturbance (16 cases, 33%), altered sensorium (15 cases, 31%), and seizures (13 cases, 27%). Chronic meningitis (13 cases, 27%) and meningoencephalitis (10 cases, 21%) were the most frequent subtypes. Neuroimaging most often showed subarachnoid or racemose cysts (14 cases, 29%) and hydrocephalus (13 cases, 27%). Cerebrospinal fluid analysis revealed elevated opening pressure (27 cases, 56%), lymphocytic pleocytosis (25 cases, 52%), eosinophilic pleocytosis (12 cases, 25%), elevated protein (42 cases, 88%), and low glucose (35 cases, 73%). Surgical intervention was required in 26 cases (54%). Albendazole, corticosteroids, and praziquantel were used in 42 (88%), 21 (44%), and 18 (38%) cases, respectively. Complete recovery occurred in 17 cases (35%), and mortality in 3 cases (6%). Neurocysticercosis-associated meningitis is a severe, often subarachnoid disease marked by diagnostic delay and frequent surgical need, but outcomes are favorable when timely, individualized medical/ surgical management is instituted.

The glymphatic system facilitates cerebrospinal fluid (CSF)-interstitial fluid exchange and plays a key role in solute clearance and neurophysiological homeostasis. While dysfunction of this system has been shown in traumatic brain injury, stroke, meningitis, idiopathic normal pressure hydrocephalus and neurodegenerative diseases, direct measurement of glymphatic transport in humans remains elusive. We propose microGLYMPH as a translational, hypothesis-generating framework that combines established clinical cerebral microdialysis with controlled CSF tracer administration via existing clinical access routes, including an external ventricular drain, cisternal access during surgery, or lumbar intrathecal injection when clinically justified. The aim is to obtain time-resolved regional tracer profiles in microdialysate and to interpret these alongside arousal state, intracranial dynamics, and, where available, complementary imaging, thereby providing an indirect measure of CSF-interstitial exchange kinetics and peripheral tracer appearance. We further define the key design, analytical and practical limitations that must be resolved before the approach can extend beyond exploratory use, notably catheter-adjacent effects, blood-brain barrier disruption, drainage practices, and the intrinsically focal nature of microdialysis. microGLYMPH is therefore intended as a staged roadmap for first-in-human feasibility studies and subsequent hypothesis-driven investigations of neurofluid solute transport after acute brain injury.

Cerebral venous sinus thrombosis (CVST) is a rare but serious cerebrovascular disorder. Although meningeal lymphatic vessels (MLVs) play a critical role in cerebrospinal fluid (CSF) clearance and neuroimmune regulation, their contribution to CVST pathophysiology remains unclear. Here, we established a FeCl3-induced CVST mouse model to investigate the role of MLV dysfunction. CVST mice exhibited impaired lymphatic drainage and neurological deficits. Ligation of MLVs further aggravated brain damage, and RNA-seq analysis identified activation of the IL-1β pathway as a key contributor. Mechanistically, neutrophils infiltrated MLVs in CVST mice and released neutrophil extracellular traps (NETs), which potentially contributing to lymphatic vessel apoptosis and reduced clearance efficiency. Therapeutic disruption of NETs with DNase I or the blockade of IL-1β signaling with IL-1 receptor antagonist (IL-1RA) preserved MLV integrity, improved CSF clearance, and ameliorated brain injury and behavioral impairments in CVST mice. Together, these findings identify the IL-1β-NET axis as a critical mediator of MLV dysfunction in CVST and highlight potential therapeutic targets to mitigate brain injury.

Echoviruses, members of the Enterovirus B genus in the Picornaviridae family, comprise numerous serotypes that frequently cause aseptic meningitis, myocarditis, and severe neonatal infections. The coexistence of multiple antigenically distinct serotypes poses a significant challenge for vaccine development, underscoring the clinical need for a broad-spectrum multivalent vaccine. In this study, we focused on three prevalent serotypes-Echovirus 11 (E11), 18 (E18), and 30 (E30)-as representative models to explore multivalent vaccine design. We first predicted and experimentally identified dominant B-cell epitopes within the VP1 proteins of these viruses. Guided by these analyses, a chimeric trivalent antigen (VP1-III) was rationally constructed by substituting epitope-containing loops from E18 and E30 into the VP1 backbone of E11. Structural modeling confirmed that VP1-III preserved native VP1 conformation while displaying multitype epitopes. Both VP1-III recombinant protein and mRNA-lipid nanoparticle vaccines induced potent immunogenicity in mice, characterized by cross-neutralizing antibodies and Th1-biased cellular responses. These findings support structure-guided epitope integration as a promising strategy for developing broadly protective multivalent Echovirus vaccines.IMPORTANCEEchoviruses cause widespread outbreaks and severe neonatal disease, yet vaccine development remains limited by extensive antigenic diversity among serotypes. Here, we rationally engineered a chimeric trivalent VP1 antigen by grafting dominant epitopes from E11, E18, and E30 through structure-guided loop substitution. Both recombinant protein and mRNA formulations induced robust cross-neutralizing and Th1-biased immune responses in mice, demonstrating that strategic epitope substitution can effectively overcome serotype barriers and providing a promising path toward broad-spectrum Echovirus vaccines.

Spontaneous Gram-negative bacillary meningitis in adults is rare and carries high mortality, particularly in elderly patients with significant comorbidities. Although multiplex meningitis-encephalitis (ME) panels have improved diagnostic turnaround time, their limited pathogen spectrum may reduce sensitivity for certain clinically relevant Gram-negative organisms. We report a 78-year-old man presenting with acute meningoencephalitis, septic deterioration, and cerebrospinal fluid (CSF) findings strongly suggestive of bacterial infection. Despite marked neutrophilic pleocytosis and elevated protein levels, the multiplex ME panel was negative. Blood cultures subsequently yielded Proteus mirabilis. Given the discordance between inflammatory CSF findings and routine molecular testing, following interdisciplinary consultation, an off-label BioFire[®] Joint Infection multiplex PCR panel was performed directly on CSF. The assay identified Proteus mirabilis harboring a cefotaximase-Munich (CTX-M)-type extended-spectrum β-lactamase (ESBL) resistance determinant. Based on this result, antimicrobial therapy was escalated from ceftriaxone-based empiric treatment to meropenem prior to availability of phenotypic susceptibility data. Despite early pathogen identification and targeted antimicrobial therapy, the patient died due to multiorgan dysfunction secondary to severe sepsis. This case suggests a potential diagnostic limitation of standard ME panels in selected high-risk scenarios and indicates that selective off-label use of broader multiplex PCR platforms may provide additional clinically relevant information in carefully selected patients. In the setting of high clinical suspicion and negative routine multiplex testing, rapid resistance-gene detection may provide actionable information within a decisive therapeutic window and support timely antimicrobial optimization in severe Gram-negative central nervous system infections. Further studies are required to evaluate the diagnostic performance and clinical impact of such approaches. Written informed consent for publication was obtained from the patient's next of kin, and the study was conducted in accordance with institutional and ethical standards.Clinical trial number Not applicable.