Meningeal lymphatic vessel crosstalk with central nervous system immune cells in aging and neurodegenerative diseases

Meningeal lymphatic vessels form a relationship between the nervous system and periphery, which is relevant in both health and disease. Meningeal lymphatic vessels not only play a key role in the drainage of brain metabolites but also contribute to antigen delivery and immune cell activation. The advent of novel genomic technologies has enabled rapid progress in the characterization of myeloid and lymphoid cells and their interactions with meningeal lymphatic vessels within the central nervous system. In this review, we provide an overview of the multifaceted roles of meningeal lymphatic vessels within the context of the central nervous system immune network, highlighting recent discoveries on the immunological niche provided by meningeal lymphatic vessels. Furthermore, we delve into the mechanisms of crosstalk between meningeal lymphatic vessels and immune cells in the central nervous system under both homeostatic conditions and neurodegenerative diseases, discussing how these interactions shape the pathological outcomes. Regulation of meningeal lymphatic vessel function and structure can influence lymphatic drainage, cerebrospinal fluid-borne immune modulators, and immune cell populations in aging and neurodegenerative disorders, thereby playing a key role in shaping meningeal and brain parenchyma immunity.

Herpes simplex virus 2-induced aseptic meningitis presenting with sudden deafness:A case report

BACKGROUND Aseptic meningitis is defined as meningeal inflammation caused by various etio-logies with negative cerebrospinal fluid(CSF)bacterial culture.The most common etiologies are viruses[enteroviruses,arboviruses,and herpes simplex virus type 2(HSV-2)].Aseptic meningitis can have various presentations,including sensori-neural deafness.While sensorineural deafness from mumps meningoencephalitis has been reported,cases of HSV-2-induced hearing loss are rare.Herein,we re-port a case of HSV-2-induced meningitis that presented with sudden deafness.CASE SUMMARY A 68-year-old man experienced a profound sudden onset of left-sided hearing loss for one day.Pure-tone audiograms demonstrated sudden left-sided sensorineural hearing loss(thresholds 80-90 dB).After treatment with high-dose steroids for 1 week,he experienced an acute consciousness change with left hemiparesis.The laboratory data showed no significant abnormalities.Brain computed tomography without contrast and magnetic resonance imaging revealed no intracranial hemo-rrhage or obvious brain lesion.The CSF analysis and the Multiplex PCR panels showed HSV-2 positivity.Hence,under the diagnosis of herpes meningoenceph-alitis,acyclovir was prescribed and his symptoms gradually resolved.CONCLUSION This case report further demonstrates that a viral infection could be a cause of sudden sensorineural hearing loss.

Application of biological dural graft made by meninges from porkers

BACKGROUND： Presently, over 40 kinds of dural grafts have been successively used in clinic. Among them, lyophilized human dura mater with good histocompatibility and less complications is applied most widely. But there are a few reports on cases of infected spongiform encephalopathy following application of lyodura. More ideal repair materials deserve to be further investigated. OBJECTIVE： To investigate the efficiency and safety of biological dural graft made by meninges from porkers to repair meningeal injury. DESIGN： A self-control observation. SETTING： Wuhan General Hospital of Guangzhou Military Area Command of Chinese PLA. MATERIALS： Sixteen New Zealand Rabbits, of either gender, weighing from 2 to 3 kg, of clean grade Ⅱ, with the age of 0.5 - 1 year, were involved in this experiment. The involved rabbits were provided by the Animal Experimental Center of the First Military Medical University of Chinese PLA. Biological surgical patch （dural graft） was developed by Guangdong Guanhao Biotechnological Co.,Ltd. It was processed by using meninges from porkers by tissue engineering technology. METHODS： This experiment was carried out in the Experimental Center of the 157 Hospital of Chinese PLA between December 2003 and June 2004. ①The experimental rabbits were anesthetized. Dura mater was exposed from two sides ofpostmedial line of coronal suture. A rectangular dura mater about 8 mm ×8 mm in size was cut off. Then a biological surgical patch （dural graft） was sheared into insert with 8 mm diameter and sutured. The left dura mater was untouched and used as control. Scalp was sutured, and postoperative wound healing and recovery were observed. ②The anesthetized rabbits were sacrificed at postoperative 3, 14, 30 and 90 days, 4 rabbits once. The whole head was cut off, and its scalp was removed. Afterwards, the head was fixed by formalin. Tissues in operative site were obtained, performed routine paraffin embedding, sliced and conducted HE staining, finally, the sections were observed. White blood cells in venous blood were counted before operation and execution, separately. The obtained data were statistically analyzed. MAIN OUTCOME MEASURES： ①Wound healing and recovery following implantation of dural graft. ②The amount of white blood cells in venous blood from rabbits at each time point before operation and before execution. ③Histological examination results of operative site. RESULTS： Sixteen experimental rabbits were involved in the final analysis. ①The experimental rabbits of each group had no local infection, effusion and abnormal appearance. They had good wound healing and were normal to access to food. ②There were no significant differences in amount of white blood cells in venous blood from experimental rabbits between at each time point after modeling and before operation （P 〉 0.05）. ③Pathological observation of operative site ： At postoperative 3 days, local acute inflammation repair reaction appeared; At postoperative 2 weeks, chronic inflammatory reaction appeared, endodermis in artificial dural graft formed, and artificial dural graft and host dura mater healed; In postoperative 1 month, wound began to chronically recover; In postoperative 3 months, host blood capillary began to form in artificial dural graft based on chronic repair. In all the control sides, fibroplasia was found, and a few neutrophils were found at postoperative 2 weeks. CONCLUSION： Biological surgical patch has high stability and good histocompatibility. It can provide dural epithelial epithelium, effectively prevent against the conglutination of scalp tissue and brain tissue, and avoid the leakage ofcerebrospinal fluid.

Meningoencephalitis due to Listeria monocytogenes in a Young Immunocompetent Patient: Case Report with Literature Review

Meningoencephalitis secondary to Listeria monocytogenes (L. monocytogenes) mainly affects newborns, the elderly and immunocompromised people;there are extremely rare cases in which said infection occurs in immunocompetent individuals. We present the case of a young adult patient without immunocompromise, who developed meningoencephalitis due to L. monocytogenes;This case is exceptional, since it occurred in an individual outside the classic age group, in addition to not having risk factors, which is why it should be considered an atypical causal agent.

Case Report: Bilateral Intra-Parenchymal Hematomas Caused by Ventricular Flood Complicating Neonatal Salmonella typhi Meningitis

Salmonella meningitis is an uncommon condition in neonates, and when it does occur, it is often linked to serious complications, such as subdural collections and abscesses. We present a case involving a 23-day-old neonate diagnosed with Salmonella meningitis, who developed complications including bilateral intra-parenchymal hematomas with ventricular involvement. The infant showed significant improvement following an extended course of systemic antibiotics and supportive care.

Early Nursing Intervention in Children with Viral Meningitis

Aim: To explore the effect of a WeChat peer education program in children with severe viral meningitis combined with respiratory failure. Design: Retrospective cohort study. Methods: Patients who had severe viral meningitis combined with respiratory failure, were admitted to the hospital from March 2017 to June 2018, and who received the WeChat-based nursing intervention were included. Patients who received routine nursing were used as controls. The family’s emotional state, self-care ability, and rehabilitation were analyzed. Results: There were 37 patients in the WeChat group (19 boys (51.3%) and 18 girls (48.7%);mean of 5.1 ± 2.4 years of age) and 37 controls (20 boys (54.1%) and 17 girls (45.9%);mean of 5.9 ± 2.4 years of age) (all P > 0.05). After nursing, improvements in the self-assessed anxiety score and self-assessed depression score were better in the WeChat group (anxiety: -29.2% vs. -20.3%, P = 0.015;depression: -25.2% vs. -15.4%, P = 0.009). After nursing, the improvements in the condition management ability scale and condition management difficulty scale scores were better in the WeChat group (ability: +80.5% vs. +44.4%. P = 0.001;difficulty: +58.4% vs. +37.8%, P = 0.003). After nursing, the improvement in the Fugl-Meyer score was better in the WeChat group (+138.0% vs. +53.0%, P Conclusion: Early nursing intervention combined with WeChat peer education can improve the emotional state of children with severe viral meningitis combined with respiratory failure and their caregivers. Impact: Viral meningitis is associated with a good prognosis, but central nervous system complications can be observed. Early intervention is the key to a good prognosis. Internet-based nursing and coaching can improve self-efficacy and care ability in patients with various conditions, as well as improve the emotional state of the children and their caregivers. The research might have an impact on any children’s hospital that deals with viral meningitis.

Predictors of cerebrospinal fluid GeneXpert MTB/RIF positivity in patients with tuberculous meningitis:A prospective cohort study

Objective:To identify the clinical,laboratory,and radiological markers that could predict a positive GeneXpert result in patients suspected of tuberculous meningitis.Methods:In this prospective,observational study,patients with tuberculous meningitis were systematically evaluated.Various clinical,laboratory[including cerebrospinal fluid(CSF)microscopy,culture,and GeneXpert],and neuroimaging factors were examined.All participants were administered anti-tuberculous treatment and corticosteroids.A six-month follow-up was done to evaluate the outcome.Results:Of the 116 patients studied,54(46.6%)tested positive for GeneXpert,while 62(53.4%)were negative.Third cranial nerve involvement(OR 3.71,95%CI 1.052-13.09,P=0.04)and the presence of basal exudates on neuroimaging(OR 5.22,95%CI 2.03-13.42,P=0.001)emerged as independent predictive factors for a positive GeneXpert result.A positive CSF GeneXpert result(P=0.002)and drug resistance(P=0.004)were significantly linked to adverse outcomes.Additionally,a high score on the Medical Research Council stageⅢ(OR 5.64,95%CI 1.18-26.87,P=0.03)and elevated CSF cell counts(OR 1.002,95%CI 1.00-1.001,P=0.03)were identified as independent predictors of poor prognosis.Conclusions:Third cranial nerve involvement and the presence of basal exudates were significant indicators of a positive GeneXpert result.MRC stageⅢdisability and elevated CSF cell counts predicted poor outcomes.

Numerical Analysis of Bacterial Meningitis Stochastic Delayed Epidemic Model through Computational Methods

Based on theWorld Health Organization(WHO),Meningitis is a severe infection of the meninges,the membranes covering the brain and spinal cord.It is a devastating disease and remains a significant public health challenge.This study investigates a bacterial meningitis model through deterministic and stochastic versions.Four-compartment population dynamics explain the concept,particularly the susceptible population,carrier,infected,and recovered.The model predicts the nonnegative equilibrium points and reproduction number,i.e.,the Meningitis-Free Equilibrium(MFE),and Meningitis-Existing Equilibrium(MEE).For the stochastic version of the existing deterministicmodel,the twomethodologies studied are transition probabilities and non-parametric perturbations.Also,positivity,boundedness,extinction,and disease persistence are studiedrigorouslywiththe helpofwell-known theorems.Standard and nonstandard techniques such as EulerMaruyama,stochastic Euler,stochastic Runge Kutta,and stochastic nonstandard finite difference in the sense of delay have been presented for computational analysis of the stochastic model.Unfortunately,standard methods fail to restore the biological properties of the model,so the stochastic nonstandard finite difference approximation is offered as an efficient,low-cost,and independent of time step size.In addition,the convergence,local,and global stability around the equilibria of the nonstandard computational method is studied by assuming the perturbation effect is zero.The simulations and comparison of the methods are presented to support the theoretical results and for the best visualization of results.

Infection with Listeria monocytogenes meningoencephalitis:A case report

BACKGROUND Listeria meningitis is an infectious disease of the central nervous system caused by Listeria monocytogenes.This bacterium is widely present in the natural environment and can be transmitted through channels such as food and water.Patients usually show symptoms such as fever,headache,and neck stiffness.In severe cases,coma,convulsions,or even death may occur.Traditional diagnostic methods,such as cerebrospinal fluid(CSF)culture and serological tests,have certain limitations.Although CSF culture is the“gold standard”for diagnosis,it is time-consuming and has a relatively low positivity rate.Serological detection may also result in false positive or false negative results.The emergence of metagenomic sequencing(mNGS)technology has led to a significant break-through in diagnosing Listeria meningitis,allowing quick and accurate detection of various pathogens in samples.CASE SUMMARY Here,we present the case of a previously healthy 64-year-old woman diagnosed with Listeria meningitis using mNGS.She was successfully treated with intravenous ampicillin and meropenem,without any complications.CONCLUSION Listeria meningitis must be considered,especially in patients who fail to show improvement with first-line antibiotic treatments.mNGS significantly reduces the diagnosis time,supporting timely treatment of patients.

Endogenous Endophthalmitis as a Triggering Factor for Fatal Bacterial Meningitis Caused by Streptococcus pneumoniae: A Case Report

Endogenous endophthalmitis is a rare condition with a poor long-term visual prognosis and significant mortality, often associated with the hematogenous spread of intravitreal infections and subsequent disruption of the blood-ocular barrier. Its anatomical proximity to the central nervous system (CNS) poses a high risk of infection dissemination, although cases documented in the literature are rare, and endogenous endophthalmitis is typically described as secondary to neuroinfections. We report the case of an 82-year-old female patient with a history of hypertension who presented with fever, decreased visual acuity, severe headache, chemosis, and conjunctival injection. Endogenous endophthalmitis was diagnosed, and antimicrobial treatment was initiated alongside surgical intervention by the ophthalmology service. However, the patient’s condition worsened neurologically, and Streptococcus pneumoniae was identified in cerebrospinal fluid cultures. Despite intensive medical treatment, the patient’s clinical course was poor, leading to death.

Meningeal cryptococcosis in a pancreas transplant recipient requiring grafectomy: A case report

BACKGROUND Through continuous improvement in transplantation medicine,a wider range of solid organ transplant(SOT)recipients is considered suitable for complex procedures.Despite advances in modern transplantation practice,transpiring invasive fungal infections pose a substantial threat for SOT recipients.To our knowledge,cryptococcal infection confined amidst sole pancreas SOT recipients has not been described to date.Enforcement of a multidisciplinary transplant team approach in the management of pancreas SOT recipients presenting with complex cryptococcal complications is fundamental in improving patient outcomes.CASE SUMMARY We present the case of a female pancreas transplant recipient,with confirmed meningeal cryptococcosis,referred to our institution for further evaluation and treatment from the Regional Center for Infectious Diseases.On admission,the patient was weaned from the protocolized immunosuppression therapy for two consecutive weeks,in addition to tapering systemic corticosteroid remedial treatment.Our novel multidisciplinary transplant team approach embodied exhaustive discussions of possible complex and diverse multiple organ system physiologic and pathologic challenges associated with distinct management strategies in pancreas transplant recipients.Owing to the potentially devastating impact of invasive cryptococcosis in terms of morbidity and mortality,a definitive surgical intervention of pancreas transplant grafectomy was reinforced,as a pathway towards secure access to early meaningful expertise care.The patient was discharged to the Regional Center for Infectious Diseases 2 mo after the admittance further advancing to a clinical improvement.CONCLUSION The precision transplantation approach by tailoring complex medical interventions to individual needs proved indispensable in improving our patient’s outcomes.

Role of savolitinib in advanced gastric adenocarcinoma with meningeal carcinomatosis and cerebellar metastasis:A case report

BACKGROUND Brain metastases(BM)are very rare in gastric adenocarcinoma(GaC),and patients with BMs have a higher mortality rate due to stronger tumor aggressiveness.However,its pathogenesis remains unclear.Genetic testing revealed cellular-mesenchymal epithelial transition factor receptor(MET)amplification.Therefore,treatment with savolitinib,a small molecule inhibitor of c-Met,was selected.CASE SUMMARY A 66-year-old woman was diagnosed with advanced GaC 6 months prior to presentation due to back pain.Cerebellar and meningeal metastases were observed during candonilimab combined with oxaliplatin and capecitabine therapy.The patient experienced frequent generalized seizures and persistent drowsiness in the emergency department.Genetic testing of cerebrospinal fluid and peripheral blood revealed increased MET amplification.After discussing treatment options with the patient,savolitinib tablets were administered.After a month of treatment,the intracranial lesions shrank considerably.CONCLUSION BM is very rare in advanced GaC,especially in meningeal cancer,that is characterized by rapid disease deterioration.There are very few effective treatment options available;however,technological breakthroughs in genomics have provided a basis for personalized treatment.Furthermore,MET amplification may be a key driver of BM in gastric cancer;however,this conclusion requires further investigation.

Human herpesvirus 7 meningitis in an adolescent with normal immune function:A case report

BACKGROUND Human herpesvirus type 7(HHV-7)is a less common herpes virus that usually causes mild,self-limiting illnesses.However,in recent years,there have been increasing reports of HHV-7 causing serious central nervous system infections,especially meningitis.The pathogenesis and clinical features of HHV-7 meningitis,particularly in adolescents with normal immune function,remain incompletely studied.Therefore,the purpose of this report is to share a case of HHV-7 meningitis in an immunocompetent adolescent with a view to deepening our understanding of the disease.CASE SUMMARY A 12-year-old female was admitted with fever,headache,and vomiting.4 d before admission,the patient developed a fever without obvious induction,with a temperature up to 39.5℃,no convulsions,accompanied by chills,headaches,fatigue,and no muscle aches.The patient was treated with fever reduction,which could be reduced to 38℃;repeated high fever,accompanied by vomiting 7-8 times;and no abdominal pain or diarrhea.The patient was diagnosed with"acute suppurative tonsillitis"in a local hospital,and the blood routine was generally normal.The patient was given symptomatic support treatment such as"ceftriaxone sodium"and antiemetic rehydration for 2 d,and his condition did not improve.The patient's physical examination showed pharyngeal congestion,bilateral tonsil grade I hypertrophy,regression of purulent secretions,and cervical resistance.Ocular B-ultrasound:Opacity of the vitreous body and edema of the optic disc in both eyes.Optical coherence tomography examination showed that the macular fovea was generally normal in both eyes,with edema of the optic disc.DNA virus monitoring results:HHV-7.We gave ganciclovir antiviral therapy,dexamethasone anti-inflammatory treatment,mannitol to reduce cranial pressure,omeprazole to protect gastrointestinal mucosa,and calcium and potassium supplementation.CONCLUSION This study reports a case of HHV-7 meningitis in an adolescent with normal immune function.Through comprehensive analysis of the clinical manifestations,laboratory tests,and treatment methods of the patient,it is found that early identification and antiviral treatment are essential for the outcome of the disease.This case suggests that despite normal immune function,adolescents may still suffer from herpes virus type 7 meningitis,so clinicians should be vigilant and take effective treatment measures in time.

Infantile bacterial meningitis combined with sepsis caused by Streptococcus gallolyticus subspecies pasteurianus:A case report

BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings.Hence,we present a case of SGSP-induced infant meningitis and sepsis,accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus(MRSA),providing insights into the identification,management,and prognosis of this bacterial infection.CASE SUMMARY A 45-day-old female infant presented with two episodes of high fever(maximum temperature:39.5°C)and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms.Postadmission,the patient’s C-reactive protein level was 40.73 mg/L,white blood cell count was 13.42×10^(9)/L,neutrophil ratio was 78.4%,procalcitonin level was 7.89μg/L,cerebrospinal fluid(CSF)white cell count was 36×10^(6)/L,multinucleated cell ratio was 95.2%,and protein concentration was 0.41 g/L.Blood and CSF culture revealed that the pathogen was SGSP.The bacterium was sensitive to ampicillin,furazolidone,penicillin,lincomycin,moxifloxacin,rifampicin,vancomycin,and levofloxacin but resistant to clindamycin and tetracycline.Sputum culture revealed the presence of MRSA,which was sensitive to vancomycin.The patient was diagnosed with meningitis and sepsis caused by SGSP,accompanied by bronchopneumonia induced by MRSA.Ceftriaxone(100 mg/kg/d)combined with vancomycin(10 mg/kg/dose,q6h)was given as an anti-infective treatment postadmission.After 12 days of treatment,the infant was discharged from the hospital with normal CSF,blood culture,and routine blood test results,and no complications,such as subdural effusion,were observed on cranial computed tomography.No growth retardation or neurological sequelae occurred during follow-up.CONCLUSION SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures,and a sensitive antibiotic therapy to ensure a favorable prognosis.

A Rare Case of Aortic Valve Endocarditis and Acute Meningitis Due to Haemophilus influenzae

HACEK organisms represent a rare but important group of causative pathogens in endocarditis. These bacteria have historically been associated with culture-negative endocarditis;however, modern laboratory techniques have made this less common. In this case, we present a 74-year-old man who presented with acute onset altered mentation, fever, and sepsis. He was ultimately found to have Haemophilus influenzae meningitis, cerebral empyema, aortic valve endocarditis, psoas myositis, and L2 - L3 diskitis with osteomyelitis. Although HACEK organisms are commonly found in the oropharynx and upper respiratory tract in humans, our patient did not report recent preceding dental or ENT procedures. H. influenzae is responsible for approximately 0.16% of all cases of bacterial endocarditis, representing a very limited subset. Although generally considered low virulent pathogens, this case demonstrates the unusual extent of infection from a HACEK organism, H. influenzae, causing aortic valve endocarditis as well as atypical non-cardiac sequelae, including acute meningitis.

Extra-Axial Anaplastic Pleomorphic Xanthoastrocytoma Mimicking Meningioma: A Case Report with Literature Review

Background: A number of meningeal neoplastic lesions may radiologically and clinically simulate meningioma, include hemangiopericytomas, solitary fibrous tumors, schwannomas, hematolymphoid lesions, metastases, and others very rarely, also may clinically mimic meningiomas. Case Description: We present the case of A 28-year-old male patient, with no notable medical history, who presented with worsening headaches for 3 months, imbalance, and visual deficits, An initial MRI revealed extra-axial lesion involving the right Parieto-occipital, The tumor was hypointense on T1-weighted MR images, hyperintense signals on T2-weightedMR images, and heterogeneously enhanced suggestive of a meningioma, total resection was achieved, and the histopathological analysis confirmed the diagnosis of an angioblastic meningioma. However, 15 months later, the patient presented with the same initial visual complaints. A subsequent MRI showed lesion recurrence, leading to a second surgical intervention. The histopathological analysis confirmed the diagnosis of an anaplastic xanthoastrocytoma. Conclusion: This represents an unusual location for an anaplastic pleomorphic xanthoastrocytoma, which should broaden the differential diagnosis of extra-axial lesions.

化脓性脑膜炎肺炎链球菌spr1759蛋白的理化性质及功能预测

目的探讨化脓性脑膜炎肺炎链球菌spr1759蛋白的理化性质并预测其功能。方法从NCBI数据库中获得spr1759蛋白的相关序列信息,运用ProtParam以及ProtScale软件对spr1759的理化特性及具体的亲疏水性予以分析,运用NetPhos、TMHMM分析spr1759的磷酸化位点及跨膜区结构,分别运用SWISS-MODEL、SOPMA、ABCpred对spr1759的二级及三级结构的具体情况予以预测,用SYFPEITHI软件进行抗原表位的预测分析,STRING预测spr1759的相互作用蛋白,并对其生物过程进行功能富集分析。结果spr1759蛋白是一种亲水蛋白,等电点为5.11,有一个跨膜区,其全部包含一个跨膜结构。肺炎链球菌spr1759蛋白属于LytRcpsApsr超家族,可能是一种参与阴离子细胞壁聚合物合成的酶。肺炎链球菌spr1759蛋白的氨基酸序列与B.炭疽杆菌的BAS5115蛋白和枯草芽孢杆菌的DJ971211蛋白高度同源,全长序列相似性为35.7%和32.5%。结论肺炎链球菌spr1759蛋白属于亲水性蛋白,具有跨膜结构,可能具有阴离子细胞壁多聚物合成相关酶学功能。

Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from China's Mainland

We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in China's Mainland. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.

Life-threatening meningitis resulting from transrectal prostate biopsy

After antibiotic prophylaxis with metronidazole and levofloxacin, a transrectal sextant biopsy was performed under the guide of transrectal ultrasonography （TRUS） for a 75-year-old suspicious patient with prostate adenocarcinoma. Although antibiotics were also given after this procedure, the patient still developed fever, anxious, agrypnia and headache. Blood cultures remained negative. Lumbar puncture was performed and was consistent with Escherichia coli bacterial meningitis.

Prostatic abscess of Klebsiella pneumoniae complicating septic pulmonary emboli and meningitis: A case report and brief review

Prostatic abscess is a rare entity with an incidence of 0.5% to 2.5% in all prostate diseases and usually occurs in the 5th and 6th decades of life with immunocompromised status,Prostatic abscess might be a process of evolution from acute prostatitis,Klebsiella pneumoniae is the leading microorganism in the diabetic patients of prostatic abscess in Taiwan,A 60-year-old diabetic man,with a one-week history of acute bacterial prostatitis was reported in this study,presenting to the emergency department with sudden altered mental status,The abdominal computed tomographic scan demonstrated lobulated prostatic abscess and multiple septic pulmonary emboli with lung abscesses,Analysis of cerebrospinal fluid showed white blood cells of 10 771 counts/mm3 with segmented neutrophils of 99%,Cultures of blood,cerebrospinal fluid and sputum yielded Klebsiella pneumoniae,We concluded that computed tomographic scan can make a definite diagnosis of prostatic abscess associated with complications and management with empiric antibiotics and adequate drainage is suggested.