Query fever (Q fever) is a widespread zoonotic disease caused by the bacterium of Coxiella burnetii (C. burnetii). Its neurological complications are rarely reported. But they may lead to severe consequences. It needs a rapid and accurate detective method to diagnose acute Q fever with neurological presentations in non-epidemic areas urgently. Here, we report an acute Q fever case with aseptic meningitis. The male patient, without any contact history in the epidemic area or with animals, was indicated to exhibit fever and headache symptoms. The cultures of blood, stool, urine, and sputum were all negative. But C. burnetii was repeatedly detected in blood by metagenomic next-generation sequencing (mNGS). He received Doxycycline therapy and quickly returned to normal. Therefore, for the diagnosis and identification of Q fever in non-reporting regions, mNGS has comparative advantages. Secondly, aseptic meningitis may be a direct infection of C. burnetii to central nervous system (CNS) or inflammatory reactions to systemic infection, we recommend detecting mNGS both in blood and cerebrospinal fluid (CSF).

Objectives: The effectiveness of prolonged infusion of meropenem in treating sepsis remains debated. This meta-analysis aims to compare the clinical effectiveness and safety of prolonged infusion versus short-term infusion of meropenem in sepsis patients. Methods: A systematic search was conducted in PubMed, Web of Science, ClinicalTrials.gov, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies published from database inception up to February 2025. Studies meeting the inclusion and exclusion criteria were included. Data were extracted in prespecified forms, and fixed-effect or random-effects models were used based on I ² values. This meta-analysis is registered with the PROSPERO database and follows the Preferred Reporting Items for Systematic and Meta-Analyses reporting guidelines. Results: A total of 1597 articles were identified and screened, leading to the inclusion of 18 studies (3703 patients) in the meta-analysis. Prolonged infusion of the meropenem was associated with a reduced risk of mortality compared to short-term infusion (risk ratio [RR] = 0.85, 95% confidence interval [CI] = 0.76–0.95). No significant heterogeneity was observed ( P = 0.24, I ² = 19%). Furthermore, prolonged infusion is associated with a higher rate of clinical cure (RR = 1.35, 95% CI = 1.25–1.47). Additionally, the group receiving prolonged infusions demonstrated a higher microbiological eradication rate (RR = 1.13, 95% CI = 1.04–1.22). Conclusions: Administering meropenem via prolonged infusion to sepsis patients is associated with short-term survival benefits, an increased likelihood of clinical cure, and greater microbiological eradication. Further high-quality RCTs are needed to determine the potential long-term survival benefits of prolonged meropenem infusion in sepsis patients.

Introduction Histiocytic sarcoma (HS) rarely affects the central nervous system (CNS) and often presents with nonspecific neurological symptoms, making diagnosis challenging. We report, to our knowledge, the first case of CNS-HS with concurrent skull base infiltration and intraventricular dissemination, highlighting the diagnostic challenges of this aggressive disease. Methods An 18-year-old woman with a 9-month history of progressive headaches and seizures was initially misdiagnosed with viral meningitis. She subsequently underwent brain magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and neuroendoscopic biopsy via a lateral ventricle approach to establish a definitive diagnosis. Results MRI revealed a lesion in the right medial temporal lobe with extensive skull base infiltration and intraventricular dissemination. CSF analysis demonstrated hypoglycorrhachia (low CSF glucose) and elevated protein levels without pleocytosis. Histopathology confirmed HS, with tumor cells strongly positive for CD68 and CD163. Discussion This case illustrates the diagnostic challenges of CNS-HS and underscores the importance of advanced neuroimaging, metabolic CSF analysis, and early biopsy in patients with atypical neurological presentations. Given the rapid progression and poor prognosis, early recognition and comprehensive molecular profiling may facilitate targeted therapies.