Polymicrobial brain abscesses: A complex condition with diagnostic and therapeutic challenges

Abstract Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we co...

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Published in:Journal of Neuropathology and Experimental Neurology 2024-10, Vol.83 (10), p.798-807
Main Authors: Eichorn, Frances-Claire, Kameda-Smith, Michelle, Fong, Crystal, Graham, Alice K, Main, Cheryl, Lu, Jian-Qiang
Format: Article
Language:English
Subjects:
Abscesses
Brain Abscess - diagnosis
Brain Abscess - diagnostic imaging
Brain Abscess - microbiology
Brain Abscess - pathology
Brain Abscess - therapy
Coinfection
Humans
Pathogenesis
Pathogens
Review
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Summary:Abstract Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we comprehensively review the prevalence, pathogenesis, clinical manifestations, and microbiological, histopathological, and radiological features of PBAs, as well as treatment and prognosis. While PBAs and monomicrobial BAs have some similarities such as nonspecific clinical presentations, PBAs are more complex in their pathogenesis, pathological, and imaging presentations. The diagnostic challenges of PBAs include nonspecific imaging features at early stages and difficulties in identification of some pathogens by routine techniques without the use of molecular analysis. Imaging of late-stage PBAs demonstrates increased heterogeneity within lesions, which corresponds to variable histopathological features depending on the dominant pathogen-induced changes in different areas. This heterogeneity is particularly marked in cases of coinfections with nonbacterial pathogens such as Toxoplasma gondii. Therapeutic challenges in the management of PBAs include initial medical therapy for possibly underrecognized coinfections prior to identification of multiple pathogens and subsequent broad-spectrum antimicrobial therapy to eradicate identified pathogens. PBAs deserve more awareness to facilitate prompt and appropriate treatment.
ISSN:0022-3069
1554-6578
1554-6578
DOI:10.1093/jnen/nlae058