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Clinicopathological heterogeneity and complexity of polymicrobial brain abscesses
Frances-Claire Eichorn1, Michelle Kameda-Smith2, Crystal Fong3
1Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
Journal of the Neurological Sciences
|May 7, 2025
Summary
Polymicrobial brain abscesses (PBAs) are complex infections that present unique diagnostic and therapeutic challenges. This study highlights their heterogeneity and imaging complexity compared to monomicrobial brain abscesses (MBAs).
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Polymicrobial brain abscess (PBA) is a severe infection caused by multiple pathogens, posing significant diagnostic and therapeutic hurdles.
- Understanding the distinct characteristics of PBAs is crucial for improving patient outcomes.
- Comparison with monomicrobial brain abscesses (MBAs) can elucidate unique PBA features.
Purpose of the Study:
- To retrospectively analyze the clinical, radiological, and pathological features of polymicrobial brain abscesses (PBAs).
- To compare these characteristics with those of monomicrobial brain abscesses (MBAs).
- To highlight the complexity and heterogeneity of PBAs for improved diagnosis and staging.
Main Methods:
- Retrospective identification and analysis of 31 patients with PBAs.
- Examination of clinical, radiological (MRI/CT), and histopathological characteristics.
- Comparison of PBA data with a previously reported cohort of 113 MBAs.
Main Results:
- PBAs showed similarities to MBAs in non-specific presentations, male predilection, and prognosis post-treatment.
- PBAs exhibited higher heterogeneity with complex MRI findings (e.g., lobulated rims, variable signal intensity) and histopathology.
- PBAs were often unifocal and linked to otogenic, odontogenic, or rhinogenic sources.
Conclusions:
- Polymicrobial brain abscesses are more heterogeneous and complex in imaging and histopathology than monomicrobial brain abscesses.
- An integrated clinico-radiologico-pathological approach is essential for accurate diagnosis and staging of PBAs.
- Increased awareness of PBAs is needed for prompt diagnosis and effective treatment.
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