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.
摘要：
脑脓肿（BA）是仍然危及生命的局灶性实质感染。多微生物BAs（PBA）是细菌或细菌和非细菌病原体（如真菌或寄生虫）的复杂共感染，诊断和治疗的挑战。在这篇文章中,我们全面回顾了患病率，发病机制，临床表现，和微生物，组织病理学,和PBA的放射学特征，以及治疗和预后。虽然PBA和单一抗菌BA有一些相似之处，如非特异性临床表现，PBAs的发病机制更为复杂,病态,和成像演示。PBA的诊断挑战包括早期的非特异性成像特征以及在不使用分子分析的情况下通过常规技术鉴定某些病原体的困难。晚期PBA的成像显示病变内异质性增加，根据不同区域的主要病原体诱导的变化，其对应于可变的组织病理学特征。在与弓形虫等非细菌性病原体合并感染的情况下，这种异质性尤其明显。PBA管理中的治疗挑战包括在鉴定多种病原体之前对可能未被识别的合并感染进行初始医学治疗，以及随后的广谱抗微生物治疗以根除已鉴定的病原体。PBA应该得到更多的认识，以促进及时和适当的治疗。
