Doctors monitoring southern Nevada’s mystery brain illness cluster in children 2023
The US Centers for Disease Control and Prevention are examining a cluster of uncommon and serious brain abscesses in children in Las Vegas, Nevada, and doctors from other states think they may be seeing more cases.
Nevada’s child brain abscesses increased in 2022, from four to five to 18.
Dr. Taryn Bragg, an associate professor at the University of Utah, treated the cases.
Rare pediatric neurosurgeons like Bragg. She is the only one in Nevada and treated all the cases, thus she was the first to detect the trend and warn local public health officials.
Brain abscesses increased “hugely” after March 2022, Bragg added. “That’s unusual.”
“And the similarities in case presentation was striking,” Bragg said.
Bragg adds that most kids would suffer an earache or sinus infection with a headache and fever, but after a week, it would become evident that something more serious was going on.
After a presentation on the Nevada cases at the Epidemic Intelligence Service Conference on Thursday, doctors from other states reported similar increases in child brain abscesses.
“We’re just impressed by the number of these that we’re seeing right now,” said Dr. Sunil Sood, a pediatric infectious disease expert at Northwell Health in New York. Though they haven’t counted, he estimates they’re seeing at least twice as many as usual. He encouraged the CDC to investigate and raise awareness.
Doctors are not compelled to report brain abscesses to public health departments.
They only become public health issues when doctors report increases.
Disease detectives
Pus-filled brain abscesses transmit infection. Seizures, visual abnormalities, speech, coordination, and balance impairments can result. Early symptoms include headaches and intermittent fever. After an abscess, kids may spend weeks or months in the hospital recovering from multiple surgeries.
Three-quarters of Clark County cases were boys, most of whom were 12.
Dr. Jessica Penney, the CDC Epidemic Intelligence Service investigator or “disease detective” assigned to Southern Nevada Health District, investigated the cases. She presented her Clark County cluster research at the CDC’s annual Epidemic Intelligence Service conference on Thursday.
Penney says they looked at travel, a history of COVID-19 infection, underlying health, common activities, and exposures to try to figure out what was causing the spike, but they found nothing.
She says they looked back to 2015 for brain abscess cases in children under 18.
In a CNN interview, Penney stated, “I felt like that helped us get a better sense of what might be contributing to it.
Penney said Clark County saw about four brain abscesses per year from 2015 to 2020. Social distance, school closures, and masking, which prevent the transmission of all respiratory diseases, may have reduced the number of brain abscesses in children in 2020. As restrictions lifted in 2021, these events returned to normal levels, then spiked in 2022.
Pandemic link?
“So the thoughts are, you know, maybe in that period where kids didn’t have these exposures, you’re not building the immunity that you would typically get with these viral infections,” Penney said. “Maybe on the other end when we had these exposures without that immunity from the years prior, we saw a higher number of infections.”
Immunity debt theory. Invasive group A strep and other dangerous pediatric illnesses have increased unexpectedly. During the epidemic, children were not exposed to as many viruses and germs as usual, which may have weakened their immune systems.
Sood disagrees that immunity debt exists. He believes Covid-19 momentarily crowded out other diseases. As Covid-19 cases have declined, he believes other childhood infections are returning, citing the unprecedented RSV outbreak last fall and winter.
Sood adds brain abscesses seldom follow sinus and inner ear infections in children. Brain abscesses have increased proportionally due to increasing infections.
Brain abscesses may have increased elsewhere if immunity debt or more infections were to blame.
The CDC and Children’s Hospital Association counted child brain abscesses last year to determine if there was a countrywide spike. According to a fall Morbidity and Mortality Weekly Report research, data from May 2022 showed no widespread increase.
Bragg believes the study’s data cutoff was too early. In spring 2022, cases in her neighborhood exploded. She said the CDC is collecting brain abscess data and analyzing local and national patterns.
Streptococcus intermedius, a harmless bacteria found in the nose and mouth, caused almost a third of the Clark County brain abscesses. It can cause difficulties if it enters the blood or brain.
That can happen after dental work or if someone has a weakened immune system, like diabetes.
Clark County kids weren’t.
“Healthy kids. Bragg adds there was no immunosuppression or other medical history that might make them more susceptible.
Sood says most of the students they see are older, in grade school and middle school, like Clark County. He claims nasal cavities are immature till this age. They may be susceptible to infection. He thinks these little areas may explode with pus. Over the eyebrow or behind the ear, where the brain-sinus barrier is thinner, the infection can reach the brain.
Sood believes children’s sinus infections might be hard to spot. If a youngster has a cold or congested nose and wakes up with a red, puffy, or closed eye, seek medical assistance. They may also say their headache is above their eyebrow.
Seeking new cases
In 2023, Bragg has treated two more children with brain abscesses, but she hopes the pace is diminishing.
She performed repeated brain and head-and-neck procedures on some children to address their infections.
Sood said his hospital has a woman who has been there for two to three months and had five procedures, but she was extreme.
Penney said the CDC is monitoring.
“We’ll continue to monitor throughout the year working very closely with our community partners to see what happens down in Southern Nevada,” she said.