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Disease detectives with the US Centers for Disease Control and Prevention are investigating a cluster of rare and serious brain abscesses in children in and around Las Vegas, Nevada, and doctors in other parts of the country say which may also be seeing an increase in cases. .
In 2022, the number of brain abscesses in children has tripled in Nevada, from an average of four to five per year to 18.
“In my 20 years of experience, I’ve never seen anything like this,” said Dr. Taryn Bragg, an associate professor at the University of Utah who treated the cases.
Pediatric neurosurgeons like Bragg are rare. She is the only one in the entire state of Nevada, and because she treated all the cases, she was the first to notice the pattern and alert local public health officials.
“After March 2022, there was a big increase” in brain abscesses, Bragg said. “I was seeing a large number of cases and that is unusual.”
“And the similarities in terms of the presentation of the cases were striking,” Bragg said.
In almost all cases, the children had a common childhood complaint, such as ear or sinus pain, with a headache and fever, but within a week or so, Bragg says, it became apparent that something more serious was going on.
After a presentation on the Nevada cases at the Epidemic Intelligence Service Conference on Thursday, doctors in other parts of the country said they are seeing similar increases in brain abscesses in children.
“We are impressed by the number of these that we are seeing right now,” said Dr. Sunil Sood, a pediatric infectious disease specialist at Northwell Health, a health system in New York. He estimates they are seeing at least twice as much as usual, though they haven’t made a formal tally. He urged the CDC to continue to investigate and work to get the word out.
Brain abscesses are not, by themselves, reportable conditions, which means that doctors are not required to alert public health departments when they have these cases.
They typically only come to the attention of public health officials when doctors notice increases and communicate.
Brain abscesses are pus-filled pockets of infection that spread to the brain. They can cause seizures, visual disturbances, or changes in vision, speech, coordination, or balance. The first symptoms are headaches and a fever that comes and goes. Abscesses often require multiple surgeries to treat, and children can spend weeks or even months in the hospital recovering after having one.
In it clark county groupabout three quarters of the cases were children, and most were around 12 years of age.
Dr. Jessica Penney is the CDC’s Epidemic Intelligence Service officer, or “disease detective,” assigned to the Southern Nevada Health District, the health department that investigated the cases. she presented your investigation from the Clark County group at the CDC’s Epidemic Intelligence Service annual conference on Thursday.
Penney says that while trying to figure out what was driving the increase, they looked at a number of factors — travel, history of covid-19 infection, underlying health, any common activity or exposure — and found nothing to be related. the cases.
Then, he says, they decided to look back in time, looking for cases of brain abscesses in children under the age of 18 to 2015.
“I felt like that helped us get a better idea of what he might be contributing,” Penney said in an interview with CNN.
From 2015 to 2020, Penney says the number of brain abscess cases in Clark County was fairly stable at around four per year. In 2020, the number of brain abscesses in children decreased, likely due to measures such as social distancing, school closures, and mask-wearing, measures that slow the spread of all types of respiratory infections, not just COVID-19 . In 2021, when the restrictions began to be lifted, the number of these events returned to normal levels, and then in 2022, there was a big increase.
“So the thoughts are, you know, maybe in that period where the kids didn’t have these exposures, you’re not developing the immunity that you would normally get before, you know with these viral infections,” Penney said. “So maybe at the other extreme, when we had these exposures without that immunity from the years before, we saw a higher number of infections.”
This is a theory called immunity debt. Doctors have recently seen unusual increases in a number of serious childhood infections, such as invasive group A strep. Some think that during the pandemic years, because children were not exposed to the amounts of viruses and bacteria they normally could find, their immune systems were less able to fight infection.
Sood said he is not sold on the theory that there is some kind of immunity debt at work. Instead, he believes that Covid-19 temporarily displaced other infections for a while, essentially displacing others. Now that covid-19 cases have declined, he believes other childhood infections are making a comeback; he points to the unprecedented rise in RSV cases last fall and winter as an example.
Sood says that brain abscesses typically follow a very small percentage of sinus infections and inner ear infections in children. Because they’re seeing more of those infections now, the number of brain abscesses has increased proportionally as well.
If immunity debt or a higher infection burden were to blame, it stands to reason that brain abscesses might have increased elsewhere as well.
Last year, the CDC worked with the Children’s Hospital Association to find and count brain abscesses in children, to see if there was some kind of national spike. Data collected through May 2022 did not detect any kind of widespread increase, according to A study published in the Morbidity and Mortality Weekly Report last fall.
But Bragg thinks the data cutoff for the study may have been too early. She says the spring of 2022 was when she saw cases in her area really take off. She says that the CDC continues to collect information on brain abscesses and assess local and national trends.
About a third of the brain abscesses in the Clark County group were caused by a type of bacteria called Streptococcus intermedius that normally remains harmless in the nose and mouth, where our immune systems keep it in check. But when it gets into places it shouldn’t be, like the blood or the brain, it can cause problems.
That can happen after dental work, for example, or when someone has an underlying health condition that weakens their immunity, such as diabetes.
However, that was not the case for the children in the Clark County group.
“These are healthy children. No significant medical history that would make them more prone… there was no known immunosuppression or anything like that,” says Bragg.
Similar to the cases in Clark County, Sood says most of the children they are seeing are older, in elementary and middle school. He says that until children reach this age, their nasal cavities are underdeveloped and have not yet grown to their full size. This can make them particularly vulnerable to infection. He thinks these little spaces can fill with pus and burst. When that happens above the eyebrow or behind the ear, where the barrier between the brain and sinuses is thinnest, the infection can travel to the brain.
Sood says the signs of a sinus infection in children can be subtle, and parents don’t always know what to look for. If a child comes down with a cold or stuffy nose and wakes up the next day with a red, swollen eye, or one eye that is swollen shut, it is a good idea to seek medical attention. They may also complain of a headache and point to the place above the eyebrow as the location of the pain.
Bragg says that so far, in 2023, he has treated two more children with brain abscesses, but the rate of new cases seems to be slowing, at least he hopes that is the case.
Some of the children he treated required multiple head and neck and brain surgeries to clear their infections.
Sood says that at his hospital, the doctors have a patient who has been there for two to three months and had five surgeries, although he says it was an extreme case.
Penney says the CDC continues to watch the situation closely.
“We are going to continue to monitor throughout the year working very closely with our community partners to find out what is happening in southern Nevada,” he said.
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