Pediatric Brain Abscess Mystery Cluster in Nevada Worries Investigators

by Staff Writer
May 1, 2023 at 10:05 AM UTC

A mystery cluster of pediatric brain abscesses has experts worried.

Clinical Relevance: Be on the lookout for an increase in pediatric brain abscess cases

  • Rare brain abscesses in children tripled in the Las Vegas area in 2022.
  • Experts aren’t sure what is causing the rise in this potentially fatal condition, but suspect immunity debt, COVID, or a bacteria.
  • A surge has not been identified in other parts of the country, though doctors are anecdotally noting increases.

Disease detectives are concerned about a cluster of brain abscesses occurring in children. The rise of the severe condition in the Las Vegas area has prompted an investigation by the Centers for Disease Control and Prevention (CDC.) 

A Sudden Spike

In 2022, the number of pediatric brain abscesses tripled in Nevada. Cases rose to 18 from an average of about four a year, CDC officials said. Nearly three-quarters of the patients in the Nevada cluster were boys and their average age was 12. 

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“In a little over 20 years, I would see one to two cases a year,” reported Taryn Bragg, MD, a pediatric neurosurgeon on the investigation team. “The numbers we were seeing in 2022 were higher than years prior.” As the only pediatric neurosurgeon in the state of Nevada, Bragg was able to spot the cluster because she treated all of the cases. 

A brain abscess typically results from a fungal infection or a head injury. The brain fills with puss, which can be fatal if swelling affects blood flow. Symptoms include severe and persistent headaches and fevers, the investigators reported. Brain abscess symptoms can also include bulging of soft spots on the head, and concussive behaviors such as abnormal sleepiness, irritability, high-pitched cry, projectile vomiting, and seizures.

In 14 of the 17 cases, patients underwent a craniotomy to drain the abscess, according to Bragg. She said that all of the children were placed on antibiotics while some of them had part of their skull temporarily removed to ease the swelling. All required from two weeks to several months in the hospital to recover. 

Tracking the Rise

The cause of the abscesses has been something of a mystery. Investigators looked at a variety of factors including travel, COVID-19 infection history, and underlying health conditions. Nothing linked the cases together, said Jessica Penney, MD, one of the CDC Epidemic Intelligence Service officers assigned to examine the cases. 

From 2015 to 2020, Penney said reports for brain abscesses in the Clark County area were pretty stable. During the height of the pandemic, the number actually dipped, most likely due to social distancing, masking and school closures. Then, as COVID rules relaxed in 2021, the numbers returned to normal levels. In 2022…a big surge!

Exploring the Cause

Penny said the investigators are considering a theory known as “immunity debt.”

“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 previously, you know with these viral infections,” Penney told CNN. “And so maybe on the other end when we you had these exposures without that immunity from the years prior, we saw a higher number of infections.”

However, other experts suspect COVID may have temporarily displaced other infections for a while. With the pandemic fading, other childhood infections have broken through once again. Some of the cases reported common childhood complaints such as an ear or sinus infection before the abscess was diagnosed.

Another clue: about one-third of the brain abscesses in the Nevada cluster were caused by a type of bacteria called Streptococcus intermedius. Normally a harmless bacteria when found in the mouth and nose, it can turn serious if it enters the bloodstream or brain. 

Continued Investigation

The CDC investigators have not pinpointed a national rise in the infection. However, after a presentation on the Nevada cases at the Epidemic Intelligence Service Conference last week, doctors from other parts of the country said they were seeing similar increases. The agency said it will continue to monitor the situation closely.

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