Doctors monitor more cases after cluster of mysterious brain infections hits children in southern Nevada

CNN
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Disease investigators at the U.S. Centers for Disease Control and Prevention are investigating clusters of rare and severe brain abscesses in children in and around Las Vegas, Nevada, and doctors in other parts of the country may also see an increase in cases. It is said that there is a nature. .

In 2022, the number of brain abscesses in children will triple in Nevada, rising from an average of 4-5 to 18 cases per year.

“In my 20 years of experience, I have never seen anything like this,” said Dr. Taryn Bragg, an associate professor at the University of Utah who handled the case.

Pediatric neurosurgeons like Bragg are rare. She was the only one in the entire state of Nevada who treated all the cases, so she was the first to notice the pattern and alert local public health officials.

“Since March 2022, there has been a significant increase in brain abscesses,” said Bragg. “I’ve seen a lot of cases, and that’s unusual.”

“And the similarities in terms of case presentation were striking,” said Bragg.

Most often, children complain of common childhood symptoms, such as earaches and sinus infections with headaches and fever, but within about a week, more serious problems develop, says Bragg. It becomes clear that

After a presentation on the cases at the Epidemic Intelligence Services conference in Nevada on Thursday, doctors in other parts of the country said they were seeing a similar increase in brain abscesses in children.

Dr. Sunil Soud, a pediatric infectious disease specialist at Northwell Health, New York’s health system, said: He doesn’t have an official tally, but he estimates he’s being seen at least twice as often as normal. He urged the CDC to continue its investigation and work to disseminate information.

Brain abscess itself is not a reportable condition, so there is no need for doctors to alert public health departments when these cases occur.

They usually only come to the attention of public health officials when doctors notice the increase and reach out.

A brain abscess is a condition in which an infection spreads into the brain as a pus-filled pocket. They can cause seizures, visual disturbances, or changes in vision, speech, coordination or balance. Early symptoms are headache and fever that comes and goes. Treatment of an abscess often requires several surgeries, and children may spend weeks or months in the hospital recovering after surgery.

in the Clark County Clusterabout three-quarters of the cases were boys, mostly around the age of 12 years.

Dr. Jessica Penney is a CDC Epidemic Intelligence Services Officer, or “disease detective,” assigned to the Southern Nevada Health District, the health department that investigated the case.she announced her research of the Clark County cluster at the CDC’s annual Epidemic Information Service conference on Thursday.

Penny looked at many factors, including travel, history of Covid-19 infections, underlying health conditions, general activities and exposures, in an attempt to figure out what was driving the increase, but found no associations. I didn’t find anything to do with the case.

She then decided to look back, looking for cases of brain abscess in children under 18 dating back to 2015, she says.

In an interview with CNN, Penney said, “I felt like it helped me better understand what was going on.

From 2015 to 2020, the number of brain abscess cases in Clark County remained fairly stable at around four cases per year, Penney said. In 2020, the number of brain abscesses in children decreased. This is probably due to measures like social distancing, school closures and masks, which stop the spread of not only Covid-19 but all kinds of respiratory infections. In 2021, as restrictions began to lift, the number of these events returned to normal levels, with a major spike in 2022.

“So what I think is possible is that, at a time when children didn’t have these exposures, they probably didn’t build the immunity they normally had with viral infections before,” Penney said. “And, conversely, we may have seen more infections when these exposures were without immunity from years ago.”

This is the theory called immune debt. Doctors have recently confirmed an unusual increase in serious childhood infections such as invasive group A streptococci. Some believe that during the years of the pandemic, children were not exposed to the number of viruses and bacteria they would normally encounter, which reduced their immune system’s ability to fight off infections.

Sood said he wasn’t convinced by the theory that some kind of immune debt was at work. Instead, he believes Covid-19 has temporarily replaced other infections, essentially shutting them out. Infectious diseases in children are raging, he points to, as an example, the unprecedented spike in RSV cases last fall and winter.

Sood says brain abscesses usually occur in a very small percentage of sinus and inner ear infections in children. Because they are seeing more of these infections now, the number of brain abscesses is also increasing proportionately.

If a weakened immune system or a heavy burden of infections is the cause, it stands to reason that brain abscesses may 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 a nationwide spike. No increase was detected. the study It was published last fall in the Weekly Report on Morbidity and Mortality.

But Bragg thinks the study’s data cutoff may have been too early. She says that in the spring of 2022, she saw a real rise in the number of cases in her area. She said the CDC continues to collect information on brain abscesses and assess local and national trends.

About a third of brain abscesses in the Clark County cluster are caused by a type of bacterium called Streptococcus intermedius that normally hangs harmlessly in the nose and mouth and is suppressed by the immune system. However, it can cause problems if it gets into places it shouldn’t be, such as the blood or brain.

For example, it can occur after dental work or if someone has an underlying disease that weakens the immune system, such as diabetes.

However, the children in the Clark County cluster did not.

“These are healthy children.

As in the Clark County case, Sood says most of the children they see are in the upper grades of elementary and middle school. He says that until a child reaches this age, their sinuses are underdeveloped and have not yet grown to their full size. He believes these tiny spaces can fill with pus and rupture. There is likely to be.

The signs of sinus infections in children can be subtle, says Sood, and parents don’t always know what to look out for. If your child catches a cold or has a stuffy nose and wakes up the next day with red and swollen eyes, or if your eyes are swollen and closed, it’s a good idea to see a doctor. They may complain of headaches and point to the area above their eyebrows as the location of pain.

Bragg said that so far, two more children have been treated for brain abscesses in 2023, but the pace of new cases appears to be slowing — at least I hope so. increase.

Some of the children she treated required multiple brain and head and neck surgeries to remove the infection.

Sood said he had a patient in his hospital who was in the hospital for two to three months and underwent five surgeries, but she was an extreme case.

Penney said the CDC continues to monitor the situation closely.

“We will continue to monitor throughout the year, working very closely with our community partners to find out what is happening in Southern Nevada,” she said.