Mysterious increase in rare pediatric intracranial abscesses in the Las Vegas area

A group of rare pediatric intracranial abscess cases in the Las Vegas, Nevada area Recommendation From the local health district in January 2023, presentation At the CDC’s Annual Epidemic Information Service (EIS) Conference in April in Atlanta, Georgia.

Jessica Penney, MD, MS, MPHTM, EIS Officer, CDC, and colleagues found that from 2015 to 2021, the county had a median incidence of 4 cases/year, compared with 18 cases/year in 2022. Reported an instance occurred. Steptococcus intermedius It was the most common bacterial pathogen isolated.

“Further research is needed to identify the specific risk factors and causes of this rare condition, and surveillance should continue to understand future trends,” Penny and colleagues noted.

in the Weekly reports of morbidity and mortality (MMWR) As of Sept. 16, 2022, the CDC reported a decline in cases across the United States at the start of the COVID-19 pandemic, followed by an increase in cases in the summer of 2021, peaking in March 2022, and then falling to base. It shows that it has been reduced to line level.

Discharge data reviewed by the CDC were based on a diagnosis of intraparenchymal brain abscess, subdural empyema or empyema, epidural empyema or empyema, or intracranial extension on imaging in the absence of prior neurosurgical surgery or head trauma. showed evidence of

In telephone interviews conducted by the Southern Nevada Health District (SNHD) to obtain details about the prehospital period, 64% (n=9) of interviewees reported cold symptoms such as nasal discharge and nasal congestion. 59% (n=7) complained of symptoms such as: Other symptoms such as headache (n=3), headache with fever (n=3), head trauma with concussion (n=2). Of those interviewed, 70% (n = 11) sought outpatient or emergency department care for their children prior to hospitalization.

SNHD found that the most common predisposing factors were consecutive infections such as otitis media, mastoiditis, sinusitis, or orbital cellulitis. Fever was present in approximately 50% of patients with brain abscess, but a history of headache was the more common symptom. Focal neurologic findings were present in about half of the patients, and about 25% experienced seizures.

Clark County’s incidence data correspond to the nationwide pattern described by the CDC during the period when COVID-19 isolation and protective measures were in place. SNHD does not show a correlation, but its data show that the surge in incidence coincided with the lifting of mask mandates in the region in February 2022. And the recommendation notes that 38% of his interviewees (6) reported having stopped masking at that point.

The advisory recommends prompt treatment of children with symptoms consistent with reported infections. It also indicates that the most important initial examination for diagnosis is her CT or MRI imaging with contrast agents.

“Consider intracranial abscess in pediatric patients with severe headache or neurologic symptoms preceding upper respiratory disease, otitis media, or sinusitis. If in doubt, consult a neurosurgeon for cranial Get an image,” the recommendation states.

The recommendation also recommends that clinicians educate patients and parents about the signs and symptoms of intracranial abscess. These include fever, severe headaches, nausea and vomiting, personality and behavioral changes, speech changes, gait disturbances, other neurological disorders, and seizures. .

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