Health officials address spike in pediatric brain abscess cases, still considered 'rare'

Cases of pediatric brain abscesses increased nearly threefold in 2022, according to the Southern Nevada Health District (SNHD).

On average, Clark County would have approximately five cases a year, but that number jumped to 18 last year. The sharp increase triggered a Centers for Disease Control (CDC) investigation and public health advisory from the SNHD.

Dr. Taryn Bragg is the only pediatric neurosurgeon in the state of Nevada. Because of that distinction, she was the first to treat all of the patients and noticed a pattern emerge. She recalled the CDC had been investigating similar increases in other states and asked them to investigate in Southern Nevada as well.

The findings were presented last Thursday at the CDC's Epidemic Intelligence Service Conference, as first reported by CNN.

"This is not the typical cold. This is not 'I have a mild headache. I have a low-grade fever. I might have some drainage from my nose.' This is severe symptoms, severe headache, lethargy, seizures, weakness, they may have even noticed swelling in the face or in the eyes," said Dr. Bragg. "And so these are things that are not subtle, you're not going to miss it."

Dr. Bragg said it was easy to detect an increase once she had eleven cases in a four or five-month period beginning Spring 2022. She wanted pediatric providers across Nevada to know about this increase so that they might consider imaging or increasing treatment for children who were showing symptoms of sinus or ear infections.

Dean Marc J Kahn with the Kirk Kerkorian School of Medicine in Las Vegas said the increase to 18 cases meant it's still a rare occurrence, but that it warranted some scrutiny.

"The case numbers are small. We don't know why we've seen this spike in cases, although they have gone down over the past several weeks, two months," said Dr. Kahn. "For parents, I think this is an unusual event. I think that, again, we want our kids to be vaccinated, and up to date on vaccinations. We want our kids to eat healthy, and we want them to be healthy."

Brain abscesses occur when bacteria or fungi that circulate in the blood get to the brain, causing an infection in the brain, Kahn said. When that happens, inflammatory cells fight the infection and create a walled off cavity (an abscess), which contains dead immune cells, frequently called pus.

Dr. Bragg was involved in all of the surgeries needed to treat the children with abscesses. She said it can be a lengthy process with up to six surgeries, some of which require portions of the skull to be temporarily removed for brain swelling. All of the children either fully recovered or are near full recovery, she said.

Dean Kahn from the UNLV Medical School called it a fortunate and unfortunate situation since Las Vegas and Nevada are lagging in pediatric care without a freestanding children's hospital, as outlined in a News 3 special report.

"One thing that a freestanding children's hospital brings to a community is the wide spectrum of specialists and subspecialists in pediatrics, including a pediatric neurosurgeon," said Kahn. "Unfortunately, we only have one pediatric neurosurgeon for our entire community. Fortunately, she was able to see the patients that we're talking about. But this really does underscore the need for a freestanding children's hospital in our community."

So far, the CDC investigation has not determined the exact cause for the rise in brain abscesses both in Nevada and elsewhere, but there are some theories. Since it's a respiratory illness, COVID infections were considered, but a majority of the patients did not have COVID.

Another consideration is something called "immunity debt," where children didn't build up typical immunities due to social distancing during the pandemic.

"We still don't have a clear answer for what might have potentially caused that within our county," said Dr. Jessica Penney, CDC Epidemic Intelligence Service (EIS) Officer. "But we hope by bringing this to everyone's awareness, we'll be able to continue to work with our local state and federal partners to continue monitoring and research."

Health officials also want to stress that the brain abscesses aren't contagious.

"So the big question that's come up, 'Well, is it the masks? Or 'Should we still be wearing masks?'" said Bragg. "This isn't something that's sitting next to their best friend on the school bus on the way home that they're going to be at risk for developing a sinus infection."

Dr. Bragg said parents do need to keep an eye on their children and take them to the hospital or a doctor should extreme symptoms present themselves.

According to the SNHD health advisory, the median time from symptoms to hospitalization reported was 7.5 days.

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Health officials address spike in pediatric brain abscess cases, still considered 'rare' - News3LV