Monday, May 1, 2023

Brain abscesses in southern Nevada

After cases of brain abscesses in children reportedly tripled last year in southern Nevada, the Centers for Disease Control and Prevention (CDC) is investigating potential reasons for the spike.

Dr. Taryn Bragg, a pediatric neurosurgeon at Intermountain Primary Children’s Hospital in Las Vegas, Nevada, reported the unexpected number of cases to the Southern Nevada Health District, which issued a public health advisory in January 2023.

"We started noticing the infections in March 2022," Dr. Bragg told "Fox & Friends Weekend" on Sunday morning. "The vast majority of children presented with sinus infections that fairly rapidly progressed to abscesses forming in the brain."

A majority of the kids also showed the presence of the bacteria Streptococcus intermedius, which is commonly found in the oral and respiratory cavity, she said.

"It often doesn’t result in infections, but it certainly can — and it’s the most common organism that will result in brain abscesses," Dr. Bragg said.

The doctor hasn’t seen evidence that the infections are caused by environmental factors in southern Nevada.

"We didn’t find anything local to our community that would help us mitigate and try to reduce infection rates," she told Fox News Digital in a phone interview.

As Dr. Bragg explained on "Fox & Friends Weekend," the children who came to the hospital with brain infections were already "incredibly sick" when they arrived.

"It’s very different from your common cold," she said.

"Most of the children had significant fevers, severe headaches, lethargy, perhaps even neurologic deficits, like speech or language difficulties or weakness."

There have not been any fatalities from these pediatric brain abscesses in southern Nevada, and the vast majority of the children have "fully recovered without neurologic deficit," Dr. Bragg said.

Many of them have required long-term antibiotics and multiple surgeries, however.
Brain abscesses are rare among children, according to the advisory.

Between 2015 and 2021, Clark County in southern Nevada only saw about five cases per year among those age 18 and younger, the Southern Nevada Health District stated.

In 2022, there were 17 cases, an increase of 240%.

The average age of the patients was 12 years old — and 76% of them were male.

Dr. Jessica Penney, an epidemic intelligence officer with the CDC, presented the increase of pediatric brain abscesses at the Epidemic Intelligence Service (EIS) Conference, held last week in Atlanta, Georgia, according to the program's agenda.

CDC is investigating

The CDC first discussed the increase in pediatric brain abscesses in its Morbidity and Mortality Weekly Report in September 2022.

After three children in California were hospitalized with the condition in May 2022, the agency began investigating.

"Discussions with clinicians in multiple states raised concerns about a possible increase in pediatric intracranial infections, particularly those caused by Streptococcus intermedius, during the past year and the possible contributing role of SARS-CoV-2 infection," the CDC stated in the report.

What to know about brain abscesses

A brain abscess, or cerebral abscess, occurs when an infection causes a pus-filled pocket to form in the brain, according to Johns Hopkins Medicine.

The most common cause is the presence of bacteria or fungi in the brain, which can enter from the ears, sinuses or bloodstream.

Those who experience a head injury or have surgery in that area could also develop an abscess.

Some people are at a higher risk, such as those who have HIV/AIDS, a heart defect, a history of intravenous drug use or a condition that weakens the immune system, Johns Hopkins states.

In the cases reported in southern Nevada, 64% of the children reported symptoms including nasal congestion and runny nose, according to the public health advisory.

Another 50% experienced headache, headache with fever and head injuries with the risk of concussion.
Other common symptoms include visual disturbances, weakness, seizures, nausea, vomiting, confusion, changes in consciousness, neck or back stiffness, and difficulty talking or moving, per Johns Hopkins.

The condition can be diagnosed by MRI or CT scans, blood tests and/or samples from the abscess.

In the southern Nevada cases, 79% of the children’s parents sought medical care that eventually led to hospitalization, with 50% of them going straight to the emergency room.

The infections are usually treated with strong antibiotics, steroids, antifungal drugs and/or anti-seizure medication, per Johns Hopkins.

In severe cases, surgery may be required to drain or remove the abscess.

"A brain abscess is a medical emergency," Dr. MarkAlain Déry, an infectious disease physician practicing at Access Health Louisiana, said in an interview with Fox News Digital.

"It needs to be drained immediately. The patient should be in the hospital, being watched by an infectious disease doctor."

Some of the more severe risks associated with brain abscesses include neurologic deficits and seizures, the doctor added.

Possible link to pandemic

Brain abscesses in children decreased when the COVID-19 pandemic began, then rose in the summer of 2021 — around the same time that pandemic-related restrictions started to lift, the CDC stated in its report.

Cases peaked in March 2022 before declining to baseline levels. The timing has led some to suggest that the spike is caused by "immunity debt," in which pandemic restrictions such as masking and lockdowns could have led to weakened immune systems.

Dr. Déry said he believes in the concept of immunity debt, but doubts that it’s a factor in the brain infections spike.

"I think immunity debt applies more to the respiratory viruses, like RSV and influenza," he told Fox News Digital. "With a brain abscess, it’s caused by bacteria or parasites, often in cases where people have had dental work or an ENT (ear, nose and throat) procedure."

He added, "You don't just get a brain abscess out of nowhere."

Other physicians are also uncertain about whether there’s a link to the pandemic.

"We don't know yet if this is just a cluster of cases or a national trend, so we can't say whether a pause in the immune system response due to COVID lockdowns or closures is playing a role, where the response to basic bugs like strep, which our kids hadn't seen in a while, is delayed," Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, told Fox News Digital.

The doctor does believe, however, that the surge in brain infections could stem from people failing to recognize sinus and ear infections due to the "hyperfocus" on COVID.

"We have seen a surge in sinus and ear infections recently — many undetected — which can spread to brain abscesses in a small number of cases," he said.

"It’s a numbers game — increased sinus and ear infections in healthy young teens lead to a corresponding increase in the number of abscesses."

About a third of the children’s parents said they had stopped masking prior to the onset of the infection, Dr. Bragg told Fox News Digital.

Until more information is received from other states across the country, Dr. Bragg said it will be difficult to make any "definitive determination" as to what is causing the infections.

"Despite the three- or fourfold increase in numbers, it’s still a relatively small sample size," she noted.

The doctor expects to see more evidence that the infections are widespread. Already, she has heard about cases in Phoenix, Seattle, California, New York and Michigan.

"We might see more information coming out of other subspecialties, such as pediatric ENT and general surgery cases," Dr. Bragg said.

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