Eighteen children in Clark County between the ages of 4 and 15 were diagnosed last year with a life-threatening abscess, or pus-filled pocket, in or around their brain, according to Southern Nevada health authorities.
The median number of annual cases from 2015 to 2021 was just four. The dramatic increase in this very rare type of infection alarmed a Las Vegas pediatric neurosurgeon treating the children. She alerted the Southern Nevada Health District.
What causes the abscesses?
The abscesses stemmed from a sinus infection or an ear infection complicated by mastoiditis, an infection of the bone behind the ear. The source of the infections was streptococcus intermedius, a bacterium in the same family as the one that causes strep throat but a different type.
“I had ear infections that then traveled through the bone locally, that then infected the brain,” said Las Vegas pediatric neurosurgeon Dr. Taryn Bragg, who treated the cases.
What are the symptoms?
The children at first had cold symptoms, fevers, headaches.
Bragg said the children became severely ill, in some cases experiencing seizures, speech and language difficulties, and weakness on one side of their bodies.
Persistent symptoms such as discolored drainage from the nose and high fevers should be brought to the attention of a medical provider, she said.
“If you have a sinus infection or ear infection that requires drainage, if we could treat those beforehand, then maybe they would not have become brain infections,” she said.
What is the treatment?
Medical treatment for the children involved long-term antibiotics as well as one or more surgeries. The nature of the surgery depended on the extent and exact location of the infection, and included draining infected areas and temporarily removing a portion of the skull to allow the brain to swell, Bragg said.
All of the children have fully covered or are nearly fully recovered, Bragg said. If left untreated, the abscesses can be fatal.
What caused the spike in cases?
“The exact cause behind the surge in cases is unknown,” said Dr. Jessica Penney, an epidemic intelligence service officer for the Centers for Disease Control and Prevention who is embedded with the health district.
Disease investigators examined whether the affected children had any unusual risk factors or common experiences, looking at travel background, secondhand smoke exposure, illness from COVID-19 and mask-wearing, but found nothing unusual, she said.
They were able to speak to most of the patients’ families, who said their children had not had a recent case of COVID-19. Most of the children also were tested for COVID-19 at the hospital and were negative for the virus.
“Our investigation revealed no relationship between the COVID-19 vaccine and the increase in brain abscesses,” said Penney, noting that only a small percentage of the children had gotten the vaccine.
Investigators continue to explore whether decreased exposure to illness during the pandemic — due to measures such as school closures and social distancing — might have weakened the children’s immune systems, a concept known as immunity debt. There isn’t data to support the theory at this point, Penney said.
Is the increase unique to Southern Nevada?
Public health authorities don’t know at this point if increases also have occurred in other parts of the country.
There is anecdotal evidence that cases are increasing not only in children but also in adults in other regions, said Bragg, who has spoken with her counterparts on the West Coast and elsewhere in the country. With no requirement to report these infections, there isn’t data to support the idea of a wider-spread increase.