REYE'S
SYNDROME.
An aspirin a day helps keep the doctor away…well, not when you're
talking about children under the age of 16. There is an illness out there that
some studies have found a common link with giving children an aspirin when they
are fighting a viral disease. The condition is called Reye's Syndrome, and usually
strikes children under the age of 15 who are recovering from a variety of illnesses
including respiratory, chicken pox or the flu.
Reye's Syndrome is a very rare, but deadly condition and may catch your health
care provider off guard. It needs to be considered, especially in ill-appearing
children that are in the post-viral phase, and if suspected, your child needs
to receive immediate care.
What is Reye's Syndrome? Reye's Syndrome is an illness
that can affect all bodily organs, but most specifically the liver and brain.
After a viral illness, the
liver and brain undergo some changes at the cellular level. Those changes are
called fatty infiltration. Reye's usually develops during the recovery phase
of the viral illness, which can be after influenza, a common cold or chicken
pox.
R.D.K. Reye first described Reye's syndrome in the 1960s in Australia and it
was described by G.M. Johnson later in the United States. It was noted that children,
in particular, developed altered states of conscious and severe vomiting in the
post-viral phase. It was later discovered that there was an association with
use of aspirin that seemed to cause the syndrome. Once this was identified, the
number of cases worldwide has decreased. Unfortunately, there is no known cause
for the development of the syndrome other than the association of aspirin usage.
It is thought that some patients may have an abnormality in metabolism contributing
to this problem.
What are the symptoms? The most common age group of
patients to be affected is from three to 12 years. As noted, the onset of Reye's
occurs after the course
of a viral illness. Initially, children will develop protracted vomiting, which
is a hallmark of the syndrome. Numerous episodes of vomiting are followed by
a change in mental status. This may involve increased sleepiness, lethargy and
difficulty with awakening. Laboratory testing may reveal an elevation in liver
enzymes that are diagnosed through blood testing. v Initial behavioral changes
may be as minor as irritability, but can be as serious as coma. Use of aspirin
is a major risk factor for the development of Reyes, but it is not necessary
in order to develop the illness.
How common is Reye's Syndrome? In the early 1980s,
there were more than one thousand cases annually. Fortunately, that number has
decreased to less than one hundred
cases per year. This has been due to the identification of associated aspirin
usage. Internationally, the number of these cases has decreased as well. Usually,
most cases are seen between the months of December through March, when the incidence
of most viral illnesses are present.
What is the treatment? First and foremost, even though
Reye's Syndrome is a rare entity, health care providers must be suspicious when
seeing very ill-appearing
children. They must be very suspicious if this is in the post-viral phase of
a respiratory illness and protracted vomiting has occurred and there are associated
changes in level of consciousness.
Next, supportive treatment is required involving the administration of fluids.
A CT Scan of the brain and possibly a spinal tap are necessary, in order to rule
out evidence of swelling in the brain or other infections such as meningitis.
Most of these children will require transfer to a children's intensive care unit
at a tertiary care medical center or specialized pediatrics hospital.
If diagnosed early, there is a 75 percent chance of full recovery. If the diagnosis
is delayed, there is a high incidence of death. Cases that are diagnosed in the
later stage may involve permanent disability, due to brain injury.
What should I do? It is essential to remember that
a large majority of cases of Reye's have been associated with aspirin. DO NOT
give aspirin to children!
It is safe to use acetaminophen (Tylenol) and ibuprofen to control fever during
a viral illness. Even if it is rare, teenagers and adults can develop Reye's
as well. It is important to be suspicious of the disease when serious illness
develops. More importantly, see your health care provider with those concerns.
