Reye's Syndrome

Named after Dr. R. Douglas Reye who published the first study of this syndrome in the year 1963, in 'The Lancet', Reye's Syndrome is a fatal illness occurring almost exclusively in children and adolescents. Its clinical characteristics include profuse vomiting and neurological dysfunction, which in acute cases, may progress to delirium, coma and death. Fortunately, according to the Centers for Disease Control and Prevention (CDC), US, the number of cases in the US have witnessed a sharp decline since the 1980's and fortunately, now in the 21st century, it occurs very rarely.

Causes
Despite constant and extensive research regarding the causes of Reye's Syndrome, the answers still elude us. However, important indicators have emerged from these investigations. A pattern that occurs repeatedly, is that most children affected with Reye's Syndrome, have a history of an antecedent viral infection, which includes chicken pox, influenza or gastroenteritis. It was observed that there was a strong relation between the use of aspirin during the preceding viral infection and the onset of Reye's Syndrome. People in the US were made aware of this and doctors were advised to substitute aspirin with some other anesthetic in these cases, as a result of which the number of RS patients started declining. According to the CDC's National Reye Syndrome Surveillance System(1988-89), the figures for this disease were the lowest in the year 1989, with just 25 cases reported. Out of this, 76% of the patients had a reported antecedent illness within 3 weeks before onset of Reye's Syndrome and the use of aspirin was implicated in these cases, but it is not certain exactly how aspirin damages the liver and affects the brain functions.

Symptoms
The first indication of the onset of Reye's Syndrome is profuse vomiting. Following this, lethargy, sleepiness and irritability set in. As the illness progresses, the patient often become disoriented, agitated and may experience seizures or lapse into a coma. Reye’s Syndrome causes encephalopathy and fatty degeneration of the liver. Changes in blood levels of certain liver enzymes point towards fatty degeneration.

Identification
When a patient exhibits all the above mentioned symptoms, certain tests are carried out to determine if the person has Reye's Syndrome. A blood chemistry test may be carried out to determine low blood sugar (glucose) levels. Liver function tests may be carried out to check for high enzyme levels. Another indicator is if the serum ammonia test is higher than normal. If required, a liver biopsy or spinal tap may be conducted. Head CT or Head MRI scan may also be used to determine brain condition and function.

Treatment
Unfortunately, for a patient suffering from RS, there is no specific line of treatment. Treatment is dependent on the degree of the illness and is administered largely to control the symptoms. When a Reye's Syndrome patient is hospitalized, his vital functions are closely monitored. Electrolytes and glucose are provided through I/V fluids. Seizures may be controlled with anticonvulsant medication and steroids may be used to reduce brain swelling.

Precautions
The phrase 'Precaution is better than cure' is ideally suited to Reye's Syndrome. As treatment is limited and fatality rate high, preventive measures are one's best bet. The most important measure for parents to remember, is to NEVER give or allow a child who is under 18 years of age, to take an aspirin, unless ordered by a physician to do so. Children and adolescents should be given the chickenpox vaccination and, if possible, the influenza one as well. Also, be alert for medications that include aspirin. It is critical to practice these precautions as 33% Reye’s syndrome patients either do not survive or they develop long-term neurological problems.

Since 1980, the Centers for Disease Control and Prevention (CDC) has been making parents and physicians aware, against the use of aspirin or salicylates (compound included in aspirin) for children with influenza or chicken pox. From 1986 onwards, all aspirin & aspirin containing products carried a warning label. The consistent efforts of the CDC have been fruitful, and no more than two cases a year were reported between 1994 to 1997. This is in sharp contrast to the 555 cases reported in 1980.