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Reye's syndrome

From Academic Kids

Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver.

Contents

Causes

The cause of Reye's syndrome remains unknown; however, a link was found with the use of aspirin or other salicylates in children and adolescents who have a viral infection such as influenza, chicken pox or the common cold. The increased risk of contracting Reye's Syndrome is one of the main reasons that aspirin is not recommended for use in people under the age of 18.

The syndrome is named for Dr R. Douglas Reye, who, along with Dr George Johnson, published the first study of the syndrome in 1963, though the disease was first diagnosed as a unique illness in 1929. In 1980 studies in Ohio, Michigan and Arizona by Starko et al pointed to the use of aspirin during an upper respiratory tract infection and chicken pox as a potential indicators for the syndrome. A decrease of the use of aspirin in children during the 1980s resulted in a corresponding decrease in the number of cases of Reye's syndrome, dramatically in children under 10 (Arrowsmith et al 1987). However, it is worth noting that a decrease in the number of cases has also been observed in countries where children's aspirin is still in use. Further case studies have revealed 19 viruses in conjuction with salicylates, pesticides and aflatoxin as potential factors contributing to the disease.

Symptoms

Reye's syndrome progresses through two stages :

  • Stage I
    • Persistent or continuous vomiting and/or nausea, except for children under two who may have diarrhea or hyperventilate.
    • Signs of brain dysfunction appear : listlessness, loss of energy, lethargy, drowsiness
  • Stage II
    • Personality changes : irritability and aggressive behavior
    • Disorientation : confusion, irrational and combative behavior
    • Delirium, convulsions and coma

Early diagnosis is vital, otherwise death or severe brain damage may follow.

Features

The disease causes hepatic steatosis with minimal inflammation and severe encephalopathy (with swelling of the brain). Jaundice is NOT usually present. The liver may become slightly enlarged and firm, and there is a change in the appearance of the kidneys. (Suchy, Frederick, Ed: J Liver Disease in Children. Mosby, St. Louis.1994. Chapter 36.

Prognosis

In adults who survive the acute illness the recovery is generally complete, with liver and brain function returning to normal within two weeks of the illness. In children however, permanent brain damage is possible, especially in infants, and ranges from mild to severe.

Differential diagnosis

Causes for similar symptoms include

Epidemiology

While Reye's Syndrome is considered a children's disease, an ever larger percentage of the cases now appear in teenagers and adults, where it is often confused with excessive alcohol or other drug consumption. Factors other than a viral infection and salicydes are suspected for the disease, while over 90% of patients admitted to hospitals in the United States with Reye's Syndrome have taken aspirin to treat the symptoms of a viral infection, less than 0.1% of children who have had their viral infections treated with aspirin develop the syndrome. The syndrome also seems to have a familial factor, with a greatly increased odds of developing this disease when a family member has had it.

The incidence of death in patients admitted with Reye's syndrome in the United States fell in the 1980's from over 40% to between 20-30%. However, the incidence of death increased again in the 1990s (52% in 1996). The CDC speculates that this may be due to decreased interest in the disease.

Reference

  • Arrowsmith JB, Kennedy DL, Kuritsky JN, Faich GA. National patterns of aspirin use and Reye syndrome reporting, United States, 1980 to 1985. Pediatrics. 1987;79:858-63. PMID 3588140.
  • Johnson GM, Scurletis TD, Carroll NB. A study of sixteen fatal cases of encephalitis-like disease in North Carolina children. N C Med J 1963;24:464-73. PMID 14053538.
  • Reye RDK, Morgan G, Basal J. Encephalopaty and fatty degeneration of the viscera. A disease entity in childhood. Lancet 1963;2:749-52. PMID 14055046.
  • Starko KM, Ray CG, Dominguez LB, Stromberg WL, Woodall DF. Reye's syndrome and salicylate use. Pediatrics 1980;66:859-64. PMID 7454476.

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