Reye’s syndrome: causes, symptoms, treatment and prevention
On rare occasions, children who are recovering from an infectious disease as common as the flu evolve into a condition that causes severe personality changes and ends up being lethal. They are the victims of the so-called Reye’s Syndrome .
Below we explain the key aspects of this strange neurological disease that seems to be closely related to the use of aspirin in children.
Discovering Reye’s Syndrome
When Ralph Douglas Reye, Graeme Morgan and Jim Baral published in 1963 an article in the prestigious medical journal The Lancet describing a picture characterized by encephalopathy and liver involvement, they laid the foundation of knowledge about a disease as rare as it is heterogeneous.
Reye’s Syndrome, named after the Australian pathologist who first identified the disease, became diagnosable in 1973, reaching its peak of incidence in 1979-1980.
It is a disease of unknown cause that affects especially children between 5 and 15 years old , but can manifest itself until the age of 21 and, very exceptionally, in adulthood.
It usually begins three to five days after the child has a viral infection. Particularly those that affect the upper respiratory tract, flu, chickenpox or gastroenteritis, and are related to the use of aspirin during the course of the infection.
Since there are no specific conclusive tests, the doctor will reach the diagnosis in a clinical way, that is, through the clinical history of the symptoms and with the support of results that evidence the affectation of the liver.Because of the lethality of Reye’s Syndrome, it is vitally important to know the initial symptoms that characterize the disease. Early diagnosis and treatment can save a child’s life.
Signs and symptoms
In Reye’s Syndrome, blood sugar levels plummet, while ammonia and acidity levels in the blood soar . At the same time, the liver can develop fat deposits. It is common for the brain to suffer from oedema, causing seizures or loss of consciousness.
The type of symptoms the patient suffers indicates how advanced the disease is. Depending on the severity of the symptoms, the course can be divided into four stages
1. Stage I symptoms
- Persistent or continuous vomiting
- Energy loss
2. Stage II Symptoms
- Aggressive behavior
3. Stage III symptoms
- Irrational behavior
4. Stage IV Symptoms
Unfortunately, the course of Reye’s syndrome is not always the same, and some symptoms may not occur or others may appear instead, making it difficult to diagnose. For example, diarrhea and rapid breathing may occur in infants instead of vomiting, so it doesn’t follow a typical pattern.
Although the presence of vomiting in the absence of infection should already sound some alarms, loss of consciousness or seizures is a medical emergency that must be attended to immediately .
How do we act in case of suspicion?
In most cases, Reye’s Syndrome will be treated by health personnel as an emergency due to neurological symptoms. However there is a small part that consults the neurologist before the course worsens.
Preparing for the visit
When the family visits the neurologist, due to the limited time usually devoted to each consultation, it will be very useful that they have followed these tips to get the most out of the appointment .
- Write down in advance any symptoms the child is experiencing.
- Make a list of all the medications you have taken.
- Bring another family member or friend.
- Write down any questions you want to ask the doctor.
It is better to write down the questions from major to minor, in case you don’t have time to cover them all. Some basic questions that should be asked to the neurologist handling the case are :
- What other possible causes may there be for these symptoms?
- What tests are needed for diagnosis?
- What treatments are available and what are the pros and cons of each?
- What results can I expect?
- What’s the next step?
Once the syndrome is diagnosed, the child will be immediately admitted to an Intensive Care Unit. There, treatment aims to minimize symptoms and maintain vital functions, such as breathing or circulation. It will also be essential to protect the brain from permanent damage that may be caused by the edema.
Drugs will be given directly into the vein, including: electrolytes and fluids, diuretics, ammonia-reducing drugs, and anticonvulsants.
Assisted breathing may be used if the patient with Reye’s syndrome needs help breathing. Vital signs, including heart rate, pulse, blood pressure , air circulation, and temperature will be monitored until brain swelling decreases and body functions return to normal.
However, it may take weeks before the patient can be discharged and can leave the hospital.
Because of the possible link between aspirin use and Reye’s syndrome, aspirin should only be administered on the advice of a physician when the benefits outweigh the risks. Children under the age of 16 should also not take products containing aspirin or salicylic salts, such as some mouthwashes or toothpastes, while safer alternatives are available.
In any case, it is important to be alert to the symptoms that children suffer after an infection , in order to reach an early diagnosis and avoid damage that could otherwise be permanent.