Paediatrics, what is Reye's Syndrome?

By Cristiano Antonino Last updated Sep 30, 2022

A recently discovered paediatric disease, Reye’s Syndrome is a rare complication of common paediatric respiratory infections, including Varicella

Reye’s syndrome should be suspected when a child starts vomiting 3-7 days after the onset of influenza or chickenpox

Vomiting usually becomes more severe within 8-12 hours.

When there is persistent vomiting that lasts more than 12 hours after 3-7 days from the onset of influenza or chickenpox, the child should have tests to confirm the diagnosis of Reye’s syndrome.

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If vomiting is associated with signs of mental disorder (stupor, delirium or strange behaviour), the child should have a medical examination immediately.

Usually, if the child vomits on the first day of illness, especially when there is also diarrhoea, it is not a symptom of Reye’s syndrome: it is simply acute infectious gastroenteritis.

Although Reye’s syndrome can strike at any time, it is most frequent during the months of January, February and March, associated with influenza and other respiratory infections.

About one third of cases of Reye’s syndrome occur as a complication of chickenpox, usually 3-4 days after the rash

Reye’s syndrome is very common, especially in school-age children and adolescents, but there are also cases occurring in childhood, while the disease is rare in adults.

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There is an excellent chance of recovery if the disease is diagnosed and treated early, before delirium and coma have developed. Children who are not diagnosed quickly may fall into a coma and die.

Symptoms

The most conspicuous signs of Reye’s syndrome are, in addition to the aforementioned persistent vomiting, indications of mental disturbances (weakening and drowsiness).

At a more advanced stage, the child shows personality changes (disorientation and aggressive behaviour), confusion, babbling, delirium (in some cases, shouting and flailing and no longer able to recognise parents).

This stage corresponds to a medical emergency phase.

Diagnosis

The diagnosis of Reye’s syndrome can be made by combining a history of previous flu and symptoms such as persistent vomiting, elevation of serum GPT with normal bilirubin and exclusion of meningitis, encephalitis,…

Almost all cases of Reye’s syndrome have high serum concentrations of certain liver enzymes; one of these is GPT.

When an increase in this enzyme occurs, in association with unexplained vomiting, the child is admitted to hospital and treated with intravenous therapies.

It is advisable not to give the child acetylsalicylic acid drugs, as they may worsen the situation, although this has not yet been proven.

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