Pathophysiology Processes: Reye’s Syndrome

Pathophysiology Processes: Reye’s Syndrome

Reye’s Syndrome

Reye’s Syndrome is a rare condition that results in swelling of the brain and liver as described by Australian Pathologist R. Douglas Reye in 1963 (Chapman, Arnold 2019). This disease mostly affects children and teens recovering from the chickenpox or the flu. With this type of disease, a child’s body organs may begin to become affected within the liver and the brain along with an increasing amount of pressure surrounding the brain.  Some side effects of the flu and chicken pox such as fever and pain are often treated with Aspirin. However there has since been a discovery that aspirin is directly correlated with Reyes Syndrome in children and teenagers recovering from chicken pox and/or flu like symptoms and thus Aspirin should not be taken. Unfortunately, the links between Aspirin and Reye’s syndrome has not be discovered, but as stated above has been reported a cause of it prior to the infection. The US insight of the number of incidences being reported: 555 cases between 1979 and 1980 and 1,207 cases reported from Dec. 1980 through November 1997 issued wide spread warnings against the use of aspirin in children (Chapman, Arnold 2019).  Thereafter a rapid decline in incidences was reported to be 0.2 to 1.1 cases per million in the US between 1991 and 1994 (Chapman, Arnold 2019).

Etiology

Individuals who contract viral pathogens such as influenza A, B and Varicella are most susceptible to Reye’s syndrome (Chapman, Arnold 2019). Typically, this disease affects our children and adolescents ranging from ages of 4 to 18. Where incidences of Reye’s were followed by an influenza infection in 73% of cases, Varicella infection in 21% of cases and gastroenteritis infection in 14% of cases from 1980 to 1997 (Chapman, Arnold 2019).

Bacterial microorganisms such as chlamydia, Bordetella pertussis, Mycoplasma, and Shigella have also be connected with the development of Reye syndrome (Chapman, Arnold 2019).

More than 80% of children diagnosed with Reye syndrome had taken aspirin previously 3 weeks prior. Risk factors that should if possible be avoided include using aspirin to treat a viral infection such as an upper respiratory tract infection, or the flu. As well as having an underlying fatty acid oxidation disorder (Stone, Ropper 2018).

Pathophysiological Processes

According to (Chapman, Arnold 2019), the initial infection of Reye’s syndrome is not quite known just yet; though, it has appeared to be involved with mitochondrial injury in the setting of a viral illness. With that being said Aspirin has been known to be the leading cause of the damage to the cellular mitochondria resulting in inhibition of fatty-acid metabolism (Chapman, Arnold 2019). Reye’s syndrome is more than likely to result from hepatic mitochondrial dysfunction increasing ammonia levels due to neurologic features (Chapman, Arnold 2019). Studies have shown that astrocyte edema, loss of neurons, fatty degeneration of kidneys, and a swollen and reduced number of mitochondria may be induced due to hyperammonemia (Chapman, Arnold 2019).

Clinical manifestations and Complications

Signs and symptoms of Reye’s syndrome tend to begin with a few days after the child develops the infection. Noticing initial signs and symptoms for a younger child may include diarrhea or rapid breathing. For an older child/teen signs and symptoms may include persistent vomiting and lethargy. As the disease begins to progress signs and symptoms may begin to become more severe for the child or adolescent leading to confusion, agitation, and even irritability. Although children and adolescents do survive Reye’s syndrome possibilities of acquiring brain damage can become an issue. Due to brain complications spending several amounts of weeks or days in the hospital can begin to take a toll on the child both physically/mentally and psychologically. If left untreated brain damage can become mild to severe. The amount of swelling is used to determine the level of brain damage. Some difficulties associated with the brain damage can lead to the child living with a disability such as: loss of vision, loss of hearing, problems with motor skills, and poor attention span.

Diagnostics

Unlike several other diseases with clinical methods there tends to be no specific test for Reye’s syndrome. Although there is no specific test that can used maintaining a healthy lifestyle as well as getting checkups from your primary care doctor can depend on early diagnosis. Screening for Reye’s syndrome can begin by checking for CBC count, urinalysis test, and other metabolic disorders. In order to evaluate possible causes of this disease further testing such as a liver biopsy and spinal tap can be used. A spinal tap can be used to remove fluid from the spine as well as the lower back using a hollow needle. A liver biopsy is another technique using a smaller needle to be inserted into the liver by collecting tissue samples.

Conclusion

 To conclude, one must use cautiousness when providing aspirin to children and adolescents. Although aspirin is approved for younger children over the age limit of 3, children and adolescents recovering from any flu like symptoms as well as chicken pox should prohibited from administering aspirin. Parents should refrain from giving any type of medication containing aspirin own its own. A safer alternative for children and adolescents is medications known as Tylenol or ibuprofen (Motrin/Advil).

References

• Noor, A., & Gradidge, E. (2018). A Case of Reye Syndrome Caused by Influenza A Virus. The Ochsner journal, 18(4), 425–427. doi:10.31486/toj.18.0098
• Chapman J, Arnold JK. Reye Syndrome. [Updated 2019 Jan 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526101/
• Reye's Syndrome Information Page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Reyes-Syndrome-Information-Page
• (2018, August 8). Reye's syndrome. Retrieved from https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255