What is Reye's Syndrome, and what causes it?

Reye’s Syndrome Explained: From Viral Triggers to Emergency Care

Reye’s syndrome is a rare but serious condition that affects children recovering from viral infections like the flu or chickenpox. It causes swelling in the liver and brain, leading to symptoms such as vomiting, confusion, and seizures.

In the 1980s, the U.S. reported over 500 cases annually, strongly linked to aspirin use during these illnesses. This led to significant changes in paediatric medication guidelines worldwide. In India, self-medication and over-the-counter use of aspirin are still common, especially in rural areas. Many parents remain unaware of its dangers when given during viral infections.

With flu and chickenpox still widespread, awareness is crucial to prevent this life-threatening condition. Continue reading to learn about Reye’s causes, symptoms, diagnosis, treatment, and how to protect your child from this rare but serious condition.

What is Reye's syndrome?

Reye's syndrome is a non-inflammatory encephalopathy—a condition that affects the brain—and is also accompanied by acute liver failure. The syndrome develops rapidly, usually occurring within a few days after a viral illness.

The standard features include vomiting, lethargy, confusion, and personality changes. If not treated promptly, the condition can worsen quickly, resulting in seizures, coma, and even death.

Reye's syndrome most commonly affects children between the ages of 4 and 12, although it can also occur in infants and young adults. The condition progresses in stages, from mild symptoms to life-threatening complications, often within hours.

What are the stages and symptoms of Reye’s syndrome?

Reye's Syndrome usually occurs in 5 stages. Listed below are the stages along with their symptoms:

• Stage I: Persistent vomiting, tiredness, and slight personality changes such as irritability or aggressiveness.
• Stage II: Continuous vomiting, confusion, and combativeness. The child may become disoriented and lethargic.
• Stage III: Coma begins to set in. The child may show signs of cerebral dysfunction, such as bizarre behavior or inability to recognize familiar people.
• Stage IV: Deep coma with no response to painful stimuli. Decerebrate posturing (abnormal body posture) may be observed.
• Stage V: Seizures, loss of deep tendon reflexes, and respiratory failure. Death may occur due to brain herniation or multiple organ failure.

Early intervention, especially in Stage I or II, significantly improves the chances of recovery. If untreated, mortality rates can be as high as 30–40%.

What are the risk factors of Reye’s syndrome?

The exact cause of Reye's syndrome is not fully understood. Still, medical evidence strongly links the condition to aspirin use in children during or shortly after viral infections, such as influenza (flu) or varicella (chickenpox).

Here are the major contributing risk factors:

Aspirin Use During Viral Illness

• The most recognised risk factor for Reye's syndrome is the use of salicylates (such as aspirin) by children and adolescents recovering from viral infections. Aspirin is effective for alleviating pain and fever; however, its interaction with the body's response to a virus can trigger abnormal liver function and swelling in the brain in susceptible individuals.

Genetic Metabolic Disorders

• Some children who develop Reye's syndrome may have an underlying metabolic condition, such as fatty acid oxidation disorder, that impairs the body’s ability to break down certain fats. Triggered by a viral infection or aspirin ingestion, these disorders can lead to the rapid onset of symptoms.

Viral Infections

Reye's syndrome almost always follows a viral infection, particularly:

• Influenza A or B
• Chickenpox (varicella)
• Epstein-Barr virus
• Cytomegalovirus
• Enteroviruses

The virus is likely to cause initial stress on the liver and, when combined with aspirin intake or other risk factors, can result in the development of Reye's Syndrome.

Environmental and Other Triggers

• While not definitively proven, environmental toxins, insecticides, and chemical exposures are also considered contributing factors in rare cases. However, these associations are weaker and not as widely accepted.

What is the diagnosis for Reye’s syndrome?

Diagnosing Reye's syndrome requires careful evaluation. Since the symptoms mimic other disorders like meningitis, encephalitis, or poisoning, specific diagnostic tests are essential:

• Blood and liver function tests
• Ammonia level tests
• CT (computed tomography) scan or MRI (magnetic resonance imaging) scan of the brain
• Liver biopsy in some instances

What are the treatment options for Reye’s syndrome?

The treatment for Reye’s syndrome typically includes:

• Hospitalisation, often in an intensive care unit (ICU)
• Intravenous fluids for hydration and glucose regulation
• Medications to reduce brain swelling, such as mannitol
• Monitoring and controlling breathing and seizure activity
• Avoidance of aspirin or salicylates in any amount

How to Prevent Reye’s Syndrome?

Prevention of Reye's syndrome is often straightforward, which includes the following:

• Do not give aspirin or salicylate products to children or teens recovering from viral infections.
• Instead, use acetaminophen (paracetamol) or ibuprofen, as advised by a doctor.
• Carefully read labels and educate carers about the risks associated with aspirin in young individuals.

Since these guidelines were implemented in the 1980s, the number of Reye’s syndrome cases has plummeted, which shows how effective prevention can be.

Though now rare, Reye’s syndrome remains a medical emergency that demands immediate attention. Its sudden onset after common viral illnesses makes it particularly dangerous for children and teens.

Public health campaigns and strict guidelines on aspirin use have significantly reduced its occurrence. However, awareness and caution are still essential, especially in vulnerable communities. By avoiding aspirin and recognising symptoms early, we can protect young lives from this serious condition.

It is also advisable to have health insurance to secure your health and finances during critical times. At Star Health, our insurance plans offer coverage for various health conditions. We also provide hassle-free claim settlements with reduced turnaround time across over 14,000 network hospitals in India.