Dr Razaq Dawar

Gram positive bacteria classification

Doge bite (Rabies infection) and its management

Reye Syndrome

Reye syndrome is a rare but life-threatening disorder characterized by:
• Acute encephalopathy (brain dysfunction/swelling)
• Fatty degeneration of the liver

It mainly affects children and teenagers, usually after a viral illness such as influenza or chickenpox.

Cause and Pathogenesis

Reye syndrome is strongly associated with the use of Aspirin during viral infections in children.

The exact mechanism is not fully understood, but aspirin may damage mitochondria, leading to:
• Impaired fatty acid metabolism
• Fat accumulation in the liver
• Increased ammonia levels
• Cerebral edema (brain swelling)

Common Triggering Viral Infections
• Influenza
• Varicella (chickenpox)
• Viral upper respiratory infections

Clinical Features

Symptoms usually begin a few days after the viral illness.

Early Symptoms
• Persistent vomiting
• Nausea
• Weakness
• Irritability

Neurological Symptoms
• Confusion
• Agitation
• Personality changes
• Drowsiness
• Seizures
• Coma in severe cases

Investigations

Typical findings include:
• Elevated AST and ALT
• Increased serum ammonia
• Hypoglycemia
• Prolonged PT/INR
• Metabolic acidosis

CSF

Usually normal, helping differentiate it from meningitis or encephalitis.

Liver Biopsy

Shows microvesicular fatty change without inflammation.

Differential Diagnosis
• Meningitis
• Encephalitis
• Poisoning
• Inborn errors of metabolism
• Hepatic failure

Management

There is no specific cure; treatment is mainly supportive in ICU.

Supportive Treatment
• Maintain airway and ventilation
• IV fluids and glucose
• Correct electrolyte imbalance
• Control raised intracranial pressure
• Treat seizures

Drugs Used
• Mannitol for cerebral edema
• Anticonvulsants if seizures occur

Complications
• Brain herniation
• Permanent neurological damage
• Respiratory failure
• Death

Prevention

Children with viral infections should avoid Aspirin unless specifically prescribed for special conditions.

For fever control, safer alternatives include:
• Paracetamol
• Ibuprofen (in appropriate age groups)

Prognosis

Early diagnosis and aggressive supportive care improve outcomes. Severe neurological involvement is associated with poorer prognosis.