Reyes Syndrome: Profile Of A Killer

The outbreak of the highly fatal Reyes Syndrome as a complication of influenza has resulted in considerable concern by parents of children with flu symptoms. As a result, The News has contacted Drs. Joseph Baublis and Mark Hildebrandt, local pediatricians, to learn more about the causes, treatment, incidence and symptoms of this non-contageous illness of children. First of all, both physicians point out that a large percentage of the illnesses " 'S ■ .' ' people commonly refer to asThe flu are really not influenza cases which can lead to Reyes Syndrome in a relatively few instances. Dr. Hildebrandt, local practicing pediatrician and U-M clinical associate professor of pédiatrics and communicable diseases, says that the illness usually referred to as intestinal flu is not influenza but gastroenteritis. He also notes that strep throat and various upper respiratory infections which are not caused by influenza viruses are often called flu. Of some 200 cal oses reported as ílu last week,] "probably only about half were influenza and only one involved Reyes Syndrome," he adds. j Dr. Baublis, U-M associaté professor ' of pediatrics and communicable diseases and local authority on Reyes Syndrome, says 'people refer to many childhood diseases which are not influenza as the flu, and thatisnot fair." . "To the best of our knowledge all of the Reyes Syndrome cases (seen at Mott Childreri's Hospital) have followed Type B, influenza," says Dr, Baublis, who also serves as assistant professor of pathology in the U-M Medical School and leeturer in epdiemology in the School of Public Health. ' But the incidence of the syndrome is only one in several thousand cases of influenza and appears to be connected to á child's disposition toward the affliction which may be genetic in origin, he says. The symptoms of Reyes Syndrome include "unrelenting and persistent vomiting, followed by the patiënt becoming less rational and getting more and more jut of touch with reality, followed by coma. If the coma becomes deep enough the patiënt expires," he says. "About 20 per cent of influenza patiente experience vomiting" but usually it doesn't indícate the syndrome unless it is persistent, and in such cases a physician should be called immediately, he says. Treatment of Reyes Syndrome includes large doses of steroids to reduce swelling of the brain, administration of fluids for dehydration, glucose to restore energy and maíntain the body, use of insulin to combat the syndromes effect on the liver, and exchange blood transfusión to combat the toxicity (poison). The present outbreak appears to be the largest ever experienced in this country, ,with no more than from three to five cases per year having been seen at the U-M Medical Center in the past, Dr. Baublis says. Michigan with more than a score of Reyes Syndrome cases, and Wisconsin, are. the hardest hit, although it has been reported in 14 states. The fatality ratio may go as high as 50 to 75 per cent, he says. First identified as au entity by an Australian physician in 1963, after whom it is named, Reyes Syndrome was probably wrongly diagnosed before that as common encephalitis, or inflammation of the brain, he says. "Most of our knowledge of this syndrome comes from Thailand where there is a steady run of cases, year in and year out, and where .it ís often associated with food poisoning produced by molds in grains and vegetables," Dr. Baublis says. But in the U.S. it ís a complication of Type B influenza and is about equally distributed bétween boys and girls up to abóut 15 years of age, he says . children have mild cases and respond rapidly to treatment, but there is no cure and no single procedure stands out - it is a very, very toxic episode, almost as if these children were poisoned," according to the U-M ! cian. "But it is not a catching disease," he adds. A total of nine children with Reyes Syndrome have been admitted to the UM's Mott Children's Hospital since Feb. 15, and three have died, including an Ann Arbor girl. A 13-year-old Coldwater girl and a seven-year-old Sturgis boy admitted to that hospital Monday were still listed in "criticar condition today. Two children have been treated at St. Joseph Mercy Hospital. Dr. Norman Hayner of the Michigan Health Department epidemiology section says the latest count of conf irmed cases .of the syndrome in Michigan stands at 31, with 11 deaths. Nationwide, more j than 130 cases have been reported as compared to the previous high of 71 in 1971.