“REYE’S SYNDROME – OFTEN MISSED IN PATIENTS OF ACUTE FEBRILE ENCEPHALOPATHY”

Dr. Bhupesh Jain*, Dr. Suresh Goyal and Dr. B. L. Meghwal

ABSTRACT

1. Background and Objective: - Acute Febrile Encephalopathy (AFE) defined as fever associated with acute depression of consciousness or mental deterioration with or without seizure, motor and/ or sensory deficit and total duration of illness one week or less. Reye’s syndrome, an encephalopathy with fatty infiltration of the viscera is an acute illness, characterized by profound disturbance in consciousness, fever, vomiting, convulsion, hypoglycemia with fatty infiltration of the viscera. This study was conducted to find out clinical and etiological profile & outcome of Acute Febrile Encephalopathy in south Rajasthan. 2. Methods:-This study was Hospital based prospective study from July 2015 to Dec. 2015. All patients of AFE with raised liver enzymes (>3 fold), raised serum ammonia (>50 mol/L), abnormal coagulogram, anicteric and usually a history of fever in recent past were diagnosed as Reye’s syndrome. 3. Results: - A total of 85 patients of AFE were admitted, 14 cases (16.47%) were diagnosed as Reye’s syndrome. Clinical profile of patients of Reye’s Syndrome include Fever and altered sensorium 14 (100%), Generalized convulsions 13 (92.85%), raised ICT 9 (64.28%), Protracted vomiting 14 (100%). Most of the patients {12 (85.71%)} had hypoglycemia. All patients of Reye’s syndrome had SGPT level >1000 IU/L, anicteric and raised Ammonia level. Seven patients show cerebral edema on neuroimaging. Four patients had raised CSF pressure. Case fatality rate (78.57%) was high in patients of Reye’s syndrome compared to Suspected viral encephalitis, Cerebral Malaria and Pyogenic Meningitis. 4. Conclusion: - Reye’s syndrome was seen in 14 patients (16.47%) of AFE. Increasing awareness of this syndrome and a high index of suspicion are important for timely diagnosis. This is important because management has to be energetic, if the mortality from this disease is to be reduced.

Keywords: Acute Febrile Encephalopathy; Reye’s syndrome; Cerebral Malaria; Suspected viral encephalitis; Pyogenic Meningitis.