Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet, February 2005)

EFFECTIVE MARCH 1, 2008 THIS DISEASE IS NO LONGER REPORTABLE IN THE STATE OF WISCONSIN. THE GUIDELINES BELOW SHOULD BE FOLLOWED FOR CASES DIAGNOSED PRIOR TO MARCH 1, 2008

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: An illness involving the central nervous system and liver. It is a rare complication in children who have ingested salicylates (aspirin) for management of viral diseases such as chickenpox or influenza.

B. REPORTING CRITERIA: Clinical diagnosis.

C. LABORATORY/CLINICAL CRITERIA FOR CONFIRMATION:

• Acute, non-inflammatory encephalopathy that is documented clinically by:

  a) alteration in consciousness and, if available,

  b) a record of the CSF containing £ 8 leukocytes/mm 3, or a histologic specimen demonstrating cerebral edema without perivascular or meningeal inflammation; AND

• Hepatopathy documented by either:

  a) a liver biopsy or an autopsy considered to be diagnostic of Reye syndrome, or

  b) a threefold or greater change in the levels of the serum glutamic-oxaloacetic transaminase (SGOT or AST), serum glutamic-pyruvic transaminase (SGPT or ALT), or serum ammonia; AND

• No more reasonable explanation for the cerebral and hepatic abnormalities.

D. WISCONSIN CASE DEFINITION: An illness that meets the clinical criteria above.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY II: Report to the patient's local health officer on an Acute and Communicable Disease Case Report (DPH 4151) or other means within 72 hours of the identification of a case or suspected case.

B. EPIDEMIOLOGY REPORTS REQUESTED:

1. Acute and Communicable Diseases Case Report (DPH 4151).

2. CDC Reye Syndrome Case Investigation Report (CDC 55.8).

C. PREVENTION MEASURES:

• Aspirin should not be used in the management of influenza or chickenpox. As a general precaution, persons under age 20 should use acetaminophen or ibuprofen rather than aspirin.

III. CONTACTS FOR CONSULTATION

A. REGIONAL STAFF: See Epinet Introduction: “REGIONAL OFFICE CONTACTS”.

B. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-7321.

IV. RELATED REFERENCES

 1. Reye Syndrome - United States , 1985. MMWR 1986; 35(5):66-74.

 V. DISEASE TRENDS

 There have been 0 cases of Reye Syndrome reported in Wisconsin between 1993 and 2003 with the last case reported in 1991.