Jarisch-Herxheimer reaction

Entity described by

Jarisch 1895
Herxheimer 1902

Definition

Due to the pronounced infestation of the pathogen in syphilis (syphilis I, syphilis II, syphilis connata praecox), there may be a massive general reaction to therapy with penicillin.

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Etiopathogenesis

The decay of a high number of spirochetes releases toxins.

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Clinical features

Reduced AZ
Fever
chills
exacerbation of existing syphilis symptomatology

Diagnosis

Anamnesis
Clinical symptoms

Complications

Rupture of an aortic aneurysm

Prophylaxis

Prednisolone 50 mg i.v. or p.o. approx. 1 hour before penicillin injection

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Prognosis

Prednisolone 50 mg i.v. or p.o. approx. 1 hour before penicillin injection

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References

Belum GR, Belum VR, Chaitanya Arudra SK, Reddy BS. The Jarisch-Herxheimer reaction: revisited. Travel Med Infect Dis. 2013 Jul-Aug;11(4):231-7.
Butler T. The Jarisch-Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. Am J Trop Med Hyg. 2017 Jan 11;96(1):46-52.
Kadam P, Gregory NA, Zelger B, Carlson JA. Delayed onset of the Jarisch-Herxheimer reaction in doxycycline-treated disease: a case report and review of its histopathology and implications for pathogenesis. Am J Dermatopathol. 2015 Jun;37(6):e68.