Jarisch-Herxheimer reaction: Difference between revisions
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Jarisch-Herxheimer reaction (JHR), also known as the Herxheimer's reaction, is a systemic reaction that believed to be caused by a reaction to endotoxins released by the death of harmful organisms within the body. | Jarisch-Herxheimer reaction (JHR), also known as the Herxheimer's reaction, is a systemic reaction that believed to be caused by a reaction to endotoxins released by the death of harmful organisms within the body. | ||
It occurs following antibiotic treatment for a number of spirochetal and bacterial infections. | It occurs following antibiotic treatment for a number of spirochetal and bacterial infections. | ||
It was classically described in the treatment of syphilis. It is believed to be caused by release of endotoxin-like substances when large numbers of ''Treponema Pallidum'' are killed by antibiotics. It also has been documented in tick-borne diseases such as Lyme disease. | It was classically described in the treatment of syphilis. It is believed to be caused by release of endotoxin-like substances when large numbers of ''Treponema Pallidum'' are killed by antibiotics. It also has been documented in tick-borne diseases such as [[Lyme disease]]. | ||
==Presentation== | ==Presentation== | ||
It resembles bacterial sepsis. Both penicillin and tetracycline can induce JHR. JHR can also occur following treatment of tick-borne relapsing fever (TBRF). These reactions tend to occur within two hours of antibiotic administration. Thus, observation for several hours after treatment is recommended. The reaction lasts for a few hours or up to a day. It is not usually seen with subsequent treatment. | It resembles bacterial sepsis. Both [[penicillin]] and [[tetracycline]] can induce JHR. JHR can also occur following treatment of tick-borne relapsing fever (TBRF). These reactions tend to occur within two hours of antibiotic administration. Thus, observation for several hours after treatment is recommended. The reaction lasts for a few hours or up to a day. It is not usually seen with subsequent treatment. | ||
===Signs & Symptoms=== | ===Signs & Symptoms=== | ||
* Malaise | * Malaise | ||
* Fever | * [[Fever]] | ||
* Rigors | * Rigors | ||
* Flushing (due to vasodilation) | * Flushing (due to vasodilation) | ||
Revision as of 22:52, 15 June 2014
Background
Jarisch-Herxheimer reaction (JHR), also known as the Herxheimer's reaction, is a systemic reaction that believed to be caused by a reaction to endotoxins released by the death of harmful organisms within the body. It occurs following antibiotic treatment for a number of spirochetal and bacterial infections. It was classically described in the treatment of syphilis. It is believed to be caused by release of endotoxin-like substances when large numbers of Treponema Pallidum are killed by antibiotics. It also has been documented in tick-borne diseases such as Lyme disease.
Presentation
It resembles bacterial sepsis. Both penicillin and tetracycline can induce JHR. JHR can also occur following treatment of tick-borne relapsing fever (TBRF). These reactions tend to occur within two hours of antibiotic administration. Thus, observation for several hours after treatment is recommended. The reaction lasts for a few hours or up to a day. It is not usually seen with subsequent treatment.
Signs & Symptoms
- Malaise
- Fever
- Rigors
- Flushing (due to vasodilation)
- Hypotension
- Tachycardia
- Tachycardia and hyperventilation are accompanied by hypertension, and then by a drop in blood pressure due to vasodilation and declining peripheral pulse.
Treatment
Complications
- The mortality rate from JHR in louse-borne relapsing fever (LBRF) in the absence of adequate monitoring and resuscitation measures is ~ 5%.
Prognosis
Sources
Harrison's Principles of Internal Medicine