Jarisch-Herxheimer reaction: Difference between revisions

Latest revision as of 22:44, 8 September 2020

Background

A systemic reaction caused by reaction to endotoxins released by the death of harmful organisms within the body
Occurs following antibiotic treatment for a number of spirochetal and bacterial infections (classically described in the treatment of syphilis)
Can also occur following treatment of tick-borne relapsing fever (TBRF) or Lyme disease
Both penicillin and tetracycline can induce JHR
Resembles bacterial sepsis.
Tends to occur within two hours of antibiotic administration
- Lasts for a few hours or up to a day
Mortality rate from JHR in louse-borne relapsing fever (LBRF) in the absence of adequate monitoring and resuscitation measures is ~5%.

Clinical Features

Jarisch–Herxheimer reaction in a person with syphilis.

Occurs 2 to 6 hours after treatment started; symptoms can last for 24 hours

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.

Differential Diagnosis

Sepsis

Evaluation

Typically a clinical diagnosis

Management

Reassurance
Acetaminophen

Disposition

Outpatient

References

Authors:

@@ Line 1: / Line 1: @@
 ==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.
+*A systemic reaction caused by 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.
+*Occurs following antibiotic treatment for a number of spirochetal and bacterial infections (classically described in the treatment of syphilis)
-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.
+*Can also occur following treatment of tick-borne relapsing fever (TBRF) or [[Lyme disease]]
+*Both [[penicillin]] and [[tetracycline]] can induce JHR
+*Resembles bacterial sepsis.
+*Tends to occur within two hours of antibiotic administration
+**Lasts for a few hours or up to a day
+*Mortality rate from JHR in louse-borne relapsing fever (LBRF) in the absence of adequate monitoring and resuscitation measures is ~5%.
-==Presentation==
+==Clinical Features==
-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.
+[[File:Jarisch-Herxheimer reaction in patient (cropped).jpg|thumb|Jarisch–Herxheimer reaction in a person with syphilis.]]
+''Occurs 2 to 6 hours after treatment started; symptoms can last for 24 hours''
+*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.
-===Signs & Symptoms===
+==Differential Diagnosis==
+*[[Sepsis]]
-* Malaise
+==Evaluation==
-* Fever
+*Typically a clinical diagnosis
-* 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==
+==Management==
-==Complications==
+*Reassurance
-*The mortality rate from JHR in louse-borne relapsing fever (LBRF) in the absence of adequate monitoring and resuscitation measures is ~ 5%.
+*[[Acetaminophen]]
-==Prognosis==
-==Sources==
+==Disposition==
-Harrison's Principles of Internal Medicine
+*Outpatient
+==See Also==
+==References==
+<References/>
+[[Category:Pharmacology]]
+[[Category:ID]]