Jarisch–Herxheimer reaction

It comprises part of what is known as sepsis and occurs after initiation of antibacterials when treating Gram-negative infections such as Escherichia coli and louse- and tick-borne infections. It usually manifests in 1–3 hours after the first dose of antibiotics as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia (muscle pain), exacerbation of skin lesions and anxiety. The intensity of the reaction indicates the severity of inflammation. Reaction commonly occurs within two hours of drug administration, but is usually self-limiting.{{cite book |last1=Lukehart |first1=Sheila A. |title=Harrison's Infectious Diseases |date=2017 |publisher=Mc Graw-Hill |isbn=978-1-259-83597-1 |editor1-last=Kasper |editor1-first=Dennis L. |edition=3 |location=New York |page=666 |chapter=Syphilis |author-link=Sheila Lukehart |editor2-last=Fauci |editor2-first=Anthony S.}}

The Jarisch–Herxheimer reaction is traditionally associated with antimicrobial treatment of syphilis.{{cite journal |vauthors=Belum GR, Belum VR, Chaitanya Arudra SK, Reddy BS |title=The Jarisch–Herxheimer reaction: revisited |journal=Travel Medicine and Infectious Disease |volume=11 |issue=4 |pages=231–7 |year=2013 |pmid=23632012 |doi=10.1016/j.tmaid.2013.04.001 }} The reaction is also seen in the other diseases caused by spirochetes: Lyme disease, relapsing fever, and leptospirosis.{{cite journal |vauthors=Butler T |title=The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis |journal=The American Journal of Tropical Medicine and Hygiene |volume=96 |issue=1 |pages=46–52 |year=2017 |pmid=28077740 |doi=10.4269/ajtmh.16-0434 |pmc=5239707}} There have been case reports of the Jarisch–Herxheimer reaction accompanying treatment of other infections, including Q fever, bartonellosis, brucellosis, trichinellosis, and African trypanosomiasis.

Lipoproteins released from treatment of Treponema pallidum infections are believed to induce the Jarisch–Herxheimer reaction. The Herxheimer reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, interleukin-6 and interleukin-8.{{cite journal |vauthors=Vidal V, Scragg IG, Cutler SJ, etal |title=Variable major lipoprotein is a principal TNF-inducing factor of louse-borne relapsing fever |journal=Nat. Med. |volume=4 |issue=12 |pages=1416–20 |date=December 1998 |pmid=9846580 |doi=10.1038/4007|s2cid=23842774 }}{{cite journal |vauthors=Kaplanski G, Granel B, Vaz T, Durand JM |title=Jarisch–Herxheimer reaction complicating the treatment of chronic Q fever endocarditis: elevated TNFalpha and IL-6 serum levels |journal=J. Infect. |volume=37 |issue=1 |pages=83–4 |date=July 1998 |pmid=9733392 |doi=10.1016/S0163-4453(98)91120-3}}

Prophylaxis and treatment with an anti-inflammatory agent may stop progression of the reaction. Oral aspirin or ibuprofen every four hours for a day or 60 mg of prednisone orally or intravenously has been used as an adjunctive treatment {{Citation needed|reason=reliable source needed for the whole sentence|date=August 2012}}. However, steroids are generally of no benefit. Patients must be closely monitored for the potential complications (collapse and shock) and may require IV fluids to maintain adequate blood pressure. If available, meptazinol, an opioid analgesic of the mixed agonist/antagonist type, should be administered to reduce the severity of the reaction. Anti TNF-α may also be effective.{{cite journal|last1=Fekade|first1=D|last2=Knox|first2=K|last3=Hussein|first3=K|last4=Melka|first4=A|last5=Lalloo|first5=DG|last6=Coxon|first6=RE|last7=Warrell|first7=DA|title=Prevention of Jarisch–Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha.|journal=The New England Journal of Medicine|date=Aug 1, 1996|volume=335|issue=5|pages=311–5|doi=10.1056/NEJM199608013350503|pmid=8663853|doi-access=free}}{{cite journal|last1=Coxon|first1=RE|last2=Fekade|first2=D|last3=Knox|first3=K|last4=Hussein|first4=K|last5=Melka|first5=A|last6=Daniel|first6=A|last7=Griffin|first7=GG|last8=Warrell|first8=DA|title=The effect of antibody against TNF alpha on cytokine response in Jarisch–Herxheimer reactions of louse-borne relapsing fever.|journal=QJM: Monthly Journal of the Association of Physicians|date=Mar 1997|volume=90|issue=3|pages=213–21|doi=10.1093/qjmed/90.3.213|pmid=9093599|doi-access=free}}

Both Adolf Jarisch,{{cite journal | author=Jarisch A | title=Therapeutische Versuche bei Syphilis | journal=Wien Med Wochenschr | year=1895 | volume=45 | pages=721–42}} an Austrian dermatologist, and Karl Herxheimer,{{cite journal | doi=10.1055/s-0028-1139096 |vauthors=Herxheimer K, Krause D | title=Ueber eine bei Syphilitischen vorkommende Quecksilberreaktion | journal=Deutsche Medizinische Wochenschrift | year=1902 | volume=28 | issue=50 | pages=895–7|url=https://zenodo.org/record/1429814 }} a German dermatologist, are credited with the discovery of the Jarisch–Herxheimer reaction. Both Jarisch and Herxheimer observed reactions in patients with syphilis treated with mercury. The reaction was first seen following treatment in early and later stages of syphilis treated with Salvarsan, mercury, or antibiotics. Jarisch thought that the reaction was caused by a toxin released from the dying spirochetes.{{cite journal |title=The Jarisch–Herxheimer reaction |journal=Lancet |volume=1 |issue=8007 |pages=340–1 |date=February 1977 |pmid=64863 |pmc=1056841 |doi= 10.1016/s0140-6736(77)91140-0}}

• Jarisch-Bezold reflex
• Immune reconstitution inflammatory syndrome, another systemic inflammatory syndrome that arises after antimicrobial treatment

{{reflist}}

{{Medical resources

| DiseasesDB = 32939

| ICD10 = {{ICD10|T|78|2|t|66}}

| ICD9 = {{ICD9|995.0}}

| ICDO =

| OMIM =

| MedlinePlus =

| eMedicineSubj =

| eMedicineTopic =

| MeshID =

}}

{{Drug reactions}}

{{DEFAULTSORT:Jarisch-Herxheimer reaction}}

Category:Spirochaetes

Category:Symptoms

Category:Complications of surgical and medical care

Category:Diseases named after discoverers