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Jarisch-Herxheimer reaction
A reaction following initiation of treatment for spirochetal infection (generally syphilis).
Etiology:
1) unknown
2) induction of inflammatory mediators (i.e. tumor necrosis factor) by treponemal antigens
Epidemiology:
1) 50% of patients with primary syphilis
2) 90% of patients with secondary syphilis
3) 25% of patients with early latent syphilis
4) particularly common in pregnant women [2]
Pathology:
- dying spirochetes release endotoxin [2]
Clinical manifestations:
1) onset occurs within 2 hours of treatment
2) fever
a) average increase of 1.5 C
b) fever peaks at 7 hours
c) defervescence in 12-24 hours
3) chills
4) myalgias
5) headache
7) tachycardia
8) tachypnea
9) neutrophilia (average WBC count of 12,500/mm3)
10) vasodilation with mild hypotension
11) erythema & edema of mucocutaneous lesions may increase with secondary syphilis
12) resolution of symptoms within 48 hours [2]
Management:
1) bedrest
2) aspirin
3) stop antibiotics until symptoms resolve [2]
4) patient education
Related
spirochete infection
General
inflammation
References
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1032
- Medical Knowledge Self Assessment Program (MKSAP) 14,
American College of Physicians, Philadelphia 2006