Jarisch-Herxheimer reaction
Alerts and Notices
Important News & Links
Synopsis
Initially, there is abrupt onset of high fever with associated chills, myalgias, headache, tachycardia, lymphadenopathy, and sometimes hypotension. Rarer manifestations include meningitis, abnormal renal or liver function, changes in mental state, and seizures. In primary syphilis, extension of ulceration of the primary chancre can be seen. In secondary syphilis, the rash worsens and may become vesicular or urticarial. In neurosyphilis, when it does occur, the JHR causes severe exacerbation of underlying neurologic or psychiatric symptoms and signs.
JHR can induce uterine contractions, premature labor, and changes in fetal activity and heart rate in pregnant patients, necessitating close fetal monitoring. Infants with congenital syphilis who undergo treatment with penicillin may also develop JHR. This typically affects infants younger than age 6 months and can lead to severe outcomes, including respiratory distress and changes in heart rate, necessitating close monitoring during treatment.
A high rapid plasma reagin (RPR) titer is a risk factor, while prior treatment with penicillin is a protective factor against the reaction. The reaction has also been shown to occur with greater frequency and severity in immunocompromised individuals.
A JHR-like reaction has been reported following treatment of other spirochete-mediated diseases such as Lyme disease, leptospirosis, and relapsing fever (tick borne, hard tick borne, louse borne), and during treatment of a wide variety of other infectious diseases, including brucellosis and trypanosomiasis.
The cause of the JHR is unknown, but it is hypothesized that the release of bacterial toxins and/or lipoproteins, elevated cytokines such as tumor necrosis factor (TNF), interleukin (IL)-6 and IL8, or immune complexes may be at play. The reaction may be the body's natural systemic inflammatory response to successful antibiotic-mediated destruction of bacterial cell membranes and the release of bacterial toxins into the bloodstream.
Codes
T36.95XA – Adverse effect of unspecified systemic antibiotic, initial encounter
T78.40XA – Allergy, unspecified, initial encounter
SNOMEDCT:
10803007 – Jarisch Herxheimer reaction
Look For
Subscription Required
Diagnostic Pearls
Subscription Required
Differential Diagnosis & Pitfalls
Subscription Required
Best Tests
Subscription Required
Management Pearls
Subscription Required
Therapy
Subscription Required
Drug Reaction Data
Subscription Required
References
Subscription Required
Last Updated:10/08/2024