Herx Studies With Quotes

2010 & Earlier

The overall rate of JH reaction was 31.5%...

Clin Infect Dis. 2010 Oct 15;51(8):976-9. doi: 10.1086/656419.

Jarisch-Herxheimer reaction after penicillin therapy among patients with syphilis in the era of the hiv infection epidemic: incidence and risk factors.

Yang CJ1, Lee NY, Lin YH, Lee HC, Ko WC, Liao CH, Wu CH, Hsieh CY, Wu PY, Liu WC, Chang YC, Hung CC.

Author information

Department of Internal Medicine, Far Eastern Memorial Hospital, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Link Here


Ten patients (9%) developed the JHR.

No patients experienced an allergic reaction to penicillin.

The JHR occurred less frequently than in previous studies.

It is important that health-care professionals recognize the clinical characteristics of the JHR so that it is not misinterpreted as an allergic reaction to penicillin.

Int J STD AIDS. 2010 Dec;21(12):806-9. doi: 10.1258/ijsa.2010.010281.

Jarisch-Herxheimer reaction among syphilis patients in Rio de Janeiro, Brazil.

Miller WM1, Gorini F, Botelho G, Moreira C, Barbosa AP, Pinto AR, Dias MF, Souza LM, Asensi MD, da Costa Nery JA.

Author information

Sanitary Dermatology Department, Professor Rubem David Azulay Dermatology Institute, Santa Casa da Misericórdia Hospital, Rio de Janeiro, Brazil. wmiller@gt.cdc.gov

Link Here


Jarisch-Herxheimer reaction is an acute systemic event that can occur during the treatment of spirochetal infections.

During pregnancy, it can cause signs and symptoms in both the mother and fetus, including fever, tachycardia, uterine contractions, and fetal heart rate pattern changes.

...she experienced subjective fever and late fetal heart rate decelerations prompting repeat cesarean delivery.

Obstet Gynecol. 2010 Aug;116 Suppl 2:552-6. doi: 10.1097/AOG.0b013e3181e7d065.

Jarisch-Herxheimer reaction triggered by group B streptococcus intrapartum antibiotic prophylaxis.

Rac MW1, Greer LG, Wendel GD Jr.

Author information

Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas, USA. MarthaRac@gmail.com

Link Here


After cefepime was initiated, he developed chills, fever, and hypotension due to Jarisch-Herxheimer reaction, necessitating respiratory support.

Pulmonary hemorrhaging was also found.

Kansenshogaku Zasshi. 2010 Jan;84(1):59-64.

[A case of severe leptospirosis infection (Weil's disease) in Tokyo].

[Article in Japanese]

Masuda K1, Uehara Y, Ono H, Furukawa K.

Author information

Division of Infectious Diseases, Department of Medicine, St. Luke's International Hospital.

Link Here



... various types of headaches, epilepsy, aseptic meningitis, systemic adverse reactions to drugs or other substances represent the Jarisch-Herxheimer reaction due to apoptosis of T. gondii tachyzoites.

Int J Neurosci. 2009;119(12):2144-82. doi: 10.3109/00207450903149217.

The importance of toxoplasma gondii infection in diseases presenting with headaches. Headaches and aseptic meningitis may be manifestations of the Jarisch-Herxheimer reaction.

Prandota J1.

Author information

Department of Social Pediatrics, Faculty of Public Health, University Medical School, Wroclaw, Poland. Prandota@ak.am.wroc.pl

Link Here


Jarisch-Herxheimer reaction caused by toxic bacterial substances massively released as a result of the antibiotic mediated-bacterial lysis occurs in some patients which may aggravate the existing severe clinical manifestations.

Protein Eng Des Sel. 2009 May;22(5):305-12. doi: 10.1093/protein/gzp008. Epub 2009 Mar 18.

Humanized-monoclonal antibody against heterologous Leptospira infection.

Maneewatch S1, Sakolvaree Y, Tapchaisri P, Saengjaruk P, Songserm T, Wongratanachewin S, Tongtawe P, Srimanote P, Chaisri U, Chaicumpa W.

Author information

Graduate Program, Faculty of Allied Health Sciences, Thammasat University, Rangsit Center, Pathum-thani 12120, Thailand.

Link Here


...the patient has clinical symptoms of a demential case starting as a typical manic episode and Jarisch-Herxheimer reaction because of intravenous penicillin treatment...

J Psychopharmacol. 2009 Nov;23(8):999-1000. doi: 10.1177/0269881108093585. Epub 2008 Jul 17.

Olanzapine treatment in Jarisch-Herxheimer reaction due to neurosyphilis with dementia: a case report.

Ates MA1, Algul A, Gecici O, Semiz UB, Yilmaz O, Gulsun M.

Author information

Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey. aates1971@yahoo.com

Link Here


...a case of JHR comprising retinal vasculitis and vitritis following initiation of antituberculous therapy (ATT)

Systemic manifestation of JRH (fever, headache, and sweating) is most commonly associated with treatment of syphilis,1 but has also been described in leptospiral infection2 and Lyme disease.3

Ocular manifestations are less common, but has been described as retinal vasculitis in Whipple's disease.4

Proposed mechanisms include endotoxin release from the death of organisms, delayed hypersensitivity, and decreased suppressor mechanisms.

JHR has been described as worsening of intracranial tuberculoma, meningeal disease, tuberculous menigeal radiculitis, pleural effusion, and abdominal TB.5

... rapid worsening of vitritis and chorioretinitis following initiation of ATT in our patient and the prompt improvement with coriticosteroid represent the JHR.

...this is the first reported case of JHR manifesting as ocular symptoms following initiation of ATT.

Eye (2009) 23, 1472–1473; doi:10.1038/eye.2008.204; published online 4 July 2008

Jarisch–Herxheimer reaction: paradoxical worsening of tuberculosis chorioretinitis following initiation of antituberculous therapy

C M G Cheung1 and S P Chee1

1Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore. E-mail: gemmy@doctors.org.uk

Link Here



Doxycycline was empirically added to his antibiotic regiment.

The patient presented an acute rise in temperature, tachycardia, tachypnea, hypoxia, hypotension and a temporary deterioration of his chest x-ray.

The same 6-hour-long reaction which is known as JHR was presented another 3 times.

Cases J. 2008 Nov 29;1(1):360. doi: 10.1186/1757-1626-1-360.

Recurrent Jarisch-Herxheimer reaction in a patient with Q fever pneumonia: a case report.

Aloizos S1, Gourgiotis S, Oikonomou K, Stakia P.

Author information

Second Surgical Department, 401 General Army Hospital of Athens, 41 Zakinthinou Street, 15669, Papagou, Athens, Greece. drsgourgiotis@tiscali.co.uk.

Link Here


The Jarisch-Herxheimer reaction is an acute worsening of skin manifestations and systemic symptoms occurring after administration of antimicrobial therapy for spirochetal infections.

Although rare, neurological signs can present as part of the Jarisch-Herxheimer reaction.

...Bell's palsy experienced by a patient shortly after treatment with penicillin for secondary syphilis .. this acute unilateral peripheral facial paralysis was a Jarisch-Herxheimer reaction in response to therapy.

J Drugs Dermatol. 2008 Jun;7(6):583-5.

Unilateral facial paralysis after treatment of secondary syphilis.

Berger EM1, Galadari HI, Gottlieb AB.

Author information

Tufts University School of Medicine, Boston, MA, USA. emily.berger@tufts.edu

Link Here


6 days after treatment, the patient was found more irritable and was unable to fall asleep at night.

On the seventh day, worsened magnetic resonance imaging (MRI) abnormalities in the bilateral medial and anterior temporal lobes were unexpectedly discovered.

We consider that these transient and slight mental symptoms may be associated with the transiently worsening phenomenon in cerebral MRI findings during the early period of treatment with penicillin.

This indicates that some nonspecific inflammatory process has happened in the early stage of treatment, which necessitates the use of corticosteroids after the occurrence of systemic or mental symptoms.

J Neuroimaging. 2008 Oct;18(4):360-3. doi: 10.1111/j.1552-6569.2007.00199.x. Epub 2008 Nov 6.

Worsened MRI findings during the early period of treatment with penicillin in a patient with general paresis.

Zhang SQ1, Wan B, Ma XL, Zheng HM.

Author information

Department of Neurology, Changhai Hospital, Shanghai, China. gen-plezhang@126.com

Link Here



...with the exception of Jarisch Herxheimer reaction which occurs in about 15% of the patients.

Med Mal Infect. 2007 Jul-Aug;37(7-8):463-72. Epub 2007 Apr 6.

[Antibiotherapy for early localized Lyme disease].

[Article in French]

Monsel G1, Canestri A, Caumes E.

Author information

Service des maladies infectieuses et tropicales, groupe hospitalier de la Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France.

Link Here


...after receiving penicillin, had non convulsive SE (status epilepticus), a clinical presentation suggesting a Jarisch-Herxheimer reaction (JHR).

Her cranial MR revealed moderate cortical atrophy and widespread confluent hyperintense foci mainly in both periventricular areas, corona radiata and centrum semiovale.

Epileptic Disord. 2007 Mar;9(1):51-6. Epub 2007 Feb 15.

Neurosyphilis presenting with status epilepticus.

Gürses C1, Kürtüncü M, Jirsch J, Yeşilot N, Hanağasi H, Bebek N, Baykan B, Emre M, Gökyiğit A, Andermann F.

Author information

Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Millet Caddesi Capa, 34390 Istanbul, Turkey. candan.gurses@gmail.com

Link Here



Jarisch-Herxheimer reaction (elevated body temperature 38-38.6 degrees C) and roseola eruptionwere observed in 2 (6.7%) patients..

Ter Arkh. 2006;78(11):35-41.

[Differential diagnosis of specific gastric lesions in early syphilis patients with helicobacter infection].

[Article in Russian]

Krivisheev AB, Kuimov AD, Krivosheev BN.

Link Here


...findings of fever, dyspnea, rigors, and hypotension, this reaction resembles the Jarisch-Herxheimer reaction...

J Allergy Clin Immunol. 2006 Feb;117(2 Suppl Mini-Primer):S464-70.

8. Drug allergy.

Greenberger PA1.

Author information

Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. Clair Street #14018, Chicago, IL 60611, USA. p-greenberger@northwestern.edu

Link Here



...a pregnant woman who experienced a Jarisch-Herxheimer reaction (J-HR).

Treatment with antibiotics precipitated J-HR.

J Reprod Med. 2005 Sep;50(9):727-9.

Tick-borne relapsing fever during pregnancy: a case report.

Guggenheim JN1, Haverkamp AD.

Author information

Department of Obstetrics and Gynecology, Exempla Saint Joseph Hospital, Denver, Colorado, USA. guggenheimj@exempla.org

Link Here


... presented with JHR after an initial intravenous dose of penicillin G...

The patient described feeling cold with worsening headache and chills approximately one hour after infusion of the first dose of penicillin.

On examination, rigors, shallow inspirations, and chills were noted.

He was afebrile, tachycardic, and tachypneic and had an oxygen saturation of 94% while breathing room air.

Initially, this reaction was thought to be a result of a drug allergy, but upon further review, we determined that it was JHR.

It is not uncommon to confuse drug allergy with JHR.

Ann Pharmacother. 2005 Dec;39(12):2128-30. Epub 2005 Nov 15.

Penicillin-induced Jarisch-Herxheimer reaction.

See S1, Scott EK, Levin MW.

Author information

College of Pharmacy and Allied Health Professions, St. John's University, Queens, NY 11439, USA. sees@stjohns.edu

Link Here


JHR often occurs with the treatment of spirochete infections. However, the mechanism by which the reaction takes place is not clearly defined.

Studies suggest with conflicting evidence that the JHR is caused by release of endotoxin-like material from the spirochete as well as cytokine elevation in the body.

J Clin Pharm Ther. 2005 Jun;30(3):291-5.

Proposed mechanisms and preventative options of Jarisch-Herxheimer reactions.

Pound MW1, May DB.

Author information

Department of Pharmacy Practice, Campbell University School of Pharmacy, Buies Creek, NC 27506, USA. mpound@capefearvalley.com

Link Here



... experienced deterioration in vision following the commencement of treatment due to a Jarisch-Herxheimer reaction.

...Jarisch-Herxheimer reaction occurring in a patient receiving treatment for ocular syphilis can be serious, resulting in the rapid loss of vision.

Med J Malaysia. 2003 Aug;58(3):437-9.

The Jarisch-Herxheimer reaction in ocular syphilis.

Fathilah J1, Choo MM.

Author information

Department of Ophthalmology, University Malaya Medical Center, 50603 Kuala Lumpur.

Link Here



Eur J Clin Microbiol Infect Dis. 2003 Oct;22(10):639; author reply 640. Epub 2003 Sep 12.

Jarisch-Herxheimer reaction in leptospirosis.

Leblebicioglu H, Sunbul M, Esen S, Eroglu C.

Link Here


The Jarisch-Herxheimer reaction was observed in 18.8%.

J Nippon Med Sch. 2003 Jun;70(3):274-7.

[Clinical analysis of 22 cases with syphilis racenta in Department of Dermatology, Nippon Medical School].

[Article in Japanese]

Kikuchi I1, Aoki M, Kitahara T, Kawana S.

Author information

Department of Dermatology, Nippon Medical School, Tokyo, Japan. ogy@nms.ac.jp

Link Here

Bartonella JH Reaction

The diagnosis of Bartonella quintana BA was confirmed by serum polymerase chain reaction. The patient's treatment course was complicated by both IRIS [immune reconstitution inflammatory syndrome] and Jarisch-Herxheimer reaction.

J Int Assoc Provid AIDS Care. 2017 Jan 1:2325957417702484. doi: 10.1177/2325957417702484. [Epub ahead of print]

The First Report of Bartonella quintana Immune Reconstitution Inflammatory Syndrome Complicated by Jarisch-Herxheimer Reaction.

DallaPiazza M1, Akiyama MJ2.

Author information

1 Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.

2 Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.

Link Here

Lucy Barnes