June 2017
Search located 230 studies using the words Jarisch Herxheimer (JH)
1945- First study reporting JH reaction.
1948- JH reaction reported after use of penicillin for first time.
2003- 5 studies
2004- 2 studies
2005- 4 studies
2006- 2 studies
2007- 2 studies
2008- 3 studies
2009 thru June 2017- 58 studies
Bartonella Jarisch Herxheimer Reaction
Abstracts & studies from 2003- 2017 showing
Possible mechanisms and underlying causes of the JH process,
Symptoms ranging from mild to severe, hospitalizations,
Warnings on the severity of JHR, fatalities and
Possible preventative options.
2017
Within 24 hours after antibiotic treatment of the spirochetal infections syphilis, Lyme disease, leptospirosis, and relapsing fever (RF), patients experience shaking chills, a rise in temperature, and intensification of skin rashes known as the Jarisch-Herxheimer reaction (JHR)...
JHR can also include uterine contractions in pregnancy, worsening liver and renal function, acute respiratory distress syndrome, myocardial injury, hypotension, meningitis, alterations in consciousness, seizures, and strokes.
Experimental evidence indicates it is caused by nonendotoxin pyrogen and spirochetal lipoproteins.
Mediation of the JHR in RF by the pro-inflammatory cytokines tumor necrosis factor (TNF), interleukin (IL)-6, and IL-8 has been proposed, consistent with measurements in patients' blood and inhibition by anti-TNF antibodies.
Accelerated phagocytosis of spirochetes by polymorphonuclear (PMN) leukocytes before rise in cytokines is responsible for removal of organisms from the blood, suggesting an early inflammatory signal from PMNs.
Am J Trop Med Hyg. 2017 Jan 11;96(1):46-52. doi: 10.4269/ajtmh.16-0434. Epub 2016 Oct 24.
The Jarisch-Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis.
Butler T1.
1
Department of Microbiology and Immunology, Ross University School of Medicine, Portsmouth, Dominica, West Indies. tbutler@rossu.edu.
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We present a case of Weil's disease complicated by a Jarisch-Herxheimer reaction (JHR) after initiation of antibiotics while in the emergency department requiring invasive monitoring and vasopressor support.
NOTE- [Weil's Disease- AKA Leptospirosis- an infection caused by corkscrew-shaped bacteria (spirochete) called Leptospira.]
The patient appeared jaundiced with conjunctival suffusion and was ultimately treated with the appropriate antibiotics for leptospirosis in the ED. She decompensated subsequently, requiring supplemental oxygen, central and arterial line placement, and vasopressor support with norepinephrine.
This JHR may be self-limited and of short duration, or it can be prolonged and severe, requiring invasive therapies such as central line placement for vasopressor support and intubation.
Am J Emerg Med. 2017 Apr 27. pii: S0735-6757(17)30328-5. doi: 10.1016/j.ajem.2017.04.064. [Epub ahead of print]
Pressor support during a Jarisch Herxheimer reaction after initiation of treatment for Weil's disease.
Connor-Schuler R1, Khan A2, Goyal N3, Zimny E4.
1
Henry Ford Hospital, Detroit, MI, USA. Electronic address: rconnor1@hfhs.org.
2
Henry Ford Hospital, Detroit, MI, USA.
3
Henry Ford Hospital, Detroit, MI, USA. Electronic address: NGOYAL1@hfhs.org.
4
Henry Ford Hospital, Detroit, MI, USA. Electronic address: EZIMNY1@hfhs.org.
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A 73-year-old man presented [to hospital] with fever and hypotension, which had developed a few hours after receiving treatment with benzyl-penicillin for secondary syphilis. ... The patient was admitted to hospital and treated with prednisone and intravenous fluids.
Ned Tijdschr Geneeskd. 2017;161(0):D649.
[Fever and hypotension after treatment of syphilis; the Jarisch-Herxheimer reaction].
[Article in Dutch]
Hendriks KD1, van Etten RW, van Wijngaarden P.
1
Amphia Ziekenhuis, afd. Inwendige Geneeskunde, Breda.
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The incidence of and risk factors for JHR were investigated retrospectively among 262 patients with confirmed leptospirosis who received amoxicillin treatment in New Caledonia and Futuna. The overall rate of JHR was 21% (12% in New Caledonia and 44% in Futuna). Strain-related factors associated with JHR occurrence and its impact on outcome remains to be explored.
Am J Trop Med Hyg. 2017 Apr;96(4):791-794. doi: 10.4269/ajtmh.16-0457. Epub 2017 Jan 23.
Jarisch-Herxheimer Reaction Among Patients with Leptospirosis: Incidence and Risk Factors.
Guerrier G1, Lefèvre P2, Chouvin C3, D'Ortenzio E4.
1
Anesthésie-réanimation, Hopital Cochin, Paris, France.
2
Service de médecine, Centre Hospitalier du Nord, Koumac, New Caledonia.
3
Dispensaire de Futuna, Agence de Santé, Alo, Futuna.
4
Institut de Veille Sanitaire, Cire Océan Indien, Saint-Denis, France.
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Case reports indicate that the JHR can also include uterine contractions in pregnancy, worsening liver and renal function, acute respiratory distress syndrome, myocardial injury, hypotension, meningitis, alterations in consciousness, seizures, and strokes.
Experimental evidence indicates it is caused by nonendotoxin pyrogen and spirochetal lipoproteins.
Am J Trop Med Hyg. 2017 Jan 11;96(1):46-52. doi: 10.4269/ajtmh.16-0434. Epub 2016 Oct 24.
The Jarisch-Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis.
Butler T1.
1
Department of Microbiology and Immunology, Ross University School of Medicine, Portsmouth, Dominica, West Indies. tbutler@rossu.edu.
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The Jarisch-Herxheimer reaction occurs in up to 44% of gravidas and can cause contractions, fetal heart rate abnormalities, and even stillbirth in the most severely affected pregnancies.
We recommend all viable pregnancies receive the first dose of benzathine penicillin G in a labor and delivery department under continuous fetal monitoring for at least 24 hours. Thereafter, the remaining benzathine penicillin G doses can be given in an outpatient setting.
Am J Obstet Gynecol. 2017 Apr;216(4):352-363. doi: 10.1016/j.ajog.2016.11.1052. Epub 2016 Dec 9.
Syphilis during pregnancy: a preventable threat to maternal-fetal health.
Rac MW1, Revell PA2, Eppes CS3.
1
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address: Martha.Rac@bcm.edu.
2
Department of Pathology and Pediatrics, Baylor College of Medicine, Houston, TX.
3
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
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Therapy harbors the danger of a Jarisch-Herxheimer reaction, a complication that may require intensive medical care.
Internist (Berl). 2017 Mar;58(3):287-292. doi: 10.1007/s00108-016-0154-3.
[A Somali refugee with fever and abnormal blood smear].
[Article in German]
Jochum J1, Tannich E2, Tappe D2, Schmiedel S3.
1
I. Medizinische Klinik und Poliklinik, Sektion Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. j.jochum@uke.de.
2
Bernhard-Nocht-Institut für Tropenmedizin, Nationales Referenzzentrum für Tropische Infektionserreger, Hamburg, Deutschland.
3
I. Medizinische Klinik und Poliklinik, Sektion Infektiologie und Tropenmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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Our objective was to describe the clinical and epidemiological factors associated with leptospirosis in an endemic area of Japan, with a focus on the occurrence of JHR, an often unrecognized and likely underestimated phenomenon.
JHR was seen in 23 (82%) of 28 cases, including 19 (90%) of 21 cases treated with bactericidal antibiotics compared to 4 (57%) of seven cases with bacteriostatic antibiotics (p=0.08).
We also found that JHR occurs frequently, and its recognition may be important for the diagnosis and management of leptospirosis in the early stage when laboratory confirmation is pending.
Trans R Soc Trop Med Hyg. 2016 Sep;110(9):558-565. Epub 2016 Oct 15.
Clinical characteristics of laboratory-confirmed leptospirosis in Okinawa, Japan, 1974-2015: high incidence of Jarisch-Herxheimer reaction.
Tsuha S1, Taniguchi T2, Shiiki S3, Narita M3, Leung DT4.
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2016
I am a 24-year-old male who was diagnosed with chronic Lyme disease after 4 years of multiple, non-specific symptoms. I have written this case as first author with my faculty mentor listed as the coauthor. The objective of this report is to highlight the experience with doxycycline treatment.
I started taking doxycycline 100 mg by mouth every 12 hours, leading to atypical sequences of events deemed a Jarisch-Herxheimer reaction by a LLMD. This case highlights the unique clinical expression of chronic Lyme disease and the Jarisch-Herxheimer response to doxycycline. [Full Article Behind Pay Wall]
BMJ Case Rep. 2016 Jul 20;2016. pii: bcr2013009433. doi: 10.1136/bcr-2013-009433.
Unique expression of chronic Lyme disease and Jarisch-Herxheimer reaction to doxycycline therapy in a young adult.
1
Ohio State University, Columbus, Ohio, USA.
2
College of Pharmacy, Ohio State University, Columbus, Ohio, USA.
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Frequently patients develop a Jarisch-Herxheimer reaction shortly after initiation of therapy, requiring hospitalization or intensive care treatment. Managing the treatment exclusively in an outpatient setting is not recommended.
Dtsch Med Wochenschr. 2016 Jul;141(14):1009-13. doi: 10.1055/s-0041-110629. Epub 2016 Jul 12.
[Relapsing fever: an almost forgotten disease in focus again].
[Article in German]
Wieser A, Löscher T, Schunk M, Seilmaier M, Balzer L, Margos G, von Both U, Schulzki T, Kopf S, Hoch M, Sing A, Fingerle V.
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2015
However, left-side hearing loss worsened temporarily, which was assumed to be a Jarisch-Herxheimer reaction.
J Nippon Med Sch. 2015;82(5):254-6. doi: 10.1272/jnms.82.254.
Neurosyphilis Mimicking Ramsay Hunt Syndrome.
Maeda T1, Yoshizawa S, Hirayama T, Saga T, Tateda K, Urita Y.
1
Department of General Medicine and Emergency Care, Toho University School of Medicine.
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Treatment was complicated by severe Jarisch-Herxheimer reactions in both patients.
Euro Surveill. 2015 Jul 30;20(30). pii: 21196.
Louse-borne relapsing fever (Borrelia recurrentis) in asylum seekers from Eritrea, the Netherlands, July 2015.
Wilting KR1, Stienstra Y, Sinha B, Braks M, Cornish D, Grundmann H.
1
Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, the Netherlands.
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Adverse effects of treatment were observed in 21% of patients treated with azithromycin and in 16% treated with amoxicillin, and the appearance of Jarisch-Herxheimer reaction was recorded in 7% and 15%, respectively (P = 0.1438).
Pediatr Infect Dis J. 2015 Oct;34(10):1045-8. doi: 10.1097/INF.0000000000000804.
Azithromycin Is Equally Effective as Amoxicillin in Children with Solitary Erythema Migrans.
1
From the *University Medical Center Ljubljana, Ljubljana, Slovenia; and †Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
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Two of the patients were hospitalized and presented a probable Jarisch-Herxheimer reaction after initiation of beta-lactam therapy.
Rev Med Suisse. 2015 Apr 15;11(470):872-6.
[Leptospirosis in a family after whitewater rafting in Thailand].
[Article in French]
Gallardo C, Williams-Smith J, Jaton K, Asner S, Cheseaux JJ, Troillet N, Manuel O, Berthod D.
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We report a rare case of congenital syphilis (CS) presenting as Jarisch-Herxheimer reaction (JHR) at birth.
The infant was given i.v. ampicillin for 14 days (50 mg/kg per day until day 3, 100 mg/kg per day thereafter). One hour after the first injection, the infant developed fever (39°C), tachycardia and tachypnea without worsening of rash.
This was considered a JHR following ampicillin injection given to the mother before delivery and to the infant after birth.
Pediatr Int. 2015 Apr;57(2):299-301. doi: 10.1111/ped.12417.
Congenital syphilis presenting as Jarisch-Herxheimer reaction at birth.
1
Department of Pediatrics, Ota Memorial Hospital, Gumma, Japan.
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One Jarisch Herxheimer reaction occurred and was resolved with systemic corticosteroid therapy.
J Fr Ophtalmol. 2015 Mar;38(3):220-8. doi: 10.1016/j.jfo.2014.09.011. Epub 2015 Jan 28.
[Clinical and paraclinical features of syphilitic uveitis].
[Article in French]
Marty AS1, Cornut PL2, Janin-Manificat H3, Perard L4, Debats F5, Burillon C3.
1
Service d'ophtalmologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003, Lyon, France. Electronic address: marty.anneso@sfr.fr.
2
Centre ophtalmologique pôle vision, clinique du Val-d'ouest, 39, chemin de la Vernique, 69130, Écully, France.
3
Service d'ophtalmologie, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003, Lyon, France.
4
Service de médecine interne, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003, Lyon, France.
5
Hôpital de la Croix-Rousse, service d'ophtalmologie, 103, Grande rue de la Croix-Rousse, 69004, Lyon, France.
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Clinically, JHR manifests as an abrupt onset of constitutional symptoms and exacerbation of cutaneous lesions...
JHR's pathogenesis is unclear and it is histopathologically rarely reported.
... presented for medical care 14 days after commencement of doxycycline therapy. She complained of malaise, facial flushing, gingival erythema, and acquisition of additional plaques characterized by swelling, increased erythema, pruritus, and exfoliative scale.
Punch biopsies demonstrated subacute to chronic spongiotic psoriasiform reaction patterns with a superficial lymphocytic infiltrate.
Liberation of endotoxin-like materials (eg, lipoproteins) from degenerating spirochetes and concomitant cytokine production is the suspected cause of JHR and supported by the finding of lesional spirochetes.
Am J Dermatopathol. 2015 Jun;37(6):e68-74. doi: 10.1097/DAD.0000000000000093.
Delayed onset of the Jarisch-Herxheimer reaction in doxycycline-treated disease: a case report and review of its histopathology and implications for pathogenesis.
Kadam P1, Gregory NA, Zelger B, Carlson JA.
1
*Department of Pathology, Divisions of Dermatology and Dermatopathology, Albany Medical College, Albany, NY; †Upper Hudson Valley Dermatology, Castleton, NY; and ‡Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria.
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2014
Jarisch-Herxheimer reaction (JHR) is a well-documented adverse effect of penicillin treatment in syphilis. Stroke has not been reported as part of its phenomenology.
Within six hours of first dose of IV crystalline penicillin G, he was found to have hemineglect and difficulty moving the left leg.
MRI of the brain showed multiple acute ischemic strokes.
Four hours later, he was found to be febrile and had two episodes of generalized tonic-clonic seizures.
We report a case of confirmed neurosyphilis with no known modifiable stroke risk factors, who developed acute ischemic stroke and other constitutional symptoms consistent with JHR after IV penicillin.
This is the first reported case in literature where an acute ischemic stroke can be attributed to Jarisch-Herxheimer reaction.
... our case underlies the importance of keeping in mind potential catastrophic drug adverse reactions in neurosyphilis patients.
Case Rep Neurol Med. 2014;2014:548179. doi: 10.1155/2014/548179. Epub 2014 Nov 5.
Stroke after Initiating IV Penicillin for Neurosyphilis: A Possible Jarisch-Herxheimer Reaction.
Punia V1, Rayi A2, Sivaraju A3.
1
Epilepsy Centre, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44106, USA.
2
Department of Neurology, SUNY Downstate Medical Center, 450 Clarkson Avenue, P.O. Box 1275, Brooklyn, NY 11203, USA.
3
Department of Neurology, Epilepsy Section, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT 06510, USA.
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The Jarisch-Herxheimer reaction, a febrile inflammatory reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women.
The overall incidence of the Jarisch-Herxheimer reaction was significantly lower in patients receiving azithromycin than those receiving benzathine penicillin G (14.1% vs. 56.3%, p<0.001).
J Int AIDS Soc. 2014 Aug 28;17:18993. doi: 10.7448/IAS.17.1.18993. eCollection 2014.
Jarisch-Herxheimer reaction among HIV-positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy.
Tsai MS1, Yang CJ1, Lee NY2, Hsieh SM3, Lin YH4, Sun HY3, Sheng WH3, Lee KY5, Yang SP6, Liu WC3, Wu PY6, Ko WC2, Hung CC7.
1
Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
2
Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan.
3
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
4
Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
5
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
6
Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan.
7
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan.
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3 days after initiation of the tuberculostatic therapy, the girl was referred to our hospital with an acute onset of blurred vision. Visual acuity (VA) was 20/200 in both eyes.
Examination revealed mild anterior chamber inflammation, optic disc swelling, cystoid macular edema and periphlebitis in both eyes.
... the prompt response to systemic steroids are typical for Jarisch-Herxheimer reaction (JHR).
Int Ophthalmol. 2014 Jun;34(3):675-77.
Isolated ocular Jarisch-Herxheimer reaction after initiating tuberculostatic therapy in a child.
Neunhöffer H, Gold A, Hoerauf H, Herbort C, Heiligenhaus A, Zimmermann O, Feltgen N.
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2013
Two hours later he became hypotensive, tachypnoeic with severe myalgia and a temperature of 41°C, type I respiratory failure and metabolic acidosis.
BMJ Case Rep. 2013 Oct 9;2013. pii: bcr2013201075. doi: 10.1136/bcr-2013-201075.
Risky behaviour: a rare complication of an uncommon disease in a returning traveller.
1
Wexham Park Hospital, Berkshire, UK.
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... can have fatal complications such as the Jarisch-Herxheimer reaction (JHR) after the commencement of treatment with antibiotics.
... fever, headache, general body malaise and vomiting
The blood slide showed Borrelia duttoni. The patient continued treatment with procaine penicillin...
Several hours later the woman died...
This case of a patient with relapsing fever who died from a JHR stresses the importance of adequate diagnosis and treatment...
Trop Doct. 2013 Oct;43(4):138-41. doi: 10.1177/0049475513497477. Epub 2013 Aug 23.
Maternal mortality in a rural Tanzanian hospital: fatal Jarisch-Herxheimer reaction in a case of relapsing fever in pregnancy.
Rustenhoven-Spaan I1, Melkert P, Nelissen E, van Roosmalen J, Stekelenburg J.
1
PHC Laboratory, PO Box 916, 1180 AX Amstelveen, The Netherlands. p.melkert@gmail.com.
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Jarisch-Herxheimer reaction (JHR) is a well-recognized transient worsening of signs and symptoms occurring soon after the first dose of an appropriate antibiotic for several spirochetal infections.
The pathogenesis of this reaction is poorly understood.
...a 55-year-old man developed a severe JHR characterized by fever, tachycardia, hypertension, obtundation, seizures, and a neutrophilia...
...this is the first report of elevated CSF cytokines in a patient with a JHR, which possibly contributed to the neurologic signs of JHR.
Further studies on the innate inflammatory response during episodes of acute infection and inflammation are needed to develop targeted therapies to modulate this system...
JAMA Neurol. 2013 Aug;70(8):1060-4. doi: 10.1001/jamaneurol.2013.2120.
Elevated CSF cytokines in the Jarisch-Herxheimer reaction of general paresis.
Davis LE1, Oyer R, Beckham JD, Tyler KL.
1
Department of Neurology Service, New Mexico VA Health Care System, Albuquerque, NM 87108, USA. ledavis@unm.edu
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Recommended treatment includes antibiotics, which may induce a Jarisch-Herxheimer reaction (JHR).
Since little information on the importance of this adverse event is available, we performed this review to quantify frequency and impact of JHR in leptospirosis management.
Publications describing JHR in leptospirosis are very limited and consist mainly of single case reports and small case series.
Not all guidelines and not all literature on leptospirosis mention this reaction which can be fatal.
...the awareness of this event is insufficient.
PLoS One. 2013;8(3):e59266. doi: 10.1371/journal.pone.0059266. Epub 2013 Mar 26.
The Jarisch-Herxheimer reaction in leptospirosis: a systematic review.
1
Département d'Anesthésie-Réanimation, Centre Hospitalier Territorial, Noumea, Nouvelle Calédonie. guerriergilles@gmail.com
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Whereas this drug effectively prevented maternofetal transmission, treating infants remained difficult due to the Jarisch-Herxheimer reaction.
Neonatology. 2013;103(4):274-80. doi: 10.1159/000347107. Epub 2013 Mar 13.
Curse on two generations: a history of congenital syphilis.
1
Department of Neonatology, Charité University Medicine, Berlin, Germany. michael.obladen@charite.de
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2012
This is potentially the first time a J-H like reaction has been described in the context of dental sepsis.
... an unusual reaction to routine treatment for a spreading odontogenic infection in a healthy male with no known allergies, requiring the patient to be managed supportively in the resuscitation room.
The patient deteriorated rapidly after the administration of paracetamol, intravenous fluids, steroids and antibiotics, demonstrating delusional behaviour, fever, rigors, tachycardia and hypoxia.
... as a reaction to antibiotic therapy known as Jarisch-Herxheimer (J-H) reaction.
BMJ Case Rep. 2012 Jun 14;2012. pii: bcr0720114500. doi: 10.1136/bcr.07.2011.4500.
'An unusual response of dental sepsis to antibiotics: parallels with the Jarisch-Herxheimer reaction'.
Moss H1, Collier JM, Collier S.
1
CSCD Department, KCH NHS Foundation Trust, London, UK. hrmoss@hotmail.co.uk
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Treatment consisted in 6 x 4 Mio. IE* Penicillin G for 14 days and 50 mg Prednisone for five days to prevent a Jarisch Herxheimer reaction.
Praxis (Bern 1994). 2012 Mar 14;101(6):419-23. doi: 10.1024/1661-8157/a000869.
[What vision loss might bring to light].
[Article in German]
Jegerlehner S1, Vogel D, Tappeiner C, Leib SL.
1
Universitätsklinik für Infektiologie, Inselspital Bern.
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....pulmonary alveolar hemorrhage (PAH).
....caused Jarisch-Herxheimer reaction.
...possibility of this disease should be included in the differential diagnosis, especially when high-resolution CT findings indicate PAH, and the imaging findings deteriorate rapidly after antibiotic therapy.
J Thorac Imaging. 2012 Jan;27(1):W24-6. doi: 10.1097/RTI.0b013e318231535b.
High-resolution computed tomography findings in a case of severe leptospira infection (Weil disease) complicated with Jarisch-Herxheimer reaction.
Hashimoto T1, Akata S, Park J, Harada Y, Hirayama Y, Otaki J, Tokuuye K.
1
Department of Radiology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan. hashi244@tokyo-med.ac.jp
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2011
Although there was significant heterogeneity between the five trials comparing the rate of JHRs, three of them showed a significant benefit in favour of penicillin.
Tetracycline appears to be the most efficient drug but also appears to be associated with a higher rate of JHRs.
Alternative regimens to treat LBRF should be investigated.
Trans R Soc Trop Med Hyg. 2011 Sep;105(9):483-90. doi: 10.1016/j.trstmh.2011.04.004. Epub 2011 Jul 30.
Comparison of antibiotic regimens for treating louse-borne relapsing fever: a meta-analysis.
1
Department of Infectious Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. guerriergilles@gmail.com
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NO ABSTRACT- "Severe Jarisch-Herxheimer reaction..."
Enferm Infecc Microbiol Clin. 2011 Nov;29(9):710-1. doi: 10.1016/j.eimc.2011.01.019. Epub 2011 Jun 30.
[Severe Jarisch-Herxheimer reaction in tick-borne relapsing fever].
[Article in Spanish]
García-Soler P, Núñez-Cuadros E, Milano-Manso G, Ruiz Sánchez P.
PMID:
21723003
DOI:
[Indexed for MEDLINE]
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柳庆君
刘国旗
王世佑
邓伟
张玲燕
颜红
(I can't read Chinese)- "Jarisch-Herxheimer reaction misdiagnosed as pneumonia..."
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 Apr;46(4):341-2.
[A Jarisch-Herxheimer reaction misdiagnosed as pneumonia after an operation for laryngeal papillary lymphoma].
[Article in Chinese]
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The patient exhibited a classic Jarisch-Herxheimer reaction of tachycardia, hypotension, and thrombocytopenia following antimicrobial therapy, and she also developed an elevated serum cardiac troponin during therapy.
Case Rep Infect Dis. 2011;2011:950314. doi: 10.1155/2011/950314. Epub 2011 Oct 9.
Elevated troponin and jarisch-herxheimer reaction in tick-borne relapsing Fever: a case report.
1
Immunology Department, Peace Health Laboratories, 2901 Squalicum Parkway, Bellingham, WA 98225, USA.
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2010
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.
1
Department of Internal Medicine, Far Eastern Memorial Hospital, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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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.
1
Sanitary Dermatology Department, Professor Rubem David Azulay Dermatology Institute, Santa Casa da Misericórdia Hospital, Rio de Janeiro, Brazil. wmiller@gt.cdc.gov
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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.
1
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, Texas, USA. MarthaRac@gmail.com
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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.
1
Division of Infectious Diseases, Department of Medicine, St. Luke's International Hospital.
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2009
... 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.
1
Department of Social Pediatrics, Faculty of Public Health, University Medical School, Wroclaw, Poland. Prandota@ak.am.wroc.pl
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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.
1
Graduate Program, Faculty of Allied Health Sciences, Thammasat University, Rangsit Center, Pathum-thani 12120, Thailand.
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...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.
1
Department of Psychiatry, GATA Haydarpasha Training Hospital, Istanbul, Turkey. aates1971@yahoo.com
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...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
1Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore. E-mail: gemmy@doctors.org.uk
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2008
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.
1
Second Surgical Department, 401 General Army Hospital of Athens, 41 Zakinthinou Street, 15669, Papagou, Athens, Greece. drsgourgiotis@tiscali.co.uk.
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The Jarisch-Herxheimer reaction is an acute worsening of skin manifestations and systemic symptomsoccurring 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.
1
Tufts University School of Medicine, Boston, MA, USA. emily.berger@tufts.edu
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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.
1
Department of Neurology, Changhai Hospital, Shanghai, China. gen-plezhang@126.com
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2007
...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.
1
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.
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...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.
1
Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Millet Caddesi Capa, 34390 Istanbul, Turkey. candan.gurses@gmail.com
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2006
Jarisch-Herxheimer reaction (elevated body temperature 38-38.6 degrees C) and roseola eruption were 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.
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...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.
1
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
2005
...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.
1
Department of Obstetrics and Gynecology, Exempla Saint Joseph Hospital, Denver, Colorado, USA. guggenheimj@exempla.org
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... 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.
1
College of Pharmacy and Allied Health Professions, St. John's University, Queens, NY 11439, USA. sees@stjohns.edu
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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.
1
Department of Pharmacy Practice, Campbell University School of Pharmacy, Buies Creek, NC 27506, USA. mpound@capefearvalley.com
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2003
... 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.
1
Department of Ophthalmology, University Malaya Medical Center, 50603 Kuala Lumpur.
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NO ABSTRACT
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.
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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.
1
Department of Dermatology, Nippon Medical School, Tokyo, Japan. ogy@nms.ac.jp
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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.
1
1 Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA.
2
2 Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Lucy Barnes