Jarisch Herxheimer Reactions (JHR)
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.
Direct Quotes Below
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.
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.
~`~`~`~`~`~`~`~`~`~`
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.
~`~`~`~`~`~`~`~`~`~`
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.
~`~`~`~`~`~`~`~`~`~`
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.
~`~`~`~`~`~`~`~`~`~`
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.
~`~`~`~`~`~`~`~`~`~`
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.
~`~`~`~`~`~`~`~`~`~`
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.
~`~`~`~`~`~`~`~`~`~`
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.
~`~`~`~`~`~`~`~`~`~`
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.
Lucy Barnes