Jarisch-Herxheimer Reaction

Aka: Jarisch-Herxheimer Reaction

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II. Pathophysiology

  1. Reaction occurs with treatment of Spirochete infection
    1. Syphilis (reaction occurs variably based on stage)
      1. Primary Syphilis: 50%
      2. Secondary Syphilis: 90%
      3. Latent Syphilis: 25%
    2. Relapsing Fever (Tick-Borne Disease)

III. Signs and Symptoms

  1. General
    1. Fever
    2. Adenopathy
    3. Skin rash
    4. Arthralgias
    5. Malaise
    6. Diaphoresis
  2. Neurologic symptoms
    1. Headache
    2. Seizures
    3. Cerebrovascular Accident

IV. Course

  1. Occurs 2 to 6 hours after treatment started
  2. Symptoms last for 24 hours

V. Management

  1. Acetaminophen 2 hours before and after antibiotic dose
  2. Corticosteroids and NSAIDs do not prevent complications
  3. Maintain hydration

VI. References

  1. Kirk, McHugh and Parnell (2023) Crit Dec Emerg Med 37(8): 23-9

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