Herxheimer reaction T78.2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 23.04.2021

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Synonym(s)

Jarisch-Herxheimer reaction; Reaction Jarisch-Herxheimer

History
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Jarisch, 1895; Herxheimer, 1902

Definition
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Reaction with fever, chills and other general reactions occurring at the beginning of therapy due to massive decay of the pathogen, e.g. in syphilis. With appropriate therapy, a similar reaction can also occur with tinea capitis profunda, tinea corporis profunda and onchocerciasis.

Etiopathogenesis
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Rapid disintegration of spirochetes or fungi with release of toxins after the first administration of antibiotics or antifungals.

Clinical features
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For syphilis: 2-6 hours after the first administration of penicillin, with feverish temperatures, flu-like symptoms, arthralgia, chills, headaches. In the rare late stage with an existing aortic aneurysm life-threatening (possible aortic aneurysm rupture due to sudden disintegration of the granulation tissue). No recurrence occurs with the following injections.

Prophylaxis
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Simultaneous administration of 25-50 mg prednisolone i.v. one hour before or with the initial administration of antibiotics.

Note(s)
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Literature
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  1. Herxheimer K (1902) On a mercury reaction occurring in syphilitic patients. German medical weekly (Berlin) 28: 895-897
  2. Jarisch A (1895) Therapeutic trials for syphilis. Viennese medical weekly 45: 720-721
  3. Leblebicioglu H (2003) Jarisch-herxheimer reaction in leptospirosis. Eur J Clin Microbiol Infect Dis 22: 639
  4. Silberstein P (2002) A case of neurosyphilis with a florid Jarisch-Herxheimer reaction. J Clin Neurosci 9: 689-690

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Last updated on: 23.04.2021