Jarisch-Herxheimer reaction

Background

• A systemic reaction caused by reaction to endotoxins released by the death of harmful organisms within the body
• Occurs following antibiotic treatment for a number of spirochetal and bacterial infections (classically described in the treatment of syphilis)
• Can also occur following treatment of tick-borne relapsing fever (TBRF) or Lyme disease
• Both penicillin and tetracycline can induce JHR
• Resembles bacterial sepsis.
• Tends to occur within two hours of antibiotic administration
  • Lasts for a few hours or up to a day
• Mortality rate from JHR in louse-borne relapsing fever (LBRF) in the absence of adequate monitoring and resuscitation measures is ~5%.

Clinical Features

Jarisch–Herxheimer reaction in a person with syphilis.

Occurs 2 to 6 hours after treatment started; symptoms can last for 24 hours

• Malaise
• Fever
• Rigors
• Flushing (due to vasodilation)
• Hypotension
• Tachycardia
  • Tachycardia and hyperventilation are accompanied by hypertension, and then by a drop in blood pressure due to vasodilation and declining peripheral pulse.

Differential Diagnosis

• Sepsis

Evaluation

• Typically a clinical diagnosis

Management

• Reassurance
• Acetaminophen

Disposition

• Outpatient