Jarisch-Herxheimer reaction

The Herxheimer reaction (also called Jarisch -Herxheimer reaction or short Herx ) is one to several days lasting body's response to bacterial toxins ( endotoxins ) that result from the therapy-induced decomposition of a large amount of pathogens and the release of inflammatory mediators lead ( anaphylactic shock).

The name goes back to the dermatologist Jarisch Adolf senior (1850-1902) and Karl Herxheimer (1861-1942). The first observation of symptoms occurred after treatment of syphilis.

Pathogen

At all effective therapies against spirochetes may be expected with a Herxheimer reaction. It typically occurs in the antibiotic therapy of syphilis, but also in other Spirochätosen as yaws, Lyme disease, leptospirosis, moreover, even in typhoid fever ( pathogens: Salmonella typhi ) and in some other bacterial infections. In Lyme disease, this reaction should occur at about 30 to 60% of patients in the Primo secondary syphilis it is frequently observed in neurosyphilis but only in 1-2 % of cases. The Jarisch -Herxheimer reaction occurs during antibiotic therapy of the following indications ( respective pathogens in brackets) to:

Expiration

Typical symptoms are sudden fever ( with chills ) and a worsening of the symptoms of the original infection ( general and focal reactions ). In principle, these symptoms can be considered as an indication of the effectiveness of an effective therapeutic.

After the start of effective antibiotic treatment may occur as part of a Herxheimer reaction to a vasoconstriction with increases in blood pressure, pallor and chills. In the following period, the symptoms turn into the opposite. It then comes to a vasodilatation with erythema and hypotension. This may be accompanied by headache, muscle and joint pain, fatigue and exhaustion great. With a longer disease course until the start of therapy, the Herxheimer reaction can lead to severe depression, fatigue and attention deficits that can last for weeks.

The cause of the Herxheimer reaction under antibiotic treatment has so far been to a reaction of the complement to the decomposition of bacteria, in particular of spirochetes recycled. D. Hassler, a Lyme disease specialist argues that this reaction most likely due to the release of tumor necrosis factor (TNF ) or interleukin -1 ( IL-1) is released from stimulated macrophages.

Therapy

Can affect the symptoms low doses of cortisone and other measures ( increased drinking, baths) as prophylaxis. The acute treatment is to administer 50 to 100 mg prednisone intravenously. Cortisone, however, should be given at a suspected disease in any case.

Reference

Also the description of acrodermatitis chronica atrophicans Herxheimer goes back to Herxheimer, which has nothing to do with the Herxheimer reaction.

Dermatology Adolf Jarisch Arthralgia
389800
de