Herxheimer reaction

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ICD10 = ICD10|T|78|2|t|66
ICD9 = ICD9|995.0
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The Herxheimer reaction (also known as Jarisch-Herxheimer or herx) occurs when large quantities of toxins are released into the body as bacteria (typically Spirochetal bacteria) die, due to antibiotic treatment.

Typically the death of these bacteria and the associated release of endotoxins occurs faster than the body can remove the toxins via the natural detoxification process performed by the kidneys and liver. It is manifested by fever, chills, headache, myalgia (muscle pain), and exacerbation of skin lesions. Duration in syphilis is normally only a few hours but can be much longer in other diseases. The intensity of the reaction reflects the intensity of inflammation present.

The Herxheimer reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, interleukin-6 and interleukin-8. [cite journal |author=Vidal V, Scragg IG, Cutler SJ, "et al" |title=Variable major lipoprotein is a principal TNF-inducing factor of louse-borne relapsing fever |journal=Nat. Med. |volume=4 |issue=12 |pages=1416–20 |year=1998 |month=December |pmid=9846580 |doi=10.1038/4007] [cite journal |author=Kaplanski G, Granel B, Vaz T, Durand JM |title=Jarisch-Herxheimer reaction complicating the treatment of chronic Q fever endocarditis: elevated TNFalpha and IL-6 serum levels |journal=J. Infect. |volume=37 |issue=1 |pages=83–4 |year=1998 |month=July |pmid=9733392 |doi=10.1016/S0163-4453(98)91120-3]

History

Both Adolf Jarisch, [cite journal | author=Jarisch A | title=Therepeutische Versuche beiSyphilis | journal=Wien Med Wochenschr | year=1895 | volume=45 | pages=721–42] an Austrian dermatologist, and Karl Herxheimer, [cite journal | author=Herxheimer K, Krause D | title=Ueber eine bei Syphilitischen vorkommende Quecksilberreaktion | journal=Deutsch Med Wochenschr | year=1902 | volume=28 | pages=895–7] a German dermatologist, are credited with the discovery of the Herxheimer reaction. Both Jarish and Herxheimer observed reactions in patients with syphilis treated with mercury. The reaction was first seen following treatment in early and later stages of syphilis treated with Salvarsan, mercury, or antibiotics. It is seen in 50% of patients with primary syphilis and about 90% of patients with secondary syphilis.fact|date=May 2008

The reaction is also seen in other diseases, such as borreliosis (Lyme diseasecite journal | author = Maloy A, Black R, Segurola R | title = Lyme disease complicated by the Jarisch-Herxheimer reaction. | journal = J Emerg Med | volume = 16 | issue = 3 | pages = 437–8 | year = | pmid = 9610974 | doi = 10.1016/S0736-4679(98)00011-0] cite journal | author = Lawrence C, Lipton R, Lowy F, Coyle P | title = Seronegative chronic relapsing neuroborreliosis. | journal = Eur Neurol | volume = 35 | issue = 2 | pages = 113–7 | year = 1995 | pmid = 7796837 | doi = 10.1159/000117104] and tick-borne relapsing fevercite journal | author = Dworkin M, Anderson D, Schwan T, Shoemaker P, Banerjee S, Kassen B, Burgdorfer W | title = Tick-borne relapsing fever in the northwestern United States and southwestern Canada. | journal = Clin Infect Dis | volume = 26 | issue = 1 | pages = 122–31 | year = 1998 | pmid = 9455520 | doi = 10.1086/516273] ), brucellosis, typhoid fever, and trichinellosis and Q fever.

References