What is the Herxheimer reaction

2 minutes of medicine knowledge: The Jarisch-Herxheimer reaction

The Jarisch-Herxheimer reaction is a reaction to endotoxins. These endotoxins are released after the first administration of an antibiotic through the decay of Treponema pallidum, the causative agent of syphilis. Similar reactions can also occur during treatment of typhus abdominalis (triggered by Salmonella), relapsing fever and leptospirosis.
Clinically, the patients present with increased temperature, chills, nausea, vomiting and headache. In addition, tachycardia, drop in blood pressure, flush, myalgias and exacerbations of the disease-related rash can also be observed. This makes it difficult to differentiate between sepsis, septic shock and allergic (or anaphylactic) reactions, not least because of the clear dynamics of the symptoms, which is why the emergency services and in-hospital emergency medicine are also confronted with these reactions.
Classical for the differential diagnosis in favor of the Jarisch-Herxheimer reaction are the temporal connection to the antibiotic therapy against the mentioned pathogens and the often self-limiting course.
Therapy is carried out through the administration of cortisone, symptomatic therapy and monitoring of the vital parameters so that nothing is missed, taking into account the life-threatening differential diagnoses.

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