What is Jarisch Herxheimer Reaction & How is it Managed, Prevented?

Jarisch Herxheimer Reaction is a natural body response to the harmful microorganisms released by the body’s inherent system during an antibiotic treatment. The reaction occurs chiefly in response to the products like endotoxin released by the body. These toxins create a temporary inflammation in the body by releasing bacterial toxins in the body’s bloodstream. The toxins are chiefly released due to the laceration of cell membranes (known as lysis) – a procedure that accompanies every anti-microbial treatment. Jarisch Herxheimer Reaction reactions are not very deleterious and can be regulated and treated easily and effectively by the body. The Jarisch Hexheimer Reaction, most commonly referred to as the Herxheimer reaction, was classically used as an efficacious treatment for syphilis.

The Jarisch Herxheimer Reaction is coined after an Austrian dermatologist- Adolf Jarisch (1850-1902) and a German dermatologist, Karl Herxheimer. Jarisch published his findings about the reaction in early 1895. Seven years later Hexheimer published his own discoveries about the same. The Jarisch Hexheimer Reaction being discovered long before the discovery of penicillin concerned itself only in the treatment with mercury. The reaction shares its discovery with another dermatologist of German origin- Karl Hexheimer (1861-1942). Hexheimer published his own findings in 1902. Hexheimer was of Jewish origin and suffered greatly in the hands of the Nazis who occupied Germany in 1933. Although, he had resigned his position due to the ill effects of old age, Hexheimer refused to leave his native country and was consequently imprisoned in the autumn of 1941. He died in the August of next year at the age of 81 in a concentration camp.

The symptoms of the Herxheimer Reaction can appear in many forms, but most usually resembles bacterial sepsis. The symptoms are mostly noticeable after the initial treatment of antibiotics, which include- mild silver protein, penicillin or tetracycline. The symptoms of Jarisch Herxheimer Reaction vary in manifestations and common symptoms include: fever, chills, rigor, headache, hypotension, hyperventilation, tachycardia, flushing, vasodilation, myalgia or muscle pain, anxiety and deteriorating conditions of the skin lesions. The amount of inflammation brought about by the release of toxins in the bloodstream mainly determines the severity of the Jarisch Herxheimer Reaction symptoms and their effects in the body. Jarisch Herxheimer reactions usually occur in about a couple of hours after the first microbial treatment the body undergoes. Almost about 50% of patients suffering from primary syphilis and 90% of patients suffering from secondary syphilis have responded positively to the above symptoms. Other bodily responses in Jarisch Herxheimer Reaction include malaise, slight to moderate pyrexia and leucocytosis. In cases of hyperventilation and tachycardia, the patient undergoes a fit of hypertension accompanied by low blood pressure and a sudden drop in peripheral resistance. Patients suffering from secondary syphilis may witness a secondary rash and its prominence which had been erstwhile absent during the treatment.

Usually the symptoms of the Jarisch Herxheimer Reaction are ascribed to the side effects of antibiotics. However, it is incumbent to recognize the disease by what it is and to take steps accordingly. Sometimes, in the treatment of diseases like Gonorrhea, a febrile reaction with the accompaniment of rashes is noticed in Jarisch Herxheimer Reaction, which is usually seen to be a sign of syphilis. The patient must immediately consult a doctor and then take the necessary steps before the situation goes out of hand. The Jarisch Herxheimer Reaction manifests between 1 to 12 hours after the first shot of antibacterial/antibiotic is taken and lasts as long as a day (shortest being a few hours). Jarisch Herxheimer Reaction resolves under an additional period of six to twelve hours. In case an unexpected reaction occurs in the body in response to the antibiotic treatment, then few serological tests might be performed on the patient. All of this should be undertaken only after consultation with a professional and medical help.

A few measures can be undertaken to alleviate the effects of the Jarisch Herxheimer Reaction or to prevent its appearance in the body. The primary steps being to avoid antibiotics, which have a higher risk of responding to the antitoxins released in the bloodstream; for example, treating HIV positive patients diagnosed with syphilis with azithromycin. For patients suffering from a severe case of syphilis, it is mandatory that they be injected with corticosteroids. About 30 mg of prednisolone is a typical dosage for patients suffering in a late case of syphilis. Although it does not completely prevent the Jarisch Hexheimer Reaction in the body, it abates the symptoms by a huge effect. A recent study also showed that treatment of the body with anti-TNF alpha Fab antibody fragments reduced the chances of manifestations of Jarisch Herxheimer Reaction by about 90 to 95%. These patients treated with anti-TNF alpha Fab antibody fragments had recorded lower temperatures along with pulse rates, lower plasma concentrations with interleukin 6 and 8, as well as lowers the systolic blood pressure after treatment with penicillin. During pregnancy, chances of occurrence of the Jarisch Herxheimer Reaction increase by about 40%. In this case, periodical fetal monitoring should be performed to avoid uterine contractions and recurring variable decelerations. The Jarisch Herxheimer Reaction can be well and easily controlled in cases where the patients are suffering from an early form of syphilis. Complications start to arise when the syphilis has lasted significantly long and are now in a mature and festering stage. In neurosyphilis for example, the Jarisch Herxheimer Reaction may lead to a case of epilepsy and irrecoverable psychosis. Even cases of death have been recorded when the patient had been suffering from cardiovascular syphilis.

Albeit it usually comes as a response to antibody treatment, particularly in treating syphilis, the Jarisch Herxheimer Reaction is also seen in diseases like relapsing fever and Lyme disease. In any case, it is advised that the patient seek medical help and take the necessary steps. Only then would the recuperating period from Jarisch Herxheimer Reaction be short and the patient would recover at ease.