Jarisch‐Herxheimer Reaction after Penicillin Therapy among Patients with Syphilis in the Era of the HIV Infection Epidemic: Incidence and Risk Factors

Abstract

The incidence of and risk factors for Jarisch-Herxheimer (JH) reaction were investigated prospectively among 240 human immunodeficiency virus (HIV)-infected and 115 HIV-uninfected patients with syphilis who received penicillin treatment. The overall rate of JH reaction was 31.5% (34.6% in HIV-infected patients and 25.2% in HIV-uninfected patients). In multivariate analysis, risk factors for JH reaction included high rapid plasma reagin (RPR) titers (per log(2) RPR increase, risk ratio [RR], 1.19; 95% confidence interval [CI], 1.04-1.37), early syphilis (RR, 8.59; 95% CI, 4.75-15.56), and prior penicillin treatment (RR, 0.39; 95% CI, 0.20-0.78).

A Nodular-Ulcerative Form of Secondary Syphilis in Aids

“…Yang et al described a rate as high as 34.6% in HIV-infected patients ( 8 ). Th e Jarisch-Herxheimer reaction is a transient immunological phenomenon seen commonly in patients during treatment of secondary syphilis; it manifests with constitutional symptoms such as fever, chills, headache, and myalgias in addition to exacerbation of existing cutaneous lesions ( 9 ).…”

Jarisch – Herxheimer Reaction in a Patient with Disseminated Lyme Disease

“…Most of the time JHR is self limited and benign, however on rare instances the reaction might be severe enough to discontinue treatment [6]. It is crucial to alert patients about the possibility if a reaction and prompt monitoring to avoid any harmful effects from it [7].…”

Treatment and follow-up using microscopy and polymerase chain reaction in East African sleeping sickness: a case report

“…Moreover, none of the following injections caused any reaction. Another explanation may be that lysis of trypanosomes triggered an immunological response, comparable with the Jarisch-Herxheimer reaction [14] . The finding of a high serum tryptase level, indicative of mast cell activation, and circulating immune complexes might be interpreted as circumstantial evidence for such an immunological reaction.…”

“…After the first gram, our patient received 5 more doses of 1 g at weekly intervals [12] , without any clinical reaction. Because the reaction occurred almost 15 h after the second dose of suramin was given, an immunological reaction related to parasite death, comparable with a Jarisch-Herxheimer reaction provoked by treatment of spirochetes [14] , was suspected. Levels of tryptase and circulating immune complexes were determined in the earliest serum sample available, taken 5 days after the first dose of suramin.…”