Jarisch–Herxheimer reaction among syphilis patients in Rio de Janeiro, Brazil

Abstract

The Jarisch-Herxheimer reaction (JHR) is a syndrome observed after antimicrobial treatment of some infectious diseases. The syndrome has clinical characteristics of an inflammatory reaction to antibiotic treatment. A prospective study of patients with a clinical and laboratory diagnosis of syphilis was conducted at a sexually transmitted diseases clinic in Rio de Janeiro, Brazil. Patients were treated with benzathine penicillin and observed for the JHR. A total of 115 patients were included in this study. Fifty-one patients (44%) had secondary syphilis; 37 (32%), primary; 26 (23%), latent; and one (1%), tertiary syphilis. Ten patients (9%) developed the JHR. All JHRs occurred in patients with secondary and latent syphilis. No patients experienced an allergic reaction to penicillin. The JHR occurred less frequently than in previous studies. It is important that health-care professionals recognize the clinical characteristics of the JHR so that it is not misinterpreted as an allergic reaction to penicillin.

The Jarisch–Herxheimer reaction in syphilis: could molecular typing help to understand it better?

“…Nowadays, the incidence of the JHR varies between 9% and 31% which is in line with the 28% found in our study . However, earlier studies found higher rates around 40–60% up to 95% in primary syphilis .…”

“…It has also been suggested that the RPR titres could be correlated with a higher bacteremia, but in this study, RPR titres were not related to JHR. The JHR started 6 h after the treatment, in a similar way as that described in previous studies . This reaction is harmless and self‐limited in general.…”

“…The incidence in patients with neurosyphilis oscillated from 64% to 79% . Contemporary studies show that the incidence of JHR in syphilis varies around 9–31%, being the most frequent in secondary syphilis . It has also been related to higher RPR titres and it seems to be less probable when the patients have been previously treated with penicillin for previous syphilis or are being treated with azithromycin or doxycycline .…”

Jarisch‐Herxheimer reaction among HIV‐positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy

“…For example, 50 to 75% of the patients with primary or secondary syphilis may experience the Jarisch-Herxheimer reaction, which typically occurs within 2 to 5 hours of initiation of penicillin therapy for syphilis and usually resolves within 24 hours [7,13,14]. In the study by Miller et al ., the overall incidence is around 9% in syphilis patients regardless of stage [15]. Patients with HIV infection and pregnant women have a higher incidence of the Jarisch-Herxheimer reaction while receiving syphilis treatment, with a rate of 35 and 40%, respectively [16,17].…”

Delayed Onset of the Jarisch–Herxheimer Reaction in Doxycycline-Treated Disease

“…The presence of constitutional symptoms and absence of dermatophytes by KOH preparation and DPAS stain argues against tinea corporis/cruris. 24 The biggest differences between our patient and those patients with typical JHR are the later time of onset, longer duration of symptoms, and the lesser severity of symptoms, not the type of symptoms (Table 1). 4,5,[20][21][22][23] Despite the onset of new lesions of EM, complete recovery days after antibiotic withdrawal and good health 5 years later negate the possibility of treatment failure and chronic Lyme disease.…”