Jarisch-Herxheimer reaction

Resembles bacterial sepsis and can occur after initiation of antibacterials such as penicillin or tetracycline, or treatment of tick-borne relapsing fever.

Related to the release of heat-stable proteins from spirochetes with initiation of treatment.

Associated with an increase in inflammatory cytokines including tumor necrosis factor alpha, interleukin-6 and interleukin-8.

Manifests as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia, and exacerbation of skin lesions.

Intensity of the reaction indicates the severity of inflammation.

Reaction commonly occurs within two hours of drug administration.

Usually self-limiting in nature.

Prophylaxis and treatment with an anti-inflammatory agent may improve clinical manifestations.

Aspirin and corticosteroids may improve clinical process.

Associated with penicillin treatment of syphilis, and also seen in other diseases caused by spirochetes, such as borreliosis and leptospirosis, Q fever. bartonellosis, brucellosis, typhoid fever, and trichinosis.

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