Jarisch-Herxheimer Reaction

JARISCH-HERXHEIMER REACTION (Jarisch, Herxheimer) is, according to some, a reactivation of spirochetal foci by an introduced specific agent, and in such a case, it is a biotropic reaction in the sense of Milian; according to others, it is caused by intensified treponemolysis under the influence of specific agents and is explained as a reaction to the endotoxins formed from the disintegrated spirochetes. The explanation that the Jarisch-Herxheimer reaction appears due to the direct action of high doses of salvarsan on blood vessels is less acceptable (Matzenauer, Hesse). The Jarisch-Herxheimer reaction appears after the administration of the first dose of a specific agent in patients who have not been treated at all or have not been treated for a long time. It is observed more frequently and manifests more sharply after the infusion of salvarsan preparations, less frequently and more weakly after the infusion of mercury preparations, and even more weakly after subcutaneous or intramuscular injections of these preparations and bismuth suspensions. After iodine preparations, the Jarisch-Herxheimer reaction is usually not observed. It appears more often in the fresh period of syphilis, less often in the late period. If the Jarisch-Herxheimer reaction manifests only on the skin and mucous membranes, it is of no serious significance, but it can cause severe complications and even a fatal outcome if it manifests in vital organs, the cardiovascular system, the central nervous system, the liver, and the kidneys. Clinically, the Jarisch-Herxheimer reaction is expressed by more intense redness and swelling of primary chancres, edema—sometimes very severe—of the surrounding connective tissue, and enlargement of regional lymph nodes. Not all phenomena may be present, but only some of them. In the secondary period, thanks to the Jarisch-Herxheimer reaction, a roseola that was previously absent may appear. The secondary rash becomes more abundant, more hyperemic, and edematous. After 2–6 hours, less often later, after the infusion of salvarsan preparations, a febrile state may appear with an increase in temperature, usually slight, but sometimes reaching 40°C. The temperature lasts for several hours and falls to normal in 10–12 hours, less often in a day. A more prolonged temperature and prolonged disturbance of the general condition, as well as an increase in temperature after repeated infusions, must be attributed to the toxicity of the preparation. After the injection of bismuth and mercury suspensions, the Jarisch-Herxheimer reaction may appear later, after 1–2 days, and last somewhat longer than with the infusion of salvarsan preparations. The same hyperemia and edema may appear around syphilitic foci in the internal organs and the nervous system. In such cases, with involvement of the coronary vessels of the heart, the Jarisch-Herxheimer reaction can cause angina pectoris and sudden death due to the closure of the entrance to the coronary artery. In the brain, it can cause acute cerebral edema and lead to basal meningitis with involvement of the cranial nerves. In the case of narrowing of the larynx and trachea by a specific infiltrate, the Jarisch-Herxheimer reaction can cause closure of the lumen of the respiratory tract. Jaundice and protein in the urine that appear after the administration of the first dose of a specific agent, and especially with simultaneous phenomena of the Jarisch-Herxheimer reaction on the skin, can also be attributed to the Jarisch-Herxheimer reaction. In most cases, unlike intoxication from medications, all phenomena of the Jarisch-Herxheimer reaction pass quickly, and the subsequent use of specific agents is tolerated well.