Jarisch-Herxheimer reaction

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The Herxheimer reaction (also called Jarisch-Herxheimer reaction or Herx for short ) is a reaction of the body that lasts up to several days to bacterial toxins ( endotoxins ), which arise from the therapy- related disintegration of a large number of pathogens and lead to the release of inflammatory messenger substances.

The name goes back to the dermatologists Adolf Jarisch senior (1850–1902) and Karl Herxheimer (1861–1942). The first observation of symptoms occurred after treatment for syphilis .

Pathogen

A Herxheimer reaction may have to be expected in all effective therapies against spirochetes . They typically occurs when antibiotic treatment of syphilis , but also in other Spirochätosen as yaws , the Lyme disease , leptospirosis , moreover, even with typhoid fever (pathogen: Salmonella typhi ) bacterial as well as some other infections. In borreliosis, this reaction is said to occur in around 30 to 60% of patients; in primosecondary syphilis it is common, but in neurosyphilis only in 1 to 2% of cases. The Jarisch-Herxheimer reaction occurs during antibiotic therapy for the following indications (respective pathogen in brackets):

procedure

Typical symptoms are sudden fever (also with chills) and worsening of the symptoms of the original infectious disease (general and focal reactions). In principle, these symptoms can be viewed as an indication of the effectiveness of an effective therapy.

After the start of effective antibiotic treatment, a Herxheimer reaction can lead to vasoconstriction with rise in blood pressure, paleness and chills. In the following period the symptoms can turn into the opposite. Vascular dilation then occurs, with reddening of the skin and a drop in blood pressure. This can be accompanied by headache , muscle and joint pain , great tiredness and exhaustion. If the disease progresses for a long time until the start of therapy, the Herxheimer reaction can lead to severe depression, states of exhaustion and attention disorders that can last for weeks.

A reaction of the complement system to the decay of bacteria, in particular of spirochetes , has been regarded as the cause of the Herxheimer reaction in the course of antibiotic treatment .

therapy

As prophylaxis, cortisone and other measures (increased drinking, baths) can have a positive effect on the symptoms. Acute treatment consists of intravenous administration of 50–100 mg prednisone . However, cortisone should not be given under any circumstances if Lyme disease is suspected.

reference

The description of akrodermatitis chronica atrophicans Herxheimer goes back to Herxheimer , which however has nothing to do with the Herxheimer reaction.

Individual evidence

  1. ↑ Heinz Lüllmann, Klaus Mohr: Pharmacology and Toxicology . 16th edition. Thieme, 2006, ISBN 3-13-368516-3 , p. 42 .
  2. ↑ a b Entry on Jarisch-Herxheimer reaction in Flexikon , a wiki from DocCheck , accessed on August 25, 2011.
  3. ↑ Wolfgang Stille, Hans-Reinhart Brodt, Andreas Groll, Gudrun Just-Nübling: Antibiotic therapy: clinic and practice of anti-infectious treatment. 11., compl. update u. exp. Edition. Schattauer, 2005, ISBN 3-7945-2160-9 .

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