Infectious Disease Compendium

Jarisch-Herxheimer Reaction

Diagnosis

Fever, chills, hypotension an hour or three after treating relapsing fever or syphilis. Due to the release of endotoxins as the organisms die.

Epidemiologic Risks

Treating relapsing fever treatment or syphilis. Were you not paying attention?

"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, early syphilis, and prior penicillin treatment (PubMed)."

Microbiology

Empiric Therapy

Supportive. Try steroids, fluids, benadryl® (my one brand name).

Pearls

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

995.0.