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Sexually Transmitted Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Aarthy K. Uthayakumar, Christopher B. Bunker
Course: Patients should be monitored clinically and serologically to ensure a curative treatment response. The cure rates with initial treatment of early syphilis are greater than 95%. The Jarisch-Herxheimer reaction is an acute, self-limiting, febrile reaction, occurring usually within 24 hours of treatment in 10–35% of cases. An adequate serologic response is demonstrated by a greater than a fourfold decline in antibody titers.
Mechanisms of Drug Reactions
Published in Kirsti Kauppinen, Kristiina Alanko, Matti Hannuksela, Howard Maibach, Skin Reactions to Drugs, 2020
Kristiina Alanko, Matti Hannuksela
Most adverse drug reactions arise from non-allergic, i.e., non-immunological, causes. Certain adverse drug reactions occur in all individuals and are a function of the known pharmacological actions of the drug. These predictable reactions constitute about 80% of all adverse drug reactions and include overdose, toxicity (side effects), cumulative effects, and drug interactions. Some adverse reactions occur only in certain, susceptible patients. These are unpredictable and include intolerance or a lowered threshold to the normal pharmacologic action of the drug and idiosyncrasy, which may result from a genetic metabolic or enzyme deficiency. Miscellaneous reactions include the Jarisch-Herxheimer reaction, which is believed to follow release of microbial endotoxins, and the infectious mononucleosis–ampicillin reaction, the exact mechanism of which is unknown.2–4
Iatrogenic and Occupational Fever
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
An additional mechanism for production of fever by medication administration includes the pharmacologic action of the drug itself. The Herxheimer reaction, seen after penicillin administration for the treatment of syphilis, includes fever, chills, and sometimes exacerbation of the underlying disease, such as accentuation of the rash of secondary syphilis or focal neurologic symptoms. Attributed to the spirochetocidal effect of the penicillin, it has been explained by some investigators as due to entotoxin release. The Herxheimer reaction is not unique to syphilis, as it may be seen in treatment of other spirochetal diseases and some bacterial infections, i.e., brucellosis. The pharmacologic action of chemotherapeutic agents in the treatment of malignancy may also result in a febrile response, and this may be the result of liberation of endogenous pyrogen from destruction of tumor cells.
Ocular Syphilis as a Cause of Chronic Postoperative Uveitis Followed by a Localized Ocular Jarisch–Herxheimer-like Reaction
Published in Ocular Immunology and Inflammation, 2023
Parsha Forouzan, David Fell, Freddie R. Jones
Treatment of syphilis can cause a temporary exacerbation of localized and systemic symptoms, usually within the first 24 hours of treatment. This well-established phenomenon has been termed the Jarisch–Herxheimer reaction (JHR) and is attributed to the lysis of spirochetes and subsequent release of inflammatory mediators, namely TNF-α, IL-6, and IL-8. Localized symptoms can vary greatly among patients, while most will experience systemic symptoms such as fever, chills, rigors, headache, tachycardia, and nausea or vomiting. Moreover, the JHR is most observed in patients with primary and secondary syphilis and is rare in late syphilis.7–9 The patient in this case report developed chronic postoperative uveitis after uncomplicated cataract surgery, which we attributed to syphilis. The case is notable as a rare example of syphilis as an etiology of chronic postoperative uveitis,10,11 as well as the first to suggest a localized ocular Jarisch–Herxheimer-like reaction.
Systemic Miltefosine as an Adjunct Treatment of Progressive Acanthamoeba Keratitis
Published in Ocular Immunology and Inflammation, 2021
Andrea Naranjo, Jaime D. Martinez, Darlene Miller, Rahul Tonk, Guillermo Amescua
Oral MLT appears to be a useful adjunctive therapy for some cases of severe, recalcitrant AK. Nevertheless, in other cases, it may be associated with a rapid and destructive inflammatory reaction in the cornea and anterior chamber. This phenomenon was also reported in a pilot study using topical MLT for AK. Bagga et al. described an initial inflammation outburst shortly after beginning treatment with topical MLT in all of the five patients treated, with three patients requiring a TPK and one requiring evisceration.1 Even though the mechanism for the inflammatory reaction following MLT initiation is unclear, we hypothesize it may be related to increased immunological activity against antigenic material released during the Acanthamoeba cell death. This reaction could be mimicking the Jarisch–Herxheimer reaction following treatment of syphilis, caused by the cytokines released during spirochete clearance from the circulation.28
Syphilitic meningomyelitis misdiagnosed as spinal cord tumor: Case and review
Published in The Journal of Spinal Cord Medicine, 2021
Huiqing Dong, Zheng Liu, Yunyun Duan, Dawei Li, Zhandong Qiu, Yaou Liu, Jing Huang, Chaodong Wang
Spinal MRI revealed swelling and diffuse high-signal intensity of the thoracic spinal cord parenchyma except T6-7 level with associated focal gadolinium at T6-7 level (“flip-flop sign”, Figs. 1 and 2). In T10 level, peripheral strip-like enhancement at the surface the spinal cord was shown on T1WI (“candle guttering appearance”, Fig. 2). Brain MRI was normal. The thoracic spinal cord lesion improved significantly after three-day dexamathosone treatment. She was diagnosed as probable syphilitic meningomyelitis based on clinical and imaging features and laboratory examinations. Patient received treatment with intravenous penicillin G 4 million units every 4 h for 14 days and dexamathosone 5 mg/d for 3 days before penicillin to prevent Jarisch-Herxheimer reaction (2015-4-29). Symptoms improved by day seven. By day 12 after treatment, her neurological examination showed normal muscle strength, right flexor plantar response and positive Romberg test. And the follow-up MRI showed limited cord lesion of T6-7 with a slight enhancement. Six months after treatment, she had complete clinical recovery.