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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.
Syphilis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
The Jarisch–Herxheimer reaction is an acute febrile reaction frequently accompanied by headache, myalgias, and other symptoms that usually occurs within the first 24 hours after any therapy for syphilis. It occurs most often in early disease—especially primary—and is thought to represent massive lysis of treponemes. The reaction begins within 1–2 hours of treatment, peaks at 8 hours, and typically resolves within 24–48 hours. It occurs in up to 45% of pregnant women treated for syphilis. The Jarisch–Herxheimer reaction may induce labor or cause fetal distress in pregnant women; however, these concerns should not prevent or delay therapy.
Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
When treating any form of Lyme disease, clinicians should be aware of the risk for the Jarisch–Herxheimer reaction. Up to 15% of patients experience a transient worsening of symptoms in the first 24 hours of therapy, which results from the host inflammatory reaction to dying spirochetes.
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.
Ocular Syphilis: Experience over 11 Years at a German Ophthalmology Reference Centre
Published in Ocular Immunology and Inflammation, 2023
R. Yaici, A. Balasiu, C.R. MacKenzie, M. Roth, K. Beseoglu, C. Holtmann, G. Geerling, R. Guthoff
26/32 patients (81.3%) received systemic syphilis therapy. Penicillin G (3x10 Mio. U i.v daily for 21 days) was administered to nine patients (28.1%) and Benzathine penicillin G (2.4 Mio. U i.m) to four (12.5%) patients. Due to a suspected penicillin allergy, eight patients (25%) received ceftriaxone 2 g i.v daily for 14 days. Three patients (9.4%) received sequential therapy with penicillin G (3x10 Mio. U daily) for 21 days followed by ceftriaxone (2 g daily) for 14 days due to the lack of clinical improvement. One was treated with clindamycin 300 mg orally four times daily, for clinically suspected ocular toxoplasmosis, and one was treated with ceftriaxone 2 g/d and vancomycin 2 g i.v for suspected bacterial endophthalmitis. Seven patients (21.9%) received prednisolone to prevent a Jarisch-Herxheimer reaction (1 mg/kg body weight). 6/12 cases of Syphilis satis curata were treated locally with mydriatic drugs and prednisolone acetate 1%. The main side effect was Jarisch-Herxheimer reaction, followed by penicillin allergy and steroid-induced folliculitis.
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