From the Guidelines
The Jarisch-Herxheimer reaction, which can occur during treatment of leptospirosis, is an inflammatory response that should be managed with supportive care, including antipyretics like acetaminophen and adequate hydration, while continuing antibiotic treatment. I cannot provide information about "Jarich hersheimer leptospirosis" as this appears to be a misunderstanding or misspelling. You may be referring to the Jarisch-Herxheimer reaction, which can occur during treatment of leptospirosis. The Jarisch-Herxheimer reaction is an inflammatory response that can happen when treating certain bacterial infections, including leptospirosis, with antibiotics. When antibiotics rapidly kill large numbers of bacteria, they release endotoxins that trigger this reaction, characterized by fever, chills, headache, and temporary worsening of symptoms. This reaction typically occurs within hours of starting antibiotic therapy for leptospirosis. Some key points to consider in the management of leptospirosis include:
- Early treatment with antibiotics such as penicillin and tetracycline is thought to be effective during the bacteraemic phase, as suggested by 1
- Patients presenting with classical symptoms and signs of Weils disease, such as jaundice, can become very unwell despite therapy and may require renal or liver support, highlighting the importance of close monitoring and supportive care
- A systematic review of antibiotic effectiveness in established leptospirosis showed no benefit for antibiotic treatment based on three trials, but most infectious disease specialists continue to recommend antibiotics, whilst accepting that severe disease is probably immunologically mediated, as noted in 1 Management of the Jarisch-Herxheimer reaction includes:
- Supportive care with antipyretics like acetaminophen
- Adequate hydration
- Continuing the antibiotic treatment The reaction is self-limiting and usually resolves within 24-48 hours, but patients should be monitored closely during this period, especially those with severe leptospirosis, as the reaction can occasionally cause significant hypotension or organ dysfunction.
From the Research
Jarisch-Herxheimer Reaction in Leptospirosis
- The Jarisch-Herxheimer reaction (JHR) is a potential complication of leptospirosis treatment, characterized by a temporary worsening of symptoms after antibiotic administration 2, 3, 4, 5, 6.
- The true prevalence of JHR in leptospirosis is unknown, but it is estimated to occur in around 21% of patients, with higher rates in certain regions 4.
- Risk factors for JHR include the infecting strain of Leptospira, such as Leptospira interrogans serogroup Australis, and delays in antibiotic treatment 4.
- The pathogenesis of JHR is thought to involve the release of pro-inflammatory cytokines, such as tumor necrosis factor, and spirochetal lipoproteins, leading to an inflammatory response 5, 6.
- Symptoms of JHR can include shaking chills, fever, intensification of skin rashes, and in severe cases, uterine contractions, worsening liver and renal function, and respiratory distress syndrome 3, 6.
- Treatment of JHR consists of general clinical support, with specific measures such as oxpentifylline therapy potentially playing a role in the future 5.
- Clinicians should be aware of JHR as a potential complication of leptospirosis and monitor patients closely after antibiotic administration 2, 4.