Praxis Medica
Sign in
Issue image

More articles from Volume 49, Issue 1, 2020

Relationship between ACR and other determinants of microalbuminuria in T2DM patients

Uticaj porođajne mase i aktuelne težine deteta na nastanak prevremenog puberteta

Frequency and histological-cytological correlation of premalignant and malignant changes in the cervix in women of different ages

Errors and artifacts on radiographs

Strategije suočavanja sa anksioznošću u situaciji testiranja engleskog jezika kod studenata visokog i niskog samopoštovanja

Jarisch-Herxheimer reaction during therapy of neuroborreliosis

Snežana Knežević Orcid logo ,
Snežana Knežević
View authors publications

Search this author on:

PubMed | Google Scholar
Jelena Vulović ,
Jelena Vulović
View authors publications

Search this author on:

PubMed | Google Scholar
Marijana Jandrić-Kočić
Marijana Jandrić-Kočić
View authors publications

Search this author on:

PubMed | Google Scholar

Published: 01.12.2019.

Volume 49, Issue 1 (2020)

pp. 49-52;

https://doi.org/10.5937/pramed2002049k

Abstract

Introduction. Jarisch-Herxheimer reaction implies trembling, headache, temperature, rash, meningitis, respiratory problems, liver, kidney and heart dysfunction during antibiotic treatment of Lyme disease. Case outline. A 47-year-old patient in May 2016 had circular redness on the thigh, fatigue, myalgia, nausea and headache. Borrelia Burgdorferi IgM antibodies were positive. She took doxycycline 200 mg/day, four weeks. Western blot IgM and IgG were positive as well. Retreated with Azithromycin, 500 mg/day, three weeks. Next year, there was a sleep and memory disorder, fatigue, dizziness, right leg paresthesia and burning in the soles, muscle weakness, decreased sensitivity and right foot hyperreflexia. Electromyography showed axonal degeneration of the peroneus and the tibialis. Pleocytosis (5 leucocytes/mm³) and intrathecal IgG were found. Magnetic resonance of the head in order. Neuroborreliosis was diagnosed and treatment included ceftriaxone, 2 grams/day, three weeks. After the second dose, trembling, myalgia, headache, nausea, flushed nose, dizziness and nausea started. Temperature 37.8°C. No changes on the skin. The antibiotic was not interrupted, symptomatic therapy was administered, and after two days the symptoms stopped. Neurological disorders have not completely disappeared. Titre antibodies still present. Conclusion. Jarisch-Herxheimer reaction occurs in 7.0-30.0% of patients treated for Lyme disease. Causes are multifactorial. Spirochetes release toxins, hypersensitivity is present, phagocytes destroy agents, complements and cytokines are activated. It is often not recognized. Tremor, fever, myalgia and skin rashes are present before the antibiotic, and the worsening is attributed to the underlying disease or allergy. Doctors should expect it during the treatment of spirochete-related diseases and provide appropriate care.

References

1.
Belum GR, Belum VR, Chaitanya Arudra SK, Reddy BSN. The Jarisch–Herxheimer reaction: Revisited. Vol. 11, Travel Medicine and Infectious Disease. 2013. p. 231–7.
2.
Takamizawa S, Gomi H, Shimizu Y, Isono H, Shirokawa T, Kato M. Leptospirosis and Jarisch–Herxheimer reaction: Table 1. Vol. 108, QJM. 2015. p. 967–8.
3.
Gallardo C, Williams-Smith J, Jaton K, Asner S, Cheseaux JJ, Troillet, et al. Leptospirosis in a family after whitewater rafting in Thailand. Vol. 11. 2015. p. 872–6.
4.
Nizič T, Velikanje E, Ružić-Sabljić E, Arnež M. Solitary erythema migrans in children: comparison of treatment with clarithromycin and amoxicillin. Vol. 124, Wiener klinische Wochenschrift. 2012. p. 427–33.
5.
Dhakal A, Reaction SEJH. 2020.
6.
Butler T. The Jarisch–Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. Vol. 96, The American Journal of Tropical Medicine and Hygiene. 2017. p. 46–52.
7.
Luft BJ, Gorevic PD, Halperin JJ, Volkman DJ, Dattwyler RJ. A Perspective on the Treatment of Lyme Borreliosis. Vol. 11, Clinical Infectious Diseases. 1989. p. S1518–25.
8.
Butler T, Aikawa M, Habte-Michael A, Wallace C. Phagocytosis of Borrelia recurrentis by blood polymorphonuclear leukocytes is enhanced by antibiotic treatment. Vol. 28, Infection and Immunity. 1980. p. 1009–13.
9.
Kadam P, Gregory NA, Zelger B, Carlson JA. Delayed Onset of the Jarisch–Herxheimer Reaction in Doxycycline-Treated Disease. Vol. 37, The American Journal of Dermatopathology. 2015. p. e68–74.
10.
Lyme borreliosis: biology, epidemiology and control. 2002.
11.
Guerrier G, D’Ortenzio E. The Jarisch-Herxheimer Reaction in Leptospirosis: A Systematic Review. Vol. 8, PLoS ONE. p. e59266.
12.
Ristanović E, Atanasievska S, Protić-Đokić V, Hinić H, Lalošević D. Mikrobiološka detekcija Borrelia burgdorferi i savremena dijagnostika Lajm borelioze. Vol. 9. 2017. p. 143–7.
13.
Robinson JM, Pilot-Matias TJ, Pratt SD, Patel CB, Bevirt TS, Hunt JC. Analysis of the humoral response to the flagellin protein of Borrelia burgdorferi: cloning of regions capable of differentiating Lyme disease from syphilis. Vol. 31, Journal of Clinical Microbiology. 1993. p. 629–35.
14.
Maloney EL. Controversies in Persistent (Chronic) Lyme Disease. Vol. 39, Journal of Infusion Nursing. 2016. p. 369–75.
15.
Waddell LA, Greig J, Mascarenhas M, Harding S, Lindsay R, Ogden N. The Accuracy of Diagnostic Tests for Lyme Disease in Humans, A Systematic Review and Meta-Analysis of North American Research. Vol. 11, PLOS ONE. p. e0168613.
16.
Henningsson AJ, Gyllemark P, Lager M, Skogman BH, Tjernberg I. Evaluation of two assays for CXCL13 analysis in cerebrospinal fluid for laboratory diagnosis of Lyme neuroborreliosis. Vol. 124, APMIS. 2016. p. 985–90.
17.
Ogrinc K, Lotrič-Furlan S, Maraspin V, Lusa L, Cerar T, Ružič-Sabljič E, et al. Suspected Early Lyme Neuroborreliosis in Patients With Erythema Migrans. Vol. 57, Clinical Infectious Diseases. 2013. p. 501–9.
18.
Dersch R, Sommer H, Rauer S, Meerpohl JJ. Prevalence and spectrum of residual symptoms in Lyme neuroborreliosis after pharmacological treatment: a systematic review. Vol. 263, Journal of Neurology. 2016. p. 17–24.
19.
Kiurski-Petrov M, Zubanov V, Živanović S. Interpersonal communication skills in the general practitioners work. Vol. 24, Opsta medicina. 2018. p. 1–15.
20.
Stanek G, Wormser GP, Gray J, Strle F. Lyme borreliosis. Vol. 379, The Lancet. 2012. p. 461–73.
21.
Rac MWF, Greer LG, Wendel GD. Jarisch-Herxheimer Reaction Triggered by Group B Streptococcus Intrapartum Antibiotic Prophylaxis. Vol. 116, Obstetrics & Gynecology. 2010. p. 552–6.

Citation

Copyright

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Most read articles

Indexed by
DOAJ
Google Scholar
ERIHPLUS
MIAR I
Crossref