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Hello ! Short Qestion About Herxheimer S Reaction And Local

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Posted on Tue, 24 Jan 2023
Question: Hello !
short qestion about Herxheimer's reaction and local inflammation - in Syphilis as they can make local damage !

can it be effecive treated with corticosteroides and prevent long term complicatuons ?

from literature !

It is customary to give corticosteroids in late symptomatic syphilis, starting a day before the first penicillin injection and tailing it off the day after the first injection. A dose of around 30 mg prednisolone is typical. This does not prevent the Jarisch-Herxheimer reaction but is said to ameliorate it

doctor
Answered by Dr. Sankaranantham Murugan (33 hours later)
Brief Answer:
JHR is rare and usually very mild, doesn't warrant any treatment mostly

Detailed Answer:
Hi,
Welcome to ASK A DOCTOR through HCM.
Thanks for posting your query.
Jarisch Herxheimer reaction is rarely seen nowadays.
JH reaction is more common in early syphilis rather than Late syphilis.
Even among late syphilis, only during the treatment of Paralysis of Insane and Cardiovascular syphilis only prior steroids are indicated to avoid serious complications which are all not at all seen in the recent decades.
In early syphilis, JH reaction, if occurs, will manifest with mild symptoms like fever, head ache and malaise which usually don't need any treatment. If at all, one or two tablets of paracetamol only may be necessary.
So, not to give much importance about JH reactions. Your Physician will take care of the same, if there is one.
Dr S. XXXXXXX
Above answer was peer-reviewed by : Dr. Saisudha Kotla
doctor
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Follow up: Dr. Sankaranantham Murugan (5 days later)
Thak you very much !

1.So it is self limiting and this reaction is treated at home ?

And as i undestand death is very rare !

as from lierature !
The Jarisch-Herxheimer reaction, a common occurrence in the treatment of acquired early syphilis in adults,385 consists of chills, fever, generalized malaise, hypotension, tachycardia, tachypnea, accentuation of the cutaneous lesions, leukocytosis, and, exceedingly rarely, death

https://www.sciencedirect.com/topics/medicine-and-dentistry/jarisch-herxheimer-reaction

2. And neirologic involment is very rare in this reaction !
And as i inderstand they all recovery during Syphis early stage !


Although rare, neurological signs can present as part of the Jarisch-Herxheimer reaction. The authors report a case of Bell's palsy experienced by a patient shortly after treatment with penicillin for secondary syphilis and propose that this acute unilateral peripheral facial paralysis was a Jarisch-Herxheimer reaction in response to therapy.

https://pubmed.ncbi.nlm.nih.gov/0000/
doctor
Answered by Dr. Sankaranantham Murugan (2 hours later)
Brief Answer:
The incidence of JHR is very less nowadays.

Detailed Answer:
Hi,
Welcome back.
The symptoms of Jarisch Herxheimer reaction ( as explained by you) may occur 4 to 6 hours after the first injection of potent anti-treponemal drugs, especially after Penicillin shot and as mentioned by you, it is a self limiting one and lasts not more than 12 hours, rarely 24 hours.
I am practicing STI Medicine since more than 40 years. In my experience, JHR is encountered in less than 20% of my patients treated for syphilis nowadays. Even among these 20%, Patients need treatment for JHR are less than 2%. Most of them need not even Paracetamol tablets. By the time they reported the symptoms would have been subsided.
Fortunately, I didn't come across any serious adverse effect while treating the late syphilis cases. The reported cases of neurological complications are just alerting the physicians to be aware of these complications and if came across one such case to think of this possibility.
At the same time, I prefer to put my patients on prior steroids while managing late manifested cases and not with late latent syphilis.
Dr S. Murugan
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Sankaranantham Murugan (3 hours later)
Can you please answer by points - that i better understand answers !

1. so there is no death to JHR and syphilis !
or very rare !

2. As you say less than 2 % need treatment for JHR
it is home treatment - or hospital treatment !
And outcome in these cases are good ?

3. in literature its said ! that some forme can cause problems - but as i understand from you it could be treated and prevented with corticostroides. And eye problems could be cured with no long term effect !
am i right ?

It may be serious in some forms of syphilis, including paretic neurosyphilis, syphilis in pregnancy, and when sites where local inflammation can cause serious functional compromise are affected, such as the eyes, inner ear, and cranial nerves (Brown, 1976


https://www.sciencedirect.com/topics/medicine-and-dentistry/jarisch-herxheimer-reaction

4.JHR symptoms that cause neurological sign recovery after treatment ! It is so ?

Although rare, neurological signs can present as part of the Jarisch-Herxheimer reaction. The authors report a case of Bell's palsy experienced by a patient shortly after treatment with penicillin for secondary syphilis and propose that this acute unilateral peripheral facial paralysis was a Jarisch-Herxheimer reaction in response to therapy.

https://pubmed.ncbi.nlm.nih.gov/0000/

doctor
Answered by Dr. Sankaranantham Murugan (7 hours later)
Brief Answer:
JHR are mostly preventable only

Detailed Answer:
Hi,
Welcome back.
1. Death due to JHR is extremely rare.
2. In my cases, I have not come across a case of JHR need to be hospitalized so far.
3. Even though incidence of syphilis has an upsurge once again in the recent years, still the manifested late syphilis, especially Neuro syphilis, cardiovascular syphilis and ocular syphilis are rare to be present.
If we come across one such case, it is always better to start systemic steroids prior to treatment.
4. JHR would not be difficult to recognize earlier. So most of the complications can be reverted if treated promptly.
Dr S Murugan
Above answer was peer-reviewed by : Dr. Saisudha Kotla
doctor
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Follow up: Dr. Sankaranantham Murugan (32 hours later)
Thank you very much for good answers !

So even eye problems from JHR could be effective treated !

Have a nice day !
doctor
Answered by Dr. Sankaranantham Murugan (1 hour later)
Brief Answer:
You are most welcome

Detailed Answer:
Hi,
Welcome back.
Your queries were different and more scientific. Congratulations.
DR S. Murugan
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Sankaranantham Murugan (3 hours later)
Thank you very much !

Sorry it was more like a question - as i understand from your answer i am right - eye problems form JHR could be effective treated !
Am i right !

Thank you very much !
doctor
Answered by Dr. Sankaranantham Murugan (2 hours later)
Brief Answer:
It will not be difficult to tackle ocular complications due to JHR

Detailed Answer:
Hi,
Welcome back.
As I had mentioned already, in case of late manifested syphilis, it is always safer to use steroids before instituting anti-syphilitic treatment, thereby we can prevent ocular complications due to JHR.
In case of early syphilis, when we suspected ocular problems due to JHR, early intervention will always be able to revert the ocular manifestations back to normal. If it was not recognized till was getting late, then there may be an irreversible loss of vision can occur. I am yet to see one such complication.
Dr S. Murugan
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Sankaranantham Murugan

HIV AIDS Specialist

Practicing since :1974

Answered : 3109 Questions

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Hello ! Short Qestion About Herxheimer S Reaction And Local

Brief Answer: JHR is rare and usually very mild, doesn't warrant any treatment mostly Detailed Answer: Hi, Welcome to ASK A DOCTOR through HCM. Thanks for posting your query. Jarisch Herxheimer reaction is rarely seen nowadays. JH reaction is more common in early syphilis rather than Late syphilis. Even among late syphilis, only during the treatment of Paralysis of Insane and Cardiovascular syphilis only prior steroids are indicated to avoid serious complications which are all not at all seen in the recent decades. In early syphilis, JH reaction, if occurs, will manifest with mild symptoms like fever, head ache and malaise which usually don't need any treatment. If at all, one or two tablets of paracetamol only may be necessary. So, not to give much importance about JH reactions. Your Physician will take care of the same, if there is one. Dr S. XXXXXXX