Abstract
BackgroundLeptospirosis is an endemo-epidemic zoonotic disease associated with potentially fatal renal, cardiovascular or pulmonary failure. Recommended treatment includes antibiotics, which may induce a Jarisch-Herxheimer reaction (JHR). Since little information on the importance of this adverse event is available, we performed this review to quantify frequency and impact of JHR in leptospirosis management.Methodology/Principal FindingsThis review systematically summarizes the literature on the JHR in leptospirosis. To approach the broader aspects of the subject, articles considering the treatment of leptospirosis, national leptospirosis guidelines and textbook and technical reports of the World Health Organisation were reviewed. Publications describing JHR in leptospirosis are very limited and consist mainly of single case reports and small case series. A single randomized control trial specifically assessed the JHR occurrence, but it has never been systematically investigated in large trials. Not all guidelines and not all literature on leptospirosis mention this reaction which can be fatal.Conclusions/SignificanceAlthough generally assumed to be a rare event, the true prevalence of JHR in leptospirosis is unknown and the awareness of this event is insufficient. All leptospirosis guidelines and local leptospirosis protocols should stress on systematic monitoring for clinical status early after antibiotic administration. Large well designed studies are required to precise the incidence and the impact of JHR as well as the severity and rates between various antibiotics.
Highlights
All leptospirosis guidelines and local leptospirosis protocols should stress on systematic monitoring for clinical status early after antibiotic administration
Leptospirosis is a widespread zoonotic disease of worldwide distribution caused by pathogenic Leptospira, a spirochetal organism that is transmitted to humans by exposure to urine of infected mammalian reservoirs such as rodents or wild and domestic animals [1]
In order to quantify frequency and impact of Jarisch-Herxheimer reaction (JHR) in leptospirosis, we systematically reviewed the published literature and put it in a broader perspective, identifying data gaps that should be addressed
Summary
Leptospirosis is a widespread zoonotic disease of worldwide distribution caused by pathogenic Leptospira, a spirochetal organism that is transmitted to humans by exposure to urine of infected mammalian reservoirs such as rodents or wild and domestic animals [1]. The disease has a wide-ranging clinical spectrum from asymptomatic forms to severe presentations The latter are estimated to occur in 5–15% of all human infections and commonly combine jaundice, renal failure, myocarditis and/or haemorrhage [2] with a significant mortality rate. Initiation of chemotherapy in spirochetal diseases may precipitate a febrile inflammatory reaction [6,7], known as the JarischHerxheimer reaction (JHR), originally described in patients with syphilis receiving mercury treatment [8,9]. This reaction is characterised by an acute inflammatory response associated with the release of large amounts of cytokines, resulting from clearance of spirochetes from the circulation [6,7]. Since little information on the importance of this adverse event is available, we performed this review to quantify frequency and impact of JHR in leptospirosis management
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