Jarisch-Herxheimer Research Articles

[Translated article] Jarisch–Herxheimer Reaction to Topical Ivermectin in Demodicosis?

[Translated article] Jarisch–Herxheimer Reaction to Topical Ivermectin in Demodicosis?

Efficacy and safety of antibiotics for treatment of leptospirosis: a systematic review and network meta-analysis

BackgroundLeptospirosis, an important zoonotic bacterial disease, commonly affects resource-poor populations and results in significant morbidity and mortality worldwide. The value of antibiotics in leptospirosis remains unclear, as evidenced by the conflicting opinions published.MethodsWe conducted a search in the PubMed, Web of Science, and Cochrane Library databases for studies. These studies included clinical trials and retrospective studies that evaluated the efficacy or safety of antibiotics for leptospirosis treatment. The primary outcomes assessed were defervescence time, mortality rate, and hospital stays. Subgroup analyses were performed based on whether there were cases involving children and whether there were cases of severe jaundice. Safety was defined as the prevalence of adverse events associated with the use of antibiotics. p scores were utilized to rank the efficacy of the antibiotics.ResultsThere are included 9 randomized controlled trials (RCTs), 1 control trial (CT), and 3 retrospective studies (RS) involving 920 patients and 8 antibiotics. Six antibiotics resulted in significantly shorter defervescence times compared to the control, namely cefotaxime (MD, − 1.88; 95% CI = − 2.60 to − 1.15), azithromycin (MD, − 1.74; 95% CI = − 2.52 to − 0.95), doxycycline (MD, − 1.53; 95% CI = − 2.05 to − 1.00), ceftriaxone (MD, − 1.22; 95% CI = − 1.89 to − 0.55), penicillin (MD, − 1.22; 95% CI = − 1.80 to − 0.64), and penicillin or ampicillin (MD, − 0.08; 95% CI = − 1.01 to − 0.59). The antibiotics were not effective in reducing the mortality and hospital stays. Common adverse reactions to antibiotics included Jarisch–Herxheimer reaction, rash, headache, and digestive reactions (nausea, vomiting, diarrhea, abdominal pain, and others).ConclusionsFindings recommend that leptospirosis patients be treated with antibiotics, which significantly reduced the leptospirosis defervescence time. Cephalosporins, doxycycline, and penicillin are suggested, and azithromycin may be a suitable alternative for drug-resistant cases.Systematic review registrationPROSPERO CRD42022354938.

An observational prospective study based on a large cohort of HIV-negative neurosyphilis patients with particular reference to the Jarisch-Herxheimer reaction.

The purpose of this study is to outline a complete picture of Jarisch-Herxheimer reaction (JHR) in the central nervous system among HIV-negative neurosyphilis patients. A prospective study cohort of 772 cases with almost all stages of neurosyphilis depicted the features of JHR including occurrence rate, risk profiles, clinical manifestations, medical management and prognosis. The total occurrence rate of JHR was 9.3% (95% CI, 7.3-11.4%), including 4.1% (95% CI, 2.7-5.6%) with severe JHR. The reaction started 5h after treatment initiation, peaked after 8h, and subsided after 18h. Patients with severe JHR experienced a longer recovery time (26h). Patients with general paresis (OR = 6.825), ocular syphilis (OR = 3.974), pleocytosis (OR = 2.426), or a high CSF-VDRL titre (per log2 titre increase, OR = 2.235) were more likely to experience JHR. Patients with general paresis had an 11.759-fold increased risk of severe JHR. Worsening symptoms included cognitive impairment, mania, nonsense speech, and dysphoria, while symptoms of hallucination, urination disorder, seizures, myoclonus, or aphasia appeared as new-onset symptoms. Neurosyphilis treatment did not need to be interrupted in most patients with JHR and could be reinstated in patients with seizures under supportive medication when JHR subsided. Severe JHR displayed a 4.1% occurrence rate and clinicians should pay particular attention to patients at a higher risk of JHR. The neurosyphilis treatment regime can be restarted under intensive observation for patients with severe JHR and, if necessary, supportive medication should be initiated and continued until the end of therapy.

Jarisch-Herxheimer reaction in a patient with Weil's disease.

Jarisch-Herxheimer reaction in a patient with Weil's disease.

Meteoric effect of meropenem: an unrevealed case report on Jarisch Herxheimer reaction

Jarisch Herxheimer Reaction is an immune mediated, self- limited reaction that releases endotoxins from the spirochetes. It occurs due to an acute inflammatory response when lipoproteins, owing to their entry into the patient's bloodstream, cause an increase in inflammatory cytokines during the period of exacerbation, resulting in body aches, fevers, rashes, nausea and vomiting, and flushing, along with other symptoms. These symptoms usually begin within 2 hours after the administration of the antibiotics. We represent a 76-year-old male patient who has had a known case of recurrent urinary tract infections since 2017 and was recently diagnosed with urosepsis and syphilis after being administered an injection of Meropenem, wherein he developed a Jarisch Herxheimer Reaction. The causality assessment revealed a Naranjo score of 7, indicating a probable adverse drug reaction. This patient was treated with intravenous antihistamines and corticosteroids for its management. Benzathine penicillin was avoided owing to the previous suspected Jarisch Herxheimer Reaction. None of the studies reported that Meropenem could contribute to such a reaction. All healthcare professionals should maintain a high alert of suspicion and be aware of antibiotic induced Jarisch Herxheimer Reaction symptoms and their management to avoid life threatening conditions.

The Jarisch-Herxheimer Reaction on Secondary Syphilis Patient with Roseola Syphilitica and Human Immunodeficiency Virus Co-Infection: A Case Report

Background: The Jarisch-Herxheimer reaction is an inflammatory reaction that occurs within 12 hours after administration of antibiotic therapy for spirochaeta species like Treponema pallidum. The reaction includes fever, headache, reappearing or worsening of skin lesions, lymphadenopathy, pharyngitis, malaise, and myalgias.
 Case presentation: We present a 27-year-old man complaining of high fever 4 hours after the injection of benzathine penicillin. The patient also complained of headaches, body aches and aches. There were no complaints of shortness of breath, itching, skin blisters, red eyes, or sores on the genitals. History of take any medication was denial by the patient. After treatment by giving antipyretics and corticosteroids and getting enough rest, in the 24 hours, the patient was improved.
 Conclusion: The Jarisch-Herxheimer reaction is an inflammatory reaction that occurs after the administration of antibiotic therapy for spirochaeta species like Treponema pallidum.

A late-onset leg rash, unique Janeway lesions or Jarisch-Herxheimer reaction? A case report

Jarisch-Herxheimer reactions typically manifest as a response to antimicrobial therapy for spirochete infections, although these reactions have also been documented following treatment of other microbes. Almost always occurring within 24 hours of treatment initiation, Jarisch-Herxheimer reactions can cause hypotension, fevers, chills, headaches, myalgia, skin rashes, and exacerbations of existing skin lesions, among others; the most feared complication from such reactions is shock. They are usually transient and self-limiting but can cause significant discomfort and concern for patients. Treatment is usually supportive, consisting mostly of nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, and intravenous fluids. Reactions with delayed onset are exceedingly rare, and to our knowledge, have been documented only one other time in literature. In this clinical vignette, we present a case in which a patient developed what we initially suspected to be Janeway lesions; however, the presence of systemic symptoms suggest that what was observed was delayed-onset Jarisch-Herxheimer reaction 16 days after initiation of antibiotics.

Use of ceftriaxone as an alternative treatment method in pregnant women diagnosed with syphilis - a single centre experience.

There are few data on the use of ceftriaxone in pregnant women diagnosed with syphilis. The aim of this study was to investigate the safety and efficacy of ceftriaxone as an alternative treatment option for syphilis during pregnancy. A retrospective analysis of 79 pregnant women diagnosed with syphilis and treated with ceftriaxone was conducted. No cases of intolerance, Jarisch-Herxheimer reactions, or allergic reactions were recorded. The average time to seronegativation for secondary syphilis with symptoms was 6.14months ± 2.76, and for latent forms, it was 7.52months ± 1.84. Patients received no additional treatment. No serious adverse drug reactions were reported. Data from our study support the use of ceftriaxone as an effective and safe alternative treatment for pregnant women diagnosed with syphilis when penicillin therapy is contraindicated or unavailable.

Eponyms that honor Jewish dermatologists: A celebration and a remembrance, Part two: Jewish physicians who practiced between 1933 and 1945

This is the second installment of a three-part contribution that highlights the achievements of Jewish dermatologists as reflected by eponyms that honor their names. It covers the period 1933-1945 when the Nazis took over Germany and how the lives of 14 notable Jewish physicians, mostly in Germany, were impacted during the Holocaust. Many of them fled from the persecution, bringing their academic talents to other lands such as the United States. At least one committed suicide (Fritz Juliusberg), and three others perished in the Holocaust (Abraham Buschke, Lucja Frey-Gottesman, and Karl Herxheimer). They are remembered by eponyms including Neisser-Juliusberg pityriasis lichenoides chronica, Buschke-Ollendorff syndrome, Frey syndrome, and Jarisch-Herxheimer reaction. It made little difference to the Nazis that several of the 14 physicians had converted to Christianity. All were persecuted by the Nazis and had their professional careers destroyed. Two of the 14 physicians lived outside of the Third Reich (Bruno Bloch and Emanuel Libman) and were spared the suffering endured by the other 12. This tragic account of Jewish dermatologists during the Holocaust, and the eponyms that honor them, will continue in part three of this contribution.

CPC04 A rare rupioid rash

Abstract A 59-year-old man was referred to an urgent skin cancer dermatology clinic with a 4-month history of multiple skin lesions on his trunk, arms and face. The lesions were painful, increasing in size, bleeding and oozing serous fluid. The patient reported being otherwise systemically well, with a history of mild eczema and a background of high alcohol intake. On examination, he had a striking rash with numerous large rupioid plaques with thick crusting and surrounding erythema on the trunk and limbs. Smaller plaques were seen on the face and neck. An infective aetiology was favoured with an initial differential diagnosis of ecthyma or atypical mycobacterial infection. A biopsy was taken, as well as screening blood tests. Treponemal antibodies were detected; rapid plasma reagin was reactive (1 : 32), as was Serodia Treponema pallidum particle agglutination test (1 : 1280), suggesting active syphilis infection. His biopsy demonstrated granulomatous inflammation, associated with neutrophils, plasma cells and increased mucin deposition. Immunohistochemical staining for T. pallidum confirmed corkscrew-like organisms within the basal epidermis and upper dermis, consistent with secondary syphilis; screening for concurrent HIV infection was negative. The patient was referred to a local genitourinary clinic for treatment with benzylpenicillin and for full sexual health screening. The word ‘rupioid’ describes oyster or limpet shell-shaped thick keratotic lesions and is derived from the Greek word rhupos, meaning ‘filth’. Differential causes for rupioid lesions include cutaneous T-cell lymphoma, psoriasis, scabies and syphilis. Rupioid syphilis is also termed ‘malignant syphilis’ or ‘Lues maligna’, describing well-demarcated plaques with thick, lamellate and adherent crusts. It is most frequently encountered in HIV-positive patients; in HIV-negative patients, the associated comorbidities are diabetes, alcoholism, drug abuse, psoriasis and hepatitis. Typically, there is rapid clinical improvement once antibiotic treatment is administered, but episodes of Jarisch Herxheimer reaction are reported. Syphilis diagnoses have tripled over the last 10 years, with cases in the heterosexual population rising most rapidly. Dermatologists have a pivotal role to play in diagnosing primary and secondary syphilis, thereby preventing the long-term sequelae of tertiary syphilis and controlling the rising prevalence of the disease in the general population. This case highlights a striking and rare manifestation of secondary syphilis which, once seen, will not be forgotten.

The incidence of Jarisch-Herxheimer reactions and associated risk factors in pregnant women and nonpregnant women: A retrospective chart review at a university hospital in Japan.

Jarisch-Herxheimer reactions (JHR) is a transient adverse event that occurs during initial antimicrobial treatment for syphilis patients, and is known to develop uterine contractions and fetal distress in pregnant women complicated with syphilis. The aim of this study is to identify risk factors for JHR in patients with syphilis, and to clarify whether pregnancy status is a risk factor for JHR, and to describe the characteristics of pregnant women who develop JHR. This was a retrospective chart review in a singleton university hospital in Japan. We collected data of syphilis patients who were diagnosed and treated at department of obstetrics and gynecology, dermatology between January 2010 and May 2022. There were no validated diagnostic criteria for JHR, we defined JHR as one or more of the following in addition to raised body temperature (≧38.0°C) within 24 h of initial antibiotic treatment: headache, chills, myalgias, tachycardia (≧110 bpm), new rash. There were 30 syphilis patients. Of whom nine (30%) were pregnant women and all their neonates were not diagnosed with congenital syphilis. Five patients (17%) developed JHR at the time of initial treatment (JHR group, n=5). There was no difference between JHR group and non-JHR group (n=25) in pregnancy status. Secondary syphilis was an only significant risk factor for JHR. Two pregnant women with JHR were both treated for secondary syphilis in the third trimester of pregnancy. Pregnancy status was not a risk factor for JHR in syphilis patients. Further research is needed.

ACUTE STROKE DURING PENICILLIN DESENSITIZATION DUE TO JARISCH HERXHEIMER

<h3>Introduction</h3> Jarisch Herxheimer reaction (JHR) is a transient episode seen within 24 hours of treatment with antibiotics in patients infected by spirochetes. Although seen in 95% of patients, it occurs rarely in late or latent syphilis. The severity depends on the spirochete load. <h3>Case Description</h3> A 21-year-old female, 23 weeks pregnant, presented for penicillin desensitization as treatment of late latent syphilis. She had developed a systemic cutaneous reaction at age 2 and anaphylaxis at age 14 after exposure to penicillin. During the last dose of desensitization, she developed acute left sided weakness (2/5 power) and numbness (absent distal sensation) of her arm and leg. The infusion was stopped and she was given tissue plasminogen activator. Her CT and MRI head were negative for stroke. Her symptoms resolved 5 hours later and were attributed to Jarisch Herximer reaction. Lumbar puncture was negative for neurosyphillis. She was subsequently re-desensitized and given 2.4 million IM Benzathine penicillin Qweek for 3 weeks. She had reduction in RPR and has delivered. <h3>Discussion</h3> We report a case of focal neurologic deficits with no known stroke risk factors, from JHR during IV penicillin desensitization. JHR presentation can vary in different stages of syphilis. It is rarely seen in late or latent syphilis infection. Neurologic manifestations include convulsions or focal deficits. During desensitization, JHR symptoms can be concerning for anaphylaxis with hypotension and rash. Although it is an acute, self-limiting condition, it is important to identify JHR and to distinguish it from allergic reactions for appropriate treatment.

IS IT A HERXHEIMER REACTION OR ANAPHYLAXIS COMPLICATING USE OF PENICILLIN IN SYPHILIS TREATMENT?

<h3>Introduction</h3> Herxheimer reactions, similar to anaphylaxis, can occur after the first dose of penicillin and can be associated with dyspnea, hypotension, rash, vomiting and tachycardia. Herein we describe a case regarding a complication of syphilis treatment that was thought to be anaphylaxis, but further investigation suggested Herxheimer reaction. <h3>Case Description</h3> A 62-year-old man with a distant history of syphilis infection was seen by an outpatient ophthalmologist for 1.5 months of rapidly worsening vision in his right eye secondary to ocular syphilis. RPR testing was positive and the patient was directly admitted for treatment. The patient reported developing a reaction to penicillin more than thirty years prior which included vomiting, dyspnea, throat tightening, and a rash fitting the description of urticaria that was reflexively diagnosed as anaphylaxis at the time. Due to the 30-year history of penicillin allergy, the Allergy Immunology Service was consulted. The patient passed the indicated penicillin skin testing and challenge. On further evaluation, it was determined that he previously had rigors, fever, and chills, which were more compatible with Herxheimer Reaction. He was then started on penicillin G 4MU IV q4 hours. Fortunately, he did not develop an "ocular" Herxheimer reaction. <h3>Discussion</h3> Distinguishing anaphylaxis from a Herxheimer reaction in this patient is important for several reasons: (1) treatment can cause an ocular Herxheimer reaction, (2) avoidance of penicillin for 30 years may have led to delayed, more expensive, and less effective therapies, and (3) the cost of skin testing, challenge, and if-needed desensitization could have been avoided based on the history.

The Expansion of Lyme Disease: A Case of Infection in the Absence of Known Exposure

Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi often carried the Ixodes tick. It is associated with dermatologic manifestations, most notably the “bullseye rash” of erythema migrans. The disease can progress in stages to involve other organs such as joints, heart, and the nervous system. Lyme disease is continuing to spread, with West Virginia cases increasing dramatically in the last 2 decades. As a result, physicians are likely to encounter this disease more often, making recognition and early treatment a top priority in order to prevent potentially dangerous sequelae. We present a case of a 60-year-old man who presented with multiple erythematous annular plaques and was subsequently diagnosed with Lyme disease. He had no known exposure to ticks, was treated for Lyme Disease, and subsequently developed a Jarisch- Herxheimer reaction (JHR).

Lyme disease in a neonate complicated by the Jarisch-Herxheimer reaction.

[For the parents’ first-hand account of this experience, see www.cmaj.ca/lookup/doi/10.1503/cmaj.220945][1] KEY POINTS A 21-day-old girl presented to the emergency department of an Ontario children’s hospital in early summer with a 1-day history of rash on the left arm and 3 days of decreased

Genesis of Antibiotic Resistance (AR) LXXXIX: Turbulence Modeling(TM) of Hemodynamics in Simplified Severe Sepsis Protocol‐2 (SSSP‐2)‐NCT01663701: Global Alliance for an Integrated Data Base on Antibiotic(AR)/Antimicrobial(AMR)Susceptibility Test Interpretive Criteria (Breakpoints) (STIC), to mitigate AR Pandemic(ARP) in turn Fetter Modalities of Neuro(logy)) Psychiatry

Problem Statement and Rationale: Unpredictable nature of fluid dynamic/mechanical properties of circulation, subsequent to ERP‐EGDT, in part attributed to multiple classes of antibiotics (met. Breakdown products, adducts), administered across the globe Tx, sepsis with CC, MCC, DDx, Rx, PX., impeded the TM of ZoO @ LPE vortices, control of VKVS, BLS on ISP surpassing GCS 3‐8 to ihm. To obtain a reasonable understanding of the factors governing, antimicrobial stewardship (AS), and STIC, which are intrinsically strewn across the globe, we have completed a review focused on its effective utilization in TM of ERP‐EGDT, Tx severe sepsis: Part I: Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data; Approved Guideline‐4ed. CLSI document M39‐A4. PA; CLSI: 2014; Part II: CLSI‐M‐100‐ED31:2021 CLSI, 31st Edition, Part III: Potential approach to susceptibility testing and management of MDR pathogens by Infectious Diseases Society of America(IDSA) Guidance on the Treatment of Antimicrobial Resistant Gram‐Negative Infections, Part IV: Antimicrobial Use and Resistance (AUR) Options: Resources: protocols, data collection forms &amp; instructions, data validation, supporting materials; Part V: Implementing an Antibiotic Stewardship Program: Guidelines by the IDSA and the Society for Healthcare Epidemiology of America, Part VI: Stewardship Assist, Antimicrobial Stewardship App. Taken together, it would be reasonable to pray that premier global health agencies such as WHO, organize a “World Congress of AR‐AMR” on an annual basis where experts on AR/AMR across the globe explore/exchange ideas to mitigate ARP. Also, to reach consensus for a centralized (agency) database for reporting on the complete information from multiple stakeholders across the globe on AF, DRI, RM, STIC, and AS strategies with a renewed focus in the area of: a comprehensive report on the list of routinely tested antibiotics (from county, city, state, country, continental), susceptible, intermediate, the pandemic potential of AR pathogens, list of unused/discontinued antibiotics/antimicrobials, confirmed list of first AR bacterial pathogen isolates,(“Pan Resistant Isolate”: ex: pan resistance enterobacter) of MDR, XDR, &amp; PDR (CRE/CRPA, CRAB), list of novel antibiotics against MDR, XDR, PDR; its pharmacokinetics/pharmacodynamics of (CminMIC, CmaxMIC, AUC:MIC), and workflow pathways for conventional and rapid diag. testing. Such an effect will definitely confer a better understanding of the impact of antibiotics (Jarisch Herxheimer Reaction @JHR‐neuropsychiatry), toxicity profile on vortices formation, control of VKVS in TM to achieve the dream to identify the point of care intervention for mitigating mortality in ERP‐EGDT. (Ack: Source: Subburaj Kannan, M.D., Ph.D., attended MyCE‐Harvard Medical School, MA “Antimicrobial Resistant Gram‐Negative Infections:”, on 11/03/21).

Genesis of Antibiotic Resistance (AR) LXXXVIII: Turbulence Modeling(TM) of Hemodynamics in Simplified Severe Sepsis Protocol‐2 (SSSP‐2)‐NCT01663701: “Hypnotic Trance Ameliorate Turbulence to Laminar Flow (Homeostasis)”: A Neuropsychiatric Basis

An effort is made to substantiate that vascular abnormalities (fluid dynamic/mechanical properties) could be restored to homeostasis by an appropriate hypnotic trance. Clinical Background:Sepsis: Clinical data/Record(observation): decreased capillary density ref Fig 4 c., PMID: 34055944, hypovolemia, endothelial dysfunction, increased WBC accumulation, thrombi deposition, altered CCP, NFP gradient, shunting, degradation of endothelial glycocalyx, vascular hyper permeability (PMID: 23566729; PMID: 20179590; PMID: 24067428), as an indicator of sepsis progress to septic shock. Neuropsychiatry diagnostic index: HAND (HIV associate neurodegenerative disorder), PTSD, psychosis, depression, mania, ANI, MND, HIV associated dementia (HAD), possible multifocal leukoencephalopathy (CMV origin, Toxoplasmaencephalitis, diffused myelin pallor, opportunistic infections, and neurosyphilis (Jarisch Herxheimer reaction). Geometry: Part I: RBC, Platelets, WBC: p47‐56; Part II: blood velocity, and function, Table 2.1; 2,2; 2.3; p63; ISBN 9780128024089; Governing Equations: Part A: CD, https://www.grc.nasa.gov/www/k‐12/airplane/shaped.html;; Part B: Keulegan – Carpenter Number equation: □=Vm/ƒoscD; Clinical Data: Hemodynamics Hypnotic Trance:Before hypnotic induction: 120.65 mmHg / 79.84 mmHg (Derived →PP= 41 mmHg Normal;Derived →MAP=93mmHg); After hypnotic induction: 115.92 mmHg /76.16 mmHg; (Derived →PP= 40 mmHg Normal;Derived →MAP= 89 mmHG)).Heart rate before hypnotic induction: 86.16 / beats per minute (Derived →CO= 86.16/ beats per minute x 70ml/min=6029.8 ml/min); After hypnotic induction, to 78.89 beats per minute (Derived →CO=78.89/ beats per minute x 70 ml/min=5522.3ml/min). (Kurnia S, et.al., (2021). Blood Pressure Control and Heart Rate: Effectiveness Brief Hypnotic Induction Methods on Adults. 10.2991/assehr.k.210423.004). Spirometry (Homeostasis): VT: 500 ml; IRV: 3100 ml; ERV: 1200 ml; VC: 4800 ml; RV: 1200 ml; A respiratory rate of 12 breaths/ minute, the minute ventilation = 12 x 500 = 6000 ml. alveoli alveolar ventilation (volume of air/min that actually reaches the alveoli) = 12 x 350 = 4200ml. Clinical correlation:The basis for correlating the sepsis, neurological(physiological/psychiatric) and hypnotic trance is that the hypnotic trance subject recovers to homeostasis provided abreaction not encountered by the subject as much as the sepsis, neurological ‐ physiological/psychiatric patients with appropriate Dx, and Tx. Taken together, it is suggested that a decrease in capillary density observed in sepsis and en route to septic shock is a transient phenomenon implicit of a reversible loss of hemodynamic function, for patients Txwith SSSP‐ERP‐EGDT similar to that of SSSP‐2 NCT0166370. Such patient cohort could possibly be reverted to sustain homeostasis in a patient‐specific hypnotic suggestion(s), re‐alert concluding with a reassuring‐post hypnotic trans conversation (devoid of abreaction).

Borreliosis, enfermedad de Lyme y fiebre recurrente

Lyme borreliosis is a bacterial infection transmitted by ticks of the Ixodes genus that are infected by some members of the Borrelia burgdorferisensu lato spirochetes group. A common symptom is migratory erythema, the early rash caused by the tick bite on the skin. The disease progresses in months or even years, causing systemic symptoms that mainly affect the skin, joints, heart, and nervous system. The diagnosis is mainly based on symptoms and serology. The treatment of choice is doxycycline or beta-lactams; macrolides are an alternative. The prognosis with appropriate antibiotic treatment is favorable. Recurrent fever is a zoonosis caused by other species of Borrelia transmitted by flea and tick bites. It is characterized by a periodic fever and short febrile periods followed by a period of apyrexia. During the febrile period, spirochetes can be observed on a blood smear test. It is treated with doxycycline or penicillin and Jarisch–Herxheimer reactions are common.

Tick borne relapsing fever - a systematic review and analysis of the literature.

Tick borne relapsing fever (TBRF) is a zoonosis caused by various Borrelia species transmitted to humans by both soft-bodied and (more recently recognized) hard-bodied ticks. In recent years, molecular diagnostic techniques have allowed to extend our knowledge on the global epidemiological picture of this neglected disease. Nevertheless, due to the patchy occurrence of the disease and the lack of large clinical studies, the knowledge on several clinical aspects of the disease remains limited. In order to shed light on some of these aspects, we have systematically reviewed the literature on TBRF and summarized the existing data on epidemiology and clinical aspects of the disease. Publications were identified by using a predefined search strategy on electronic databases and a subsequent review of the reference lists of the obtained publications. All publications reporting patients with a confirmed diagnosis of TBRF published in English, French, Italian, German, and Hungarian were included. Maps showing the epidemiogeographic mosaic of the different TBRF Borrelia species were compiled and data on clinical aspects of TBRF were analysed.The epidemiogeographic mosaic of TBRF is complex and still continues to evolve. Ticks harbouring TBRF Borrelia have been reported worldwide, with the exception of Antarctica and Australia. Although only molecular diagnostic methods allow for species identification, microscopy remains the diagnostic gold standard in most clinical settings. The most suggestive symptom in TBRF is the eponymous relapsing fever (present in 100% of the cases). Thrombocytopenia is the most suggestive laboratory finding in TBRF. Neurological complications are frequent in TBRF. Treatment is with beta-lactams, tetracyclines or macrolids. The risk of Jarisch-Herxheimer reaction (JHR) appears to be lower in TBRF (19.3%) compared to louse-borne relapsing fever (LBRF) (55.8%). The overall case fatality rate of TBRF (6.5%) and LBRF (4–10.2%) appears to not differ. Unlike LBRF, where perinatal fatalities are primarily attributable to abortion, TBRF-related perinatal fatalities appear to primarily affect newborns.

Retrospective Cohort Study of the Incidence and Outcomes of Jarisch-Herxheimer Reactions After Treatment of Infectious Syphilis in Late Pregnancy.

Of 39 pregnant women at ≥20 weeks' gestation treated with benzathine penicillin G for infectious syphilis, we identified only 2 mild Jarisch-Herxheimer reactions. There were no immediate fetal sequelae. Data from our study do not support the recommendation for routine admission for the treatment of infectious syphilis in late pregnancy.