Jarisch–Herxheimer Reaction Among Patients with Leptospirosis: Incidence and Risk Factors

Guerrier, Gilles; Lefèvre, Patrick; Chouvin, Chantal; D’Ortenzio, Éric

doi:10.4269/ajtmh.16-0457

Cited by 24 publications

(14 citation statements)

References 19 publications

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“…Dysregulation of these mechanisms can trigger cytokine storm and related multi-organ failures as observed during severe leptospirosis and sepsis. Interestingly, the Jarisch-Herxheimer Reaction (JHR) noticed among leptospirosis patients is also characterized by large cytokine overproduction induced by massive bacterial product release consequent to antibiotic treatment (Friedland and Warrell, 1991 ; Guerrier and D'ortenzio, 2013 ; Guerrier et al, 2017 ). It is worth noticing that anti-TNF-α antibody therapy was proposed to prevent and ameliorate the JHR (Pound and May, 2005 ; Butler, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Leptospirosis Pathophysiology: Into the Storm of Cytokines

Cagliero

Villanueva

Matsui

2018

Front. Cell. Infect. Microbiol.

111

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Leptospirosis is a neglected tropical zoonosis caused by pathogenic spirochetes of the genus Leptospira. Infected reservoir animals, typically mice and rats, are asymptomatic, carry the pathogen in their renal tubules, and shed pathogenic spirochetes in their urine, contaminating the environment. Humans are accidental hosts of pathogenic Leptospira. Most human infections are mild or asymptomatic. However, 10% of human leptospirosis cases develop into severe forms, including high leptospiremia, multi-organ injuries, and a dramatically increased mortality rate, which can relate to a sepsis-like phenotype. During infection, the triggering of the inflammatory response, especially through the production of cytokines, is essential for the early elimination of pathogens. However, uncontrolled cytokine production can result in a cytokine storm process, followed by a state of immunoparalysis, which can lead to sepsis and associated organ failures. In this review, the involvement of cytokine storm and subsequent immunoparalysis in the development of severe leptospirosis in susceptible hosts will be discussed. The potential contribution of major pro-inflammatory cytokines in the development of tissue lesions and systemic inflammatory response, as well as the role of anti-inflammatory cytokines in contributing to the onset of a deleterious immunosuppressive cascade will also be examined. Data from studies comparing susceptible and resistant mouse models will be included. Lastly, a concise discussion on the use of cytokines for therapeutic purposes or as biomarkers of leptospirosis severity will be provided.

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Section: Discussionmentioning

confidence: 99%

Leptospirosis Pathophysiology: Into the Storm of Cytokines

Cagliero

Villanueva

Matsui

2018

Front. Cell. Infect. Microbiol.

111

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“…One study has suggested a significant association between one species, L. Interrogans icterohaemorrhagiae, and more severe disease; however, this has not been widely collaborated . Similarly, there could also be an association between serogroups and the development of a Jarisch‐Herxheimer reaction, with L. interrogans autumnalis implicated .…”

Section: Discussionmentioning

confidence: 99%

Leptospirosis presenting as acute acalculous cholecystitis

Davies

Aoyagi

2017

Clinical Case Reports

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Key Clinical MessageLeptospirosis is the commonest zoonotic infection worldwide but is vastly underreported and extremely heterogeneous in its presentation. Acalculous cholecystitis is an under recognized presentation of acute leptospirosis. In the appropriate clinical context, with a clear exposure history, recognition of this association presents a unifying diagnosis and limits unnecessary surgical interventions.

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“…Treponema und Borrelien) und Leptospiren innerhalb der ersten 24 Stunden durch Freisetzung bakterieller Lipoproteine oder Toxine zu einer Jarisch-Herxheimer-Reaktion kommenbei Syphilis in~20-40 % der Patienten, bei Rückfallfieber höhere, bei Leptospirose und Lyme-Borreliose niedrigere Inzidenz. Betalaktame lösen die Reaktion häufiger aus als Doxycyclin [28,29].…”

Section: Herxheimer-reaktionunclassified

Steroide in der Infektionsmedizin

Spinner

Barton

Biever

et al. 2021

Dtsch Med Wochenschr

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Was ist neu?Steroide sollen bei der Sepsis/septischen Schock, der Tuberkulose und der Meningtitis weiterhin nur in bestimmten Fällen zum Einsatz kommen: Nämlich bei anders nicht stabilisierbarem Kreislaufversagen in der Sepsis, bei tuberkulöser Meningitis oder bei eitriger Meningitis durch Pneumokokken.Der Einsatz von Steroiden bei eher später, hyperinflammatorischer Covid-19-Erkrankung kann die Sterblichkeit wesentlich senken, wobei die Effekte vor allem für sauerstoffpflichtige und intubiert beatmete Patienten signifikant sind, während Steroide bei Patienten ohne Sauerstoffpflichtigkeit keine signifikant mortalitätssenkende Effekte haben. Untersucht sind Dexamethason, Methylprednisolon und Hydrocortison, wobei die Evidenzlage für Dexamethason am besten ist.Steroide kommen weiterhin beim Immunrekonstitutionssyndrom (IRIS) des erworbenen Immunschwächesyndroms (AIDS) durch HIV zum Einsatz.

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Jarisch–Herxheimer Reaction Among Patients with Leptospirosis: Incidence and Risk Factors

Cited by 24 publications

References 19 publications

Leptospirosis Pathophysiology: Into the Storm of Cytokines

Leptospirosis Pathophysiology: Into the Storm of Cytokines

Leptospirosis presenting as acute acalculous cholecystitis

Steroide in der Infektionsmedizin

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