Jarisch-Herxheimer Reaction in Neurosyphilis Treated With Penicillin

Jarisch-Herxheimer reaction in a patient with neurosyphilis.

“…The frequency of reactions increases proportionally with white cell count and total protein in CSF. Hoekenga et al 17 found the highest incidence of Jarisch-Herxheimer reaction in patients with dementia paralytica and in whom both cell count and protein content in CSF were raised. Incidence is not related to race or sex, duration of infection with syphilis, serological titre, or dose of penicillin.…”

Pathogenesis of the Jarisch-Herxheimer Reaction: A REVIEW OF CLINICAL AND EXPERIMENTAL OBSERVATIONS

“…If, as Moore, Farmer, and Hoekenga (1948) have pointed out, the reaction were due solely to the release of spirochaetal breakdown substances, its incidence and severity should vary with (1) the number of treponemata present in a given individual at the time of treatment, and (2) the number of organisms destroyed by specific therapy. These workers, however, have observed that the incidence of Herxheimer reactions in patients with sero- 58 JARISCH-HERXHEIMER REACTION negative primary syphilis is approximately the same as in patients with secondary syphilis, even though the latter group presumably harbours a greater number of treponemata.…”

“…It has been estimated that approximately 64 to 79 per cent. of all patients with neurosyphilis treated with penicillin develop Herxheimer reactions (Hoekenga and Farmer, 1948). The incidence is particularly high in paresis and seems to be more common in patients with markedly abnormal spinal fluid findings.…”

Treatment of the Neurosyphilitic Psychoses

“…Putkonen & Rehtijarvi (1951) found an even lower percentage of Herxheimer reactions in 229 patients with neurosyphilis and they concludcd that adverse reactions decreased in frequency a s the duration of the disease increased. Hoekenga gL Farmer (1948) found that 34 $% of 344 patients with neurosyphilis had febrile reactions; they reported a close relationship between C.S.F. activity (a high cell count and increased proteins) and a febrile reaction to penicillin as confirmed by Hahn et al (1959).…”