ReviewThe American journal of tropical medicine and hygiene2017
The Jarisch-Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis.
Review in The American journal of tropical medicine and hygiene, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 96 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
96 citing papers in PubMed, 5 syntheses or guidelines pooled it, 196 citations in OpenAlex.
- Corticosteroids for treatment of leptospirosis.The Cochrane database of systematic reviews · 2025Pooled it
- Antibiotics for treatment of leptospirosis.The Cochrane database of systematic reviews · 2024Pooled it
- Tick borne relapsing fever - a systematic review and analysis of the literature.PLoS neglected tropical diseases · 2022Pooled it
- Sexually Transmitted Infections Treatment Guidelines, 2021.MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports · 2021Guideline
- Louse-borne relapsing fever-A systematic review and analysis of the literature: Part 2-Mortality, Jarisch-Herxheimer reaction, impact on pregnancy.PLoS neglected tropical diseases · 2021Pooled it
- Jarisch-Herxheimer Reaction After Benzathine Penicillin G Treatment in Adults With Early Syphilis: Secondary Analysis of a Randomized Clinical Trial.JAMA network open · 2025Trial
- Systems analysis-based assessment of post-treatment adverse events in lymphatic filariasis.PLoS neglected tropical diseases · 2019Trial
- Article
- Whipple Disease: A Two-Decade Multisystem Masquerade Preceding Gastrointestinal Presentation.ACG case reports journal · 2026Article
- β-Lactam antibiotics trigger mouse TLR2/4- and human TLR2/5-dependent Jarisch-Herxheimer reaction in leptospirosis.bioRxiv : the preprint server for biology · 2026Article
- Questions Ophthalmology Trainees Ask About Ocular Syphilis: A Question-Driven Narrative Review.Cureus · 2026Review
- A Case of Facial Nerve Palsy As the Initial Presentation of Early Neurosyphilis: A Diagnostic Challenge.Cureus · 2026Article
- Effects of TUS-NMES Combined with Glucocorticoid on Clinical Outcomes and Rehabilitation Efficacy of Neurosyphilis Patients with Cerebral Infarction.Therapeutics and clinical risk management · 2026Article
- Development of bilateral facial nerve palsies while receiving doxycycline for early disseminated Lyme disease.IDCases · 2026Article
- Arresting spirochetes: nonthermal extremely low-frequency electromagnetic field exposure suppressesFrontiers in medicine · 2026Article
- A Case of Jarisch-Herxheimer Reaction After Ceftriaxone Initiation for Lyme Carditis in Postpartum Female.Case reports in infectious diseases · 2026Article
- Unusual presentation of complicated relapsing fever with spontaneous hemoperitoneum mimicking surgical acute abdomen: a case report.International journal of emergency medicine · 2025Article
- Anti-inflammatory cytokine profile and Jarisch-Herxheimer reaction in Leptospirosis patients: A prospective case-series study in New Caledonia.PLoS neglected tropical diseases · 2025Observational
- Distinguishing Jarisch-Herxheimer Reaction From Septic Shock in Leptospirosis Patients: A Case Study.The American journal of case reports · 2025Article
- Neurosyphilis: Discussing the Diagnostic Challenges.Clinical case reports · 2025Article
36 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Within 24 hours after antibiotic treatment of the spirochetal infections syphilis, Lyme disease, leptospirosis, and relapsing fever (RF), patients experience shaking chills, a rise in temperature, and intensification of skin rashes known as the Jarisch-Herxheimer reaction (JHR) with symptoms resolving a few hours later. Case reports indicate that the JHR can also include uterine contractions in pregnancy, worsening liver and renal function, acute respiratory distress syndrome, myocardial injury, hypotension, meningitis, alterations in consciousness, seizures, and strokes. Experimental evidence indicates it is caused by nonendotoxin pyrogen and spirochetal lipoproteins. Mediation of the JHR in RF by the pro-inflammatory cytokines tumor necrosis factor (TNF), interleukin (IL)-6, and IL-8 has been proposed, consistent with measurements in patients' blood and inhibition by anti-TNF antibodies. Accelerated phagocytosis of spirochetes by polymorphonuclear (PMN) leukocytes before rise in cytokines is responsible for removal of organisms from the blood, suggesting an early inflammatory signal from PMNs. Rarely fatal, except in neonates and in pregnancy for African women whose babies showed high perinatal mortality because of low birth weight, the JHR can be regarded as an adverse effect of antibiotics, necessary for achieving a cure of spirochetal infections.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.