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S P Chee - One of the best experts on this subject based on the ideXlab platform.

George D. Wendel - One of the best experts on this subject based on the ideXlab platform.

  • Jarisch-Herxheimer Reaction triggered by group B streptococcus intrapartum antibiotic prophylaxis.
    Obstetrics & Gynecology, 2010
    Co-Authors: Martha W F Rac, Laura G Greer, George D. Wendel
    Abstract:

    BACKGROUND: The Jarisch-Herxheimer Reaction is an acute systemic event that can occur during the treatment of spirochetal infections. During pregnancy, it can cause signs and symptoms in both the mother and fetus, including fever, tachycardia, uterine contractions, and fetal heart rate pattern changes. CASE: A pregnant woman with limited prenatal care presented at 34 weeks of gestation in preterm labor with possible genital herpes. She received ampicillin for group B Streptococcus prophylaxis. Subsequently, she experienced subjective fever and late fetal heart rate decelerations prompting repeat cesarean delivery. Postpartum, her genital lesions were diagnosed as secondary syphilis, and her newborn had congenital syphilis. CONCLUSION: Beta-lactam antibiotics for group B Streptococcus intrapartum prophylaxis can trigger the Jarisch-Herxhemer Reaction in patients with undiagnosed syphilis resulting in unanticipated changes in maternal and fetal well-being.

  • Jarisch-Herxheimer Reaction triggered by group B streptococcus intrapartum antibiotic prophylaxis.
    Obstetrics and gynecology, 2010
    Co-Authors: Martha W F Rac, Laura G Greer, George D. Wendel
    Abstract:

    The Jarisch-Herxheimer Reaction is an acute systemic event that can occur during the treatment of spirochetal infections. During pregnancy, it can cause signs and symptoms in both the mother and fetus, including fever, tachycardia, uterine contractions, and fetal heart rate pattern changes. A pregnant woman with limited prenatal care presented at 34 weeks of gestation in preterm labor with possible genital herpes. She received ampicillin for group B Streptococcus prophylaxis. Subsequently, she experienced subjective fever and late fetal heart rate decelerations prompting repeat cesarean delivery. Postpartum, her genital lesions were diagnosed as secondary syphilis, and her newborn had congenital syphilis. Beta-lactam antibiotics for group B Streptococcus intrapartum prophylaxis can trigger the Jarisch-Herxhemer Reaction in patients with undiagnosed syphilis resulting in unanticipated changes in maternal and fetal well-being.

  • The Jarisch-Herxheimer Reaction complicating syphilotherapy in pregnancy
    Obstetrics & Gynecology, 1990
    Co-Authors: Victor R. Klein, Susan M. Cox, Murray D. Mitchell, George D. Wendel
    Abstract:

    Thirty-three gravidas with syphilis were monitored with hourly vital signs and examinations for 24 hours after treatment with benzathine penicillin G. Fifteen (45%) of the subjects had a Jarisch-Herxheimer Reaction, including all three, 12 of 20 (60%), and none of ten of those with primary, secondary, and latent syphilis, respectively. The most common symptoms were fever (73%), uterine contractions (67%), and decreased fetal movement (67%). The signs or symptoms began 2-8 hours after treatment; fevers peaked at 6-12 hours post-therapy and the events usually abated by 16-24 hours after treatment. Uterine contractions and decreased fetal activity began concurrent with maternal fever in eight of ten women reporting contractions. Transient late decelerations were detected in three of 11 monitored patients. Three of the women with Jarisch-Herxheimer Reactions delivered infants with congenital syphilis, including one stillbirth, but none of those without a detectable Reaction had fetal treatment failures. Prostaglandin F2 alpha and prostacyclin metabolites were elevated transiently in the one subject studied, suggesting their role in mediating the cardiovascular and uterine events in the post-treatment period. The Jarisch-Herxheimer Reaction in pregnancy is similar in frequency, character, and intensity to that in nonpregnant adults, but gravidas may have increase uterine activity and transient alterations in fetal well-being. The pregnant patient with a severely affected fetus with congenital syphilis may experience preterm labor, preterm delivery, or fetal death in association with the Jarisch-Herxheimer Reaction.

C M G Cheung - One of the best experts on this subject based on the ideXlab platform.

Nicolas Feltgen - One of the best experts on this subject based on the ideXlab platform.

  • isolated ocular jarisch Herxheimer Reaction after initiating tuberculostatic therapy in a child
    International Ophthalmology, 2014
    Co-Authors: Henrike Neunhöffer, Annika Gold, Hans Hoerauf, Carl P. Herbort, Arnd Heiligenhaus, Ortrud Zimmermann, Nicolas Feltgen
    Abstract:

    After being exposed to a kindergarten teacher with infectious pulmonary tuberculosis, a7-year-old girl with a positive tuberculin skin test was treated with isoniazid. 3 days after initiation of the tuberculostatic therapy, the girl was referred to our hospital with an acute onset of blurred vision. Visual acuity (VA) was 20/200 in both eyes. Examination revealed mild anterior chamber inflammation, optic disc swelling, cystoid macular edema and periphlebitis in both eyes. However, although active tuberculosis was ruled out, the interferon-gamma release assay was positive. The anti-tuberculosis therapy was intensified with pyrazinamide, isoniazid, rifampicin and methylprednisolone. Within 10 days we saw a resolution of the macular edema and VA was 20/25. The paradoxical worsening of the patient’s condition after initiation of tuberculostatic therapy with isoniazid and the prompt response to systemic steroids are typical for Jarisch-Herxheimer Reaction (JHR). Our patient presented no symptoms before the isoniazid therapy was started and the Reaction was ocular without any generalized symptoms. This is unique among all other reported cases of ocular JHR.

  • Isolated ocular Jarisch−Herxheimer Reaction after initiating tuberculostatic therapy in a child
    International Ophthalmology, 2013
    Co-Authors: Henrike Neunhöffer, Annika Gold, Hans Hoerauf, Carl P. Herbort, Arnd Heiligenhaus, Ortrud Zimmermann, Nicolas Feltgen
    Abstract:

    After being exposed to a kindergarten teacher with infectious pulmonary tuberculosis, a7-year-old girl with a positive tuberculin skin test was treated with isoniazid. 3 days after initiation of the tuberculostatic therapy, the girl was referred to our hospital with an acute onset of blurred vision. Visual acuity (VA) was 20/200 in both eyes. Examination revealed mild anterior chamber inflammation, optic disc swelling, cystoid macular edema and periphlebitis in both eyes. However, although active tuberculosis was ruled out, the interferon-gamma release assay was positive. The anti-tuberculosis therapy was intensified with pyrazinamide, isoniazid, rifampicin and methylprednisolone. Within 10 days we saw a resolution of the macular edema and VA was 20/25. The paradoxical worsening of the patient’s condition after initiation of tuberculostatic therapy with isoniazid and the prompt response to systemic steroids are typical for Jarisch-Herxheimer Reaction (JHR). Our patient presented no symptoms before the isoniazid therapy was started and the Reaction was ocular without any generalized symptoms. This is unique among all other reported cases of ocular JHR.

Wen-chun Liu - One of the best experts on this subject based on the ideXlab platform.

  • Jarisch-Herxheimer Reaction among HIV-positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy
    Journal of the International AIDS Society, 2014
    Co-Authors: Mao-song Tsai, Chia-jui Yang, Nan-yao Lee, Szu-min Hsieh, Yu-hui Lin, Hsin-yun Sun, Wang-huei Sheng, Kuan-yeh Lee, Shan-ping Yang, Wen-chun Liu
    Abstract:

    Introduction : The Jarisch-Herxheimer Reaction, a febrile inflammatory Reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women. A single 2-g oral dose of azithromycin is an alternative treatment to benzathine penicillin G for early syphilis in areas with low macrolide resistance. With its potential anti-inflammatory activity, the impact of azithromycin on the incidence of the Jarisch-Herxheimer Reaction in HIV-positive patients with early syphilis has rarely been investigated. Methods : In HIV-positive patients with early syphilis, the Jarisch-Herxheimer Reaction was prospectively investigated using the same data collection form in 119 patients who received benzathine penicillin G between 2007 and 2009 and 198 who received azithromycin between 2012 and 2013, when shortage of benzathine penicillin G occurred in Taiwan. Between 2012 and 2013, polymerase chain Reaction (PCR) assay was performed to detect Treponema pallidum DNA in clinical specimens, and PCR restriction fragment length polymorphism of the 23S ribosomal RNA was performed to detect point mutations (2058G or A2059G) that are associated with macrolide resistance. Results : The overall incidence of the Jarisch-Herxheimer Reaction was significantly lower in patients receiving azithromycin than those receiving benzathine penicillin G (14.1% vs. 56.3%, p< 0.001). The risk increased with higher rapid plasma reagin (RPR) titres (adjusted odds ratio [AOR] per 1-log 2 increase, 1.21; confidence interval [CI], 1.04–1.41), but decreased with prior penicillin therapy for syphilis (AOR, 0.37; 95% CI, 0.19–0.71) and azithromycin treatment (AOR, 0.15; 95% CI, 0.08–0.29). During the study period, 310 specimens were obtained from 198 patients with syphilis for PCR assays, from whom T. pallidum was identified in 76 patients, one of whom (1.3%) was found to be infected with T. pallidum harbouring the macrolide resistance mutation (A2058G). In subgroup analyses confined to the 75 patients infected with T. pallidum lacking resistance mutation, a statistically significantly lower risk for the Jarisch-Herxheimer Reaction following azithromycin treatment was noted. Conclusions : Treatment with azithromycin was associated with a lower risk for the Jarisch-Herxheimer Reaction than that with benzathine penicillin G in HIV-positive patients with early syphilis. Previous benzathine penicillin G therapy for syphilis decreased the risk, whereas higher RPR titres increased the risk, for the Reaction. Keywords: sexually transmitted diseases; spirochetal disease; macrolides; macrolide resistance; immunomodulation. (Published: 28 August 2014) Citation: Tsai M-S et al. Journal of the International AIDS Society 2014, 17 :18993 http://www.jiasociety.org/index.php/jias/article/view/18993 | http://dx.doi.org/10.7448/IAS.17.1.18993

  • Jarisch-Herxheimer Reaction among HIV-positive patients with early syphilis: azithromycin versus benzathine penicillin G therapy
    Wiley, 2014
    Co-Authors: Mao-song Tsai, Chia-jui Yang, Nan-yao Lee, Szu-min Hsieh, Yu-hui Lin, Hsin-yun Sun, Wang-huei Sheng, Kuan-yeh Lee, Shan-ping Yang, Wen-chun Liu
    Abstract:

    Introduction: The Jarisch-Herxheimer Reaction, a febrile inflammatory Reaction that often occurs after the first dose of chemotherapy in spirochetal diseases, may result in deleterious effects to patients with neurosyphilis and to pregnant women. A single 2-g oral dose of azithromycin is an alternative treatment to benzathine penicillin G for early syphilis in areas with low macrolide resistance. With its potential anti-inflammatory activity, the impact of azithromycin on the incidence of the Jarisch-Herxheimer Reaction in HIV-positive patients with early syphilis has rarely been investigated. Methods: In HIV-positive patients with early syphilis, the Jarisch-Herxheimer Reaction was prospectively investigated using the same data collection form in 119 patients who received benzathine penicillin G between 2007 and 2009 and 198 who received azithromycin between 2012 and 2013, when shortage of benzathine penicillin G occurred in Taiwan. Between 2012 and 2013, polymerase chain Reaction (PCR) assay was performed to detect Treponema pallidum DNA in clinical specimens, and PCR restriction fragment length polymorphism of the 23S ribosomal RNA was performed to detect point mutations (2058G or A2059G) that are associated with macrolide resistance. Results: The overall incidence of the Jarisch-Herxheimer Reaction was significantly lower in patients receiving azithromycin than those receiving benzathine penicillin G (14.1% vs. 56.3%, p