### Diagnosis [[Fever]], chills, hypotension an hour or three after treating spirochetes: [[Lyme]], *[[Leptospira]]*, relapsing Fever or syphilis (*[[Treponema]]* *pallidum*). [^1] Due to the release of endotoxins as the organisms die. ### Epidemiologic Risks Treating relapsing Fever, [[Lyme]], *[[Leptospira]]*, or syphilis (*[[Treponema]]* *pallidum*). Were you not paying attention? > "The overall rate of JH reaction was 31.5% (34.6% in [[HIV]]-infected patients and 25.2% in [[HIV]]-uninfected patients). In multivariate analysis, risk factors for JH reaction included high rapid plasma reagin (RPR) titers, early syphilis (*[[Treponema]]* *pallidum*), and prior penicillin treatment." [^2] ### Microbiology The spirochetes: causing [[lyme]], *[[Leptospira]]*, relapsing Fever or syphilis (*[[Treponema]]* *pallidum*) ### Empiric Therapy Supportive. Try steroids, fluids, and Benadryl® (my one brand name). ### Pearls It was first noticed by Jarisch & Herxheimer when syphilis (*[[Treponema]]* *pallidum*) was treated with mercury. ### Rants "Chronic" [[Lyme]] patients talk about 'herxing' whenever they get antibiotics. They don't. ### Rationalizations [^1]: Butler T. The [[Jarisch-Herxheimer Reaction]] Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis. Am J Trop Med Hyg. 2017 Jan 11;96(1):46-52. doi: 10.4269/ajtmh.16-0434. Epub 2016 Oct 24. PMID: 28077740; PMCID: PMC5239707. [^2]: Yang CJ, Lee NY, Lin YH, Lee HC, Ko WC, Liao CH, Wu CH, Hsieh CY, Wu PY, Liu WC, Chang YC, Hung CC. [[Jarisch-Herxheimer Reaction]] after penicillin therapy among patients with syphilis (*[[Treponema]]* *pallidum*) in the era of the [[HIV]] infection epidemic: incidence and risk factors. Clin Infect Dis. 2010 Oct 15;51(8):976-9. doi: 10.1086/656419. PMID: 20825309.