Exam Cram

• Jarisch herxheimer reaction caused by acute antimicrobial destruction of spirochetes

• Common spirochete infections: syphillis, lyme disease and leptospirosis

• Presentation: post antibiotic fever, hypotension, tachycardia

• Management: paracetamol, supportive

Outline

Background

• Comparable to tumour lysis syndrome, where destruction of spirochete cells releases large volumes of endotoxin

Assessment

History

• Reaction after antibiotics for syphillis, lyme disease or leptospirosis

• Global lethargy

Examination

• Hypotensive

• Tachycardic

• Febrile

Investigations- nil

Diagnosis

Diagnostic criteria: clinical

Differentials: sepsis

Management

1. Supportive: paracetamol, fluids, continue antibiotics

Little evidence for antihistamines or steroids but unlikely to cause harm. 

References and Resources

Written in 2025