title: The Jarisch-Herxheimer reaction in leptospirosis: a systematic review.
abstract: BACKGROUND
  Leptospirosis is an endemo-epidemic zoonotic disease associated with potentially fatal renal, cardiovascular or pulmonary failure. Recommended treatment includes antibiotics, which may induce a Jarisch-Herxheimer reaction (JHR). Since little information on the importance of this adverse event is available, we performed this review to quantify frequency and impact of JHR in leptospirosis management.
  
  
  RESULTS
  This review systematically summarizes the literature on the JHR in leptospirosis. To approach the broader aspects of the subject, articles considering the treatment of leptospirosis, national leptospirosis guidelines and textbook and technical reports of the World Health Organisation were reviewed. Publications describing JHR in leptospirosis are very limited and consist mainly of single case reports and small case series. A single randomized control trial specifically assessed the JHR occurrence, but it has never been systematically investigated in large trials. Not all guidelines and not all literature on leptospirosis mention this reaction which can be fatal.
  
  
  CONCLUSIONS
  Although generally assumed to be a rare event, the true prevalence of JHR in leptospirosis is unknown and the awareness of this event is insufficient. All leptospirosis guidelines and local leptospirosis protocols should stress on systematic monitoring for clinical status early after antibiotic administration. Large well designed studies are required to precise the incidence and the impact of JHR as well as the severity and rates between various antibiotics.
authors.affiliation: Département d'Anesthésie-Réanimation, Centre Hospitalier Territorial, Noumea, Nouvelle Calédonie. guerriergilles@gmail.com
authors.forename: Gilles
authors.initials: G
authors.lastname: Guerrier
authors.forename: Eric
authors.initials: E
authors.lastname: D'Ortenzio
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D016206:Databases, Bibliographic; D019468:Disease Management; D005334:Fever / Q000139:chemically induced* / Q000276:immunology; D006801:Humans; D007249:Inflammation; D007922:Leptospirosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D010406:Penicillins / Q000009:adverse effects*; D017410:Practice Guidelines as Topic
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins
references.citation: Presse Med. 1995 Dec 2;24(37):1753
references.pmid: 8545419
references.citation: Ann Intern Med. 1951 Nov;35(5):981-98
references.pmid: 14885881
references.citation: Antimicrob Agents Chemother. 2007 Sep;51(9):3259-63
references.pmid: 17638700
references.citation: Am J Trop Med Hyg. 1988 Oct;39(4):388-90
references.pmid: 3189700
references.citation: Emerg Infect Dis. 2012 Dec;18(12):2079-81
references.pmid: 23171761
references.citation: Rev Inst Med Trop Sao Paulo. 2000 Nov-Dec;42(6):327-32
references.pmid: 11136519
references.citation: Lancet Infect Dis. 2003 Dec;3(12):757-71
references.pmid: 14652202
references.citation: Lancet. 1958 Nov 29;2(7057):1143-5
references.pmid: 13612142
references.citation: Lancet. 1988 Feb 27;1(8583):433-5
references.pmid: 2893865
references.citation: Ann Intern Med. 1984 May;100(5):696-8
references.pmid: 6712032
references.citation: Am J Trop Med Hyg. 2008 Dec;79(6):911-4
references.pmid: 19052303
references.citation: Br Med J. 1955 Apr 9;1(4918):885-7
references.pmid: 14363740
references.citation: J Emerg Med. 1998 May-Jun;16(3):437-8
references.pmid: 9610974
references.citation: Clin Infect Dis. 2003 Jun 15;36(12):1507-13
references.pmid: 12802748
references.citation: Clin Infect Dis. 2004 Nov 15;39(10):1417-24
references.pmid: 15546074
references.citation: N Engl J Med. 1996 Aug 1;335(5):311-5
references.pmid: 8663853
references.citation: Lancet. 1956 Jan 7;270(6906):13-6
references.pmid: 13279151
references.citation: Kansenshogaku Zasshi. 2010 Jan;84(1):59-64
references.pmid: 20170016
references.citation: Cochrane Database Syst Rev. 2012 Feb 15;(2):CD008264
references.pmid: 22336839
references.citation: Clin Sci. 1972 Sep;43(3):343-54
references.pmid: 5077513
references.citation: JAMA. 1986 Jul 18;256(3):388-90
references.pmid: 3723728
references.citation: Q J Med. 1984 Autumn;53(212):487-95
references.pmid: 6334867
references.citation: Rev Inst Med Trop Sao Paulo. 2003 May-Jun;45(3):141-5
references.pmid: 12870063
references.citation: Clin Infect Dis. 1997 Sep;25(3):720-4
references.pmid: 9314467
references.citation: J Clin Pharm Ther. 2005 Jun;30(3):291-5
references.pmid: 15896248
references.citation: Eur J Clin Microbiol Infect Dis. 2003 Jul;22(7):449
references.pmid: 12827534
references.citation: J Thorac Imaging. 2012 Jan;27(1):W24-6
references.pmid: 22071677
references.citation: Clin Infect Dis. 1998 Jan;26(1):122-31
references.pmid: 9455520
references.citation: Clin Infect Dis. 1994 Jun;18(6):1004-6
references.pmid: 8086528
references.citation: Ther Hung. 1972;20(4):152-5
references.pmid: 4679501
references.citation: J Infect Dis. 1976 Jun;133(6):696-704
references.pmid: 932495
references.citation: Australas Ann Med. 1955 Feb;4(1):53-63
references.pmid: 14363039
references.citation: Curr Opin Infect Dis. 2005 Oct;18(5):376-86
references.pmid: 16148523
references.citation: J Infect Dis. 1990 Aug;162(2):564-7
references.pmid: 2197347
references.citation: Rev Infect Dis. 1991 Mar-Apr;13(2):207-10
references.pmid: 2041950
references.citation: Am J Trop Med Hyg. 2005 Oct;73(4):652-6
references.pmid: 16222003
references.citation: Am J Trop Med Hyg. 1997 Mar;56(3):307-10
references.pmid: 9129533
references.citation: J Infect Dis. 1983 May;147(5):898-909
references.pmid: 6842024
references.citation: Postgrad Med J. 1994 Feb;70(820):118-21
references.pmid: 8170883
references.citation: Am J Trop Med Hyg. 2007 Dec;77(6):1111-9
references.pmid: 18165532
references.citation: J R Army Med Corps. 1957 Oct;103(4):186-97
references.pmid: 13481991
references.citation: Med J Aust. 2012 Sep 3;197(5):276-7
references.pmid: 22938123