What Is the Herxheimer Reaction?

Herisch reaction (Jarisch-Herxheimer reaction), Chinese literal translation is called "Herxheimer reaction". It was first discovered by the Austrian dermatologists Jarisch Adolf Herxheimer and Karl Herxheimer during the application of mercury, arsenic, and bismuth in the treatment of syphilis, named after the discoverer. The patient showed symptoms of high fever, sweating, night sweats, nausea and vomiting, skin lesions enlarged and worsened; even a sudden drop in body temperature, cold limbs, and induced diffuse pulmonary bleeding.

Herxheimer reaction

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Herisch reaction (Jarisch-Herxheimer reaction), Chinese literal translation is called "Herxheimer reaction". It was first discovered by the Austrian dermatologists Jarisch Adolf Herxheimer and Karl Herxheimer during the application of mercury, arsenic, and bismuth in the treatment of syphilis, named after the discoverer. The patient showed symptoms of high fever, sweating, night sweats, nausea and vomiting, skin lesions enlarged and worsened; even a sudden drop in body temperature, cold limbs, and induced diffuse pulmonary bleeding.

Hershey's reaction is also called a transient contradiction reaction, which originally meant that when treating advanced syphilis, anti- Treponema pallidum drugs, such as penicillin or arsenic, were used immediately. Local and systemic reactions can occur within 24 hours after injection, making the original Increased symptoms ^[1]

Due to the strong killing effect of large doses of antibacterial drugs on Leptospira, a large number of Borrelia died, and a large amount of foreign proteins or toxins overflowed from the dead Borrelia to cause internal production in the body.

Most patients present with high fever, headache, chills, myalgia, increased heart rate and breathing, and exacerbation of previous symptoms. However, as the treatment progressed, the above reactions disappeared and alleviated, usually lasting from 30 minutes to 1 hour, showing a transient, temporary "deterioration". Some patients may experience a sudden drop in temperature, cold limbs, and a few may induce diffuse pulmonary bleeding, exacerbate symptoms, and even cause a crisis and death. ^[2]

When using sensitive antibacterial drugs to treat patients' reactions closely, once an adverse reaction occurs, be sure to make a differential diagnosis of penicillin allergy reaction, infusion reaction, and Hershey reaction in order to deal with it correctly and in time. ^[3]

Psychological care

Elderly and fragile patients have decreased immune function, and are prone to Hirsch's reaction during treatment. When patients have adverse reactions, they are prone to produce negative emotions such as anxiety, depression, annoyance, and fear. Nursing staff should patiently explain the reaction mechanism and Possible symptoms, from establishing a good relationship between nurses and patients, actively assisting patients in maintaining physical and mental balance, gaining patients 'trust, eliminating the patients' unhealthy psychology, and actively cooperating with treatment to achieve early recovery ^[3]

2. Medication care

The Hershey reaction often occurs during the first syphilitic treatment. Therefore, the amount of penicillin should be gradually increased from a small dose to the normal amount. The treatment of cardiovascular syphilis does not use stella penicillin. The amount of syphilis treatment should be sufficient. The treatment course must be standardized. Prednisone 5 mg orally 1 day before treatment, 4 times a day, and continuous intravenous administration should pay attention to controlling the speed to allow the drug to drip slowly.

3. Nursing of complications

Nurses with Hearst Response should be alert to the occurrence of diffuse pulmonary hemorrhage. When the patient's temperature suddenly drops, and chest tightness, irritability, paleness, weak pulse, shallow breathing, and decreased blood pressure are indicated, the possibility of major pulmonary bleeding is indicated. At this time, the physician should be reported immediately and rescued with blood. ready. At the same time, special care is provided to care for and comfort the patient, keep the patient lying, stabilize the patient's mood, and immediately give oxygen, ECG monitoring, and give sedatives, hydrocortisone and hemostatic drugs as prescribed by the doctor. When massive hemoptysis occurs, the airway must be kept unobstructed, and the patient's head should be turned to the side immediately, and the blood clots in the mouth and airway should be quickly sucked out. If necessary, perform tracheotomy or tracheal intubation. At the same time, observe the nature and amount of hemoptysis, and make good recording.