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The Jarisch–Herxheimer reaction in a patient with leptospirosis: a foreseeable problem in managing spirochaete infections

Ryan Markham, Andrew Slack and John Gerrard
Med J Aust 2012; 197 (5): . || doi: 10.5694/mja11.11175
Published online: 3 September 2012

To the Editor: A 60-year-old male farmer presented to the Gold Coast Hospital Emergency Department with a 2-day history of fever (38.5°C), retro-orbital pain, photophobia and confusion. In the preceding 2 weeks he had been working on a farm that had cattle and horses and which was infested with rats. The property had been flooded in the 2011 Queensland flood disaster, about a month before he worked there.


  • Department of Medicine, Gold Coast Hospital, Gold Coast, QLD.


Correspondence: rmarkham19@gmail.com

Competing interests:

No relevant disclosures.

  • 1. Slack A. Leptospirosis. Aust Fam Physician 2010; 39: 495-498
  • 2. See S, Scott EK, Levin MW. Penicillin-induced Jarisch-Herxheimer Reaction. Ann Pharmacother 2005; 39: 2128-2130.
  • 3. Pound MW, May DB. Proposed mechanisms and preventative options of the Jarisch-Herxheimer reactions. J Clin Pharm Ther 2005; 30: 291-295.
  • 4. Fekade D, Knox K, Hussein K, et al. Prevention of the Jarisch-Herxheimer reaction by treatment with antibodies against tumor necrosis factor alpha. N Engl J Med 1996; 335: 311-315.

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