The Jarisch-Herxheimer reaction in leptospirosis: a systematic review.

The Jarisch-Herxheimer reaction in leptospirosis: a systematic review.
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DOI:
10.1371/journal.pone.0059266
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发表时间:
2013
期刊:
影响因子:
3.7
通讯作者:
D'Ortenzio E
D'Ortenzio E
中科院分区:
综合性期刊3区
文献类型:
--
作者:
Guerrier G;D'Ortenzio E

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钩端螺旋体病是一种地方性流行性人畜共患病,与可能致命的肾、心血管或肺功能衰竭有关。推荐的治疗方法包括抗生素,这可能会引起Jarisch-Herxheimer反应(JHR)。由于关于这一不良事件的重要性的信息很少,我们进行了这项综述,以量化JHR在钩端螺旋体病治疗中的频率和影响。本文系统地综述了钩端螺旋体病中JHR的研究进展。为了探讨这一主题的更广泛的方面,审查了关于钩端螺旋体病治疗的文章、国家钩端螺旋体病指南以及世界卫生组织的教科书和技术报告。描述钩端螺旋体病JHR的出版物非常有限,主要由单个病例报告和小病例系列组成。一项单独的随机对照试验专门评估了JHR的发生,但从未在大型试验中进行过系统的调查。并不是所有的指南和所有关于钩端螺旋体病的文献都提到这种反应,这种反应可能是致命的。虽然通常认为这是一种罕见的事件,但钩端螺旋体病中JHR的真实流行率尚不清楚,而且对这一事件的认识还不够。所有的钩端螺旋体病指南和局部的钩端螺旋体病治疗方案都应强调在使用抗生素后早期对临床状态进行系统监测。需要进行大量精心设计的研究,以精确了解JHR的发病率和影响,以及各种抗生素之间的严重程度和比率。
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. 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. 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.
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发表时间: 2012-01-01
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