{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:29:09Z","timestamp":1787020149029,"version":"build-2736575974"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82172319"],"award-info":[{"award-number":["82172319"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82472329"],"award-info":[{"award-number":["82472329"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003399","name":"Shanghai Science and Technology Commission","doi-asserted-by":"crossref","award":["YDZX20193100002868"],"award-info":[{"award-number":["YDZX20193100002868"]}],"id":[{"id":"10.13039\/501100003399","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Jarisch-Herxheimer reaction (JHR) is a complication of antibiotic treatment in neurosyphilis, and the profile of JHR in patients treated with different antibiotics remains unclear. This study investigates the incidence, clinical manifestations, and management of JHR in patients treated with penicillin G or ceftriaxone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study was conducted at the Shanghai Skin Disease Hospital, China, involving 1010 inpatients diagnosed with neurosyphilis, among whom 103 developed JHR. Statistical analyses included Student\u2019s t-test or Mann-Whitney test for continuous variables and Fisher\u2019s exact test for categorical data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall incidence of JHR among neurosyphilis patients was 10.20% (103\/1010), with rates varying from 0% \u2212\u200925% across different subtypes. Incidence was similar in penicillin G-treated (10.20%, 92\/902) and ceftriaxone-treated (10.19%, 11\/108) cohorts. The 92 JHR cases of penicillin G group manifested as fever (98.91%, 91\/92) and neuropsychiatric symptoms (25%, 23\/92). All 11 cases of JHR in the ceftriaxone group presented with fever (100%, 11\/11). Penicillin G treatment resulted in an earlier fever onset (8.92\u2009\u00b1\u20094.98\u00a0h vs. 14.00\u2009\u00b1\u20095.90\u00a0h, 95% CI: 1.861 to 8.303,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05) and a shorter time to defervescence (16.35\u2009\u00b1\u20095.48\u00a0h vs. 20.80\u2009\u00b1\u20093.79\u00a0h, 95% CI: 1.085 to 7.848,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05) than ceftriaxone. Management strategies included physical cooling, indomethacin suppositories, and supportive treatment for neuropsychiatric symptoms. Neuropsychiatric symptoms of JHR resolved within 2\u20137 days of initiating antibiotic therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>JHR is a notable complication of neurosyphilis treatment, presenting as febrile and neuropsychiatric symptoms. JHR frequency is comparable between penicillin G and ceftriaxone treatment. Penicillin G triggers an earlier febrile response of JHR compared to ceftriaxone. While generally mild and self-limiting, JHR can present with neuropsychiatric symptoms and severe conditions. This study contributes to the understanding of JHR and provides insights into the comparative effects of penicillin G and ceftriaxone treatment in neurosyphilis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-026-12683-2","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T15:39:39Z","timestamp":1769528379000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Jarisch-Herxheimer reaction as a complication of penicillin G and ceftriaxone treatment in neurosyphilis"],"prefix":"10.1186","volume":"26","author":[{"given":"Xin","family":"Feng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junjun","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanyan","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guixuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danyang","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiping","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pingyu","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"issue":"9","key":"12683_CR1","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1056\/NEJMra1901593","volume":"382","author":"KG Ghanem","year":"2020","unstructured":"Ghanem KG, Ram S, Rice PA. The modern epidemic of syphilis. N Engl J Med. 2020;382(9):845\u201354.","journal-title":"N Engl J Med"},{"key":"12683_CR2","unstructured":"World Health Organization. Implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, 2022\u20132030: report on progress and gaps. 2024. [https:\/\/www.who.int\/publications\/i\/item\/9789240094925]"},{"key":"12683_CR3","unstructured":"European Centre for Disease. Prevention and Control. Syphilis. In: ECDC. Annual Epidemiological Report. 2022. [https:\/\/www.ecdc.europa.eu\/en\/publications-data\/syphilis-annual-epidemiological-report-2022]"},{"key":"12683_CR4","unstructured":"Centers for Disease Control and Prevention. Announcing Sexually Transmitted Infections Surveillance. 2023. [https:\/\/www.cdc.gov\/sti\/php\/from-the-director\/announcing-sti-surveillance-2023.html]."},{"issue":"14","key":"12683_CR5","doi-asserted-by":"publisher","first-page":"1358","DOI":"10.1056\/NEJMra1906228","volume":"381","author":"AH Ropper","year":"2019","unstructured":"Ropper AH. Neurosyphilis. N Engl J Med. 2019;381(14):1358\u201363.","journal-title":"N Engl J Med"},{"key":"12683_CR6","doi-asserted-by":"publisher","first-page":"1340321","DOI":"10.3389\/fneur.2023.1340321","volume":"14","author":"S Wu","year":"2023","unstructured":"Wu S, Ye F, Wang Y, Li D. Neurosyphilis: insights into its pathogenesis, susceptibility, diagnosis, treatment, and prevention. Front Neurol. 2023;14:1340321.","journal-title":"Front Neurol"},{"issue":"3","key":"12683_CR7","first-page":"168","volume":"53","author":"National Center for STD Control","year":"2020","unstructured":"National Center for STD Control. Chinese society of Dermatology, subcommittee on Venereology, China dermatologist association: guidelines for diagnosis and treatment of syphilis, gonorrhea and genital chlamydia trachomatis infection (2020). Chin J Dermatology. 2020;53(3):168\u201379.","journal-title":"Chin J Dermatology"},{"issue":"4","key":"12683_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7004a1","volume":"70","author":"KA Workowski","year":"2021","unstructured":"Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually transmitted infections treatment Guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1\u2013187.","journal-title":"MMWR Recomm Rep"},{"issue":"3","key":"12683_CR9","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/jdv.16946","volume":"35","author":"M Janier","year":"2021","unstructured":"Janier M, Unemo M, Dupin N, Tiplica GS, Poto\u010dnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021;35(3):574\u201388.","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"12683_CR10","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s42466-020-00081-1","volume":"2","author":"M Klein","year":"2020","unstructured":"Klein M, Angstwurm K, Esser S, Hahn K, Maschke M, Scheithauer S, Schoefer H, Sturzenegger M, Wildemann B, Weber J. German guidelines on the diagnosis and treatment of neurosyphilis. Neurol Res Pract. 2020;2:33.","journal-title":"Neurol Res Pract"},{"issue":"6","key":"12683_CR11","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1001\/archinte.1948.00220290095007","volume":"82","author":"MT Hoekenga","year":"1948","unstructured":"Hoekenga MT, Farmer TW. Jarisch-Herxheimer reaction in neurosyphilis treated with penicillin. Arch Intern Med (Chic). 1948;82(6):611\u201322.","journal-title":"Arch Intern Med (Chic)"},{"issue":"2","key":"12683_CR12","first-page":"50","volume":"28","author":"A Heyman","year":"1952","unstructured":"Heyman A, Sheldon WH, Evans LD. Pathogenesis of the Jarisch-Herxheimer reaction; a review of clinical and experimental observations. Br J Vener Dis. 1952;28(2):50\u201360.","journal-title":"Br J Vener Dis"},{"key":"12683_CR13","doi-asserted-by":"crossref","unstructured":"Peng RR, Wu J, Zhao W, Zhu L, Guan Z, Gu X, Shi M, Yu J, Cheng Y, Zhou P. An observational prospective study based on a large cohort of HIV-negative neurosyphilis patients with particular reference to the Jarisch-Herxheimer reaction. Eur J Clin Microbiol Infect Dis. 2024.","DOI":"10.1007\/s10096-024-04810-1"},{"issue":"5","key":"12683_CR14","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/OLQ.0b013e3181ffa5d0","volume":"38","author":"JB Bucher","year":"2011","unstructured":"Bucher JB, Golden MR, Heald AE, Marra CM. Stroke in a patient with human immunodeficiency virus and syphilis treated with penicillin and antiretroviral therapy. Sex Transm Dis. 2011;38(5):442\u20134.","journal-title":"Sex Transm Dis"},{"issue":"4","key":"12683_CR15","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1001\/jama.1949.02900210023006","volume":"139","author":"V Scott","year":"1949","unstructured":"Scott V, Maxwell RW, Skinner JS. The Jarisch-Herxheimer phenomenon in late syphilis; probable fatal reactions to penicillin. J Am Med Assoc. 1949;139(4):217\u201320.","journal-title":"J Am Med Assoc"},{"key":"12683_CR16","doi-asserted-by":"publisher","first-page":"100436","DOI":"10.1016\/j.ensci.2022.100436","volume":"29","author":"Y Takahashi","year":"2022","unstructured":"Takahashi Y, Morimoto N, Morimoto M, Mori S, Takahashi Y, Ichikawa T, Yokota K, Yamashita T. Cerebral syphilitic Gumma mimicking a brain tumor that enlarged temporarily after commencing antibiotic treatment. eNeurologicalSci. 2022;29:100436.","journal-title":"eNeurologicalSci"},{"issue":"4","key":"12683_CR17","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1177\/19418744231175564","volume":"13","author":"V Ariza Hutchinson","year":"2023","unstructured":"Ariza Hutchinson V, Shnawa A, Lerner DP, Wener K, Cervantes-Arslanian A, Burns JD. Gummatous neurosyphilis with transient worsening of neurological symptoms after treatment initiation. Neurohospitalist. 2023;13(4):403\u20135.","journal-title":"Neurohospitalist"},{"issue":"4","key":"12683_CR18","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1007\/s00415-010-5808-9","volume":"258","author":"J Kobayashi","year":"2011","unstructured":"Kobayashi J, Nakagawa Y, Tobisawa S, Isozaki E, Koide R. Deterioration of MRI findings related to Jarisch-Herxheimer reaction in a patient with neurosyphilis. J Neurol. 2011;258(4):699\u2013701.","journal-title":"J Neurol"},{"issue":"1","key":"12683_CR19","doi-asserted-by":"publisher","first-page":"18993","DOI":"10.7448\/IAS.17.1.18993","volume":"17","author":"MS Tsai","year":"2014","unstructured":"Tsai MS, Yang CJ, Lee NY, Hsieh SM, Lin YH, Sun HY, Sheng WH, Lee KY, Yang SP, Liu WC, et al. Jarisch-Herxheimer reaction among HIV-positive patients with early syphilis: Azithromycin versus benzathine penicillin G therapy. J Int AIDS Soc. 2014;17(1):18993.","journal-title":"J Int AIDS Soc"},{"issue":"4","key":"12683_CR20","first-page":"239","volume":"65","author":"J Anderson","year":"1989","unstructured":"Anderson J, Mindel A, Tovey SJ, Williams P. Primary and secondary syphilis, 20 years\u2019 experience. 3: Diagnosis, treatment, and follow up. Genitourin Med. 1989;65(4):239\u201343.","journal-title":"Genitourin Med"},{"issue":"10","key":"12683_CR21","doi-asserted-by":"publisher","first-page":"1791","DOI":"10.1111\/jdv.15078","volume":"32","author":"M Arando","year":"2018","unstructured":"Arando M, Fernandez-Naval C, Mota-Foix M, Alvarez A, Armegol P, Barber\u00e1 MJ, Esperalba J, Vall-Mayans M. The Jarisch-Herxheimer reaction in syphilis: could molecular typing help to understand it better? J Eur Acad Dermatol Venereol. 2018;32(10):1791\u20135.","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"10","key":"12683_CR22","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1016\/S1473-3099(20)30857-4","volume":"21","author":"T Bettuzzi","year":"2021","unstructured":"Bettuzzi T, Jourdes A, Robineau O, Alcaraz I, Manda V, Molina JM, Mehlen M, Cazanave C, Tattevin P, Mensi S, et al. Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in france: a retrospective multicentre study. Lancet Infect Dis. 2021;21(10):1441\u20137.","journal-title":"Lancet Infect Dis"},{"issue":"4","key":"12683_CR23","first-page":"293","volume":"47","author":"RN Thin","year":"1971","unstructured":"Thin RN. An unusual Jarisch-Herxheimer reaction. Br J Vener Dis. 1971;47(4):293\u20134.","journal-title":"Br J Vener Dis"},{"issue":"1","key":"12683_CR24","first-page":"42","volume":"21","author":"VE Lloyd","year":"1945","unstructured":"Lloyd VE. The Jarisch-Herxheimer reaction. Br J Vener Dis. 1945;21(1):42\u20134.","journal-title":"Br J Vener Dis"},{"key":"12683_CR25","unstructured":"Dhakal A, Sbar E. Jarisch Herxheimer Reaction. In: StatPearls. edn. Treasure Island (FL): StatPearls Publishing Copyright \u00a9 2022, StatPearls Publishing LLC. 2022."},{"issue":"1","key":"12683_CR26","first-page":"27","volume":"61","author":"C Loveday","year":"1985","unstructured":"Loveday C, Bingham JS. Changes in intravascular complement, kininogen, and Histamine during Jarisch-Herxheimer reaction in secondary syphilis. Genitourin Med. 1985;61(1):27\u201332.","journal-title":"Genitourin Med"},{"key":"12683_CR27","doi-asserted-by":"publisher","first-page":"5121","DOI":"10.2147\/IDR.S335121","volume":"14","author":"YT Tseng","year":"2021","unstructured":"Tseng YT, Chou PY, Tai MH, Dai CY, Lee SS, Chen YS, Tsai HC, Chen YH. High baseline C-Reactive protein level can predict the occurrence of the Jarisch-Herxheimer reaction in patients with active syphilis. Infect Drug Resist. 2021;14:5121\u20139.","journal-title":"Infect Drug Resist"},{"issue":"8","key":"12683_CR28","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1001\/jamaneurol.2013.2120","volume":"70","author":"LE Davis","year":"2013","unstructured":"Davis LE, Oyer R, Beckham JD, Tyler KL. Elevated CSF cytokines in the Jarisch-Herxheimer reaction of general paresis. JAMA Neurol. 2013;70(8):1060\u20134.","journal-title":"JAMA Neurol"},{"issue":"5","key":"12683_CR29","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1093\/infdis\/146.5.606","volume":"146","author":"EJ Young","year":"1982","unstructured":"Young EJ, Weingarten NM, Baughn RE, Duncan WC. Studies on the pathogenesis of the Jarisch-Herxheimer reaction: development of an animal model and evidence against a role for classical endotoxin. J Infect Dis. 1982;146(5):606\u201315.","journal-title":"J Infect Dis"},{"issue":"3","key":"12683_CR30","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1007\/s40121-021-00450-6","volume":"10","author":"KY Lin","year":"2021","unstructured":"Lin KY, Yang CJ, Sun HY, Chuang YC, Chang LH, Liu WC, Su YC, Chang SY, Hung CC, Chang SC. Comparisons of serologic responses of early syphilis to treatment with a Single-Dose benzathine penicillin G between HIV-Positive and HIV-Negative patients. Infect Dis Ther. 2021;10(3):1287\u201398.","journal-title":"Infect Dis Ther"},{"issue":"1\u20132","key":"12683_CR31","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1007\/s12016-011-8279-6","volume":"43","author":"C Chang","year":"2012","unstructured":"Chang C, Mahmood MM, Teuber SS, Gershwin ME. Overview of penicillin allergy. Clin Rev Allergy Immunol. 2012;43(1\u20132):84\u201397.","journal-title":"Clin Rev Allergy Immunol"},{"issue":"2","key":"12683_CR32","doi-asserted-by":"publisher","first-page":"163","DOI":"10.2500\/aap.2022.43.210002","volume":"43","author":"DH Voelker","year":"2022","unstructured":"Voelker DH, Gonzalez-Estrada A, Park MA. Female sex as a risk factor for penicillin drug allergy in the inpatient setting. Allergy Asthma Proc. 2022;43(2):163\u20137.","journal-title":"Allergy Asthma Proc"},{"issue":"10","key":"12683_CR33","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1097\/OLQ.0000000000001983","volume":"51","author":"GY Callado","year":"2024","unstructured":"Callado GY, Pardo I, Gutfreund MC, Deliberato RO, Holubar M, Salinas JL, Marra CM, Perencevich EN, Marra AR. Insights into treatment alternatives for neurosyphilis: systematic literature review and Meta-Analysis. Sex Transm Dis. 2024;51(10):641\u20137.","journal-title":"Sex Transm Dis"},{"issue":"12","key":"12683_CR34","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1258\/ijsa.2010.010281","volume":"21","author":"WM Miller","year":"2010","unstructured":"Miller WM, Gorini F, Botelho G, Moreira C, Barbosa AP, Pinto AR, Dias MF, Souza LM, Asensi MD. Da Costa nery JA: Jarisch-Herxheimer reaction among syphilis patients in Rio de Janeiro, Brazil. Int J STD AIDS. 2010;21(12):806\u20139.","journal-title":"Int J STD AIDS"},{"issue":"10","key":"12683_CR35","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1111\/j.1468-3083.2012.04544.x","volume":"27","author":"J Li","year":"2013","unstructured":"Li J, Wang LN, Zheng HY. Jarisch-Herxheimer reaction among syphilis patients in China. J Eur Acad Dermatol Venereol. 2013;27(10):1304\u20137.","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"1","key":"12683_CR36","first-page":"e12750","volume":"13","author":"C McKenzie","year":"2021","unstructured":"McKenzie C, Olges J. Jarisch-Herxheimer reaction after cephalosporin administration in syphilis. Cureus. 2021;13(1):e12750.","journal-title":"Cureus"},{"issue":"6","key":"12683_CR37","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1054\/jocn.2002.1129","volume":"9","author":"P Silberstein","year":"2002","unstructured":"Silberstein P, Lawrence R, Pryor D, Shnier R. A case of neurosyphilis with a florid Jarisch-Herxheimer reaction. J Clin Neurosci. 2002;9(6):689\u201390.","journal-title":"J Clin Neurosci"},{"key":"12683_CR38","first-page":"548179","volume":"2014","author":"V Punia","year":"2014","unstructured":"Punia V, Rayi A, Sivaraju A. Stroke after initiating IV penicillin for neurosyphilis: A possible Jarisch-Herxheimer reaction. Case Rep Neurol Med. 2014;2014:548179.","journal-title":"Case Rep Neurol Med"},{"issue":"1","key":"12683_CR39","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1684\/epd.2007.0058","volume":"9","author":"C G\u00fcrses","year":"2007","unstructured":"G\u00fcrses C, K\u00fcrt\u00fcnc\u00fc M, Jirsch J, Ye\u015filot N, Hana\u011fasi H, Bebek N, Baykan B, Emre M, G\u00f6kyi\u011fit A, Andermann F. Neurosyphilis presenting with status epilepticus. Epileptic Disord. 2007;9(1):51\u20136.","journal-title":"Epileptic Disord"},{"issue":"1","key":"12683_CR40","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1097\/NRL.0000000000000219","volume":"24","author":"JP Rissardo","year":"2019","unstructured":"Rissardo JP, Caprara ALF, Silveira JOF. Generalized convulsive status epilepticus secondary to Jarisch-Herxheimer reaction in neurosyphilis: A case report and literature review. Neurologist. 2019;24(1):29\u201332.","journal-title":"Neurologist"},{"issue":"5","key":"12683_CR41","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1056\/NEJM199608013350503","volume":"335","author":"D Fekade","year":"1996","unstructured":"Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, Coxon RE, Warrell DA. Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha. N Engl J Med. 1996;335(5):311\u20135.","journal-title":"N Engl J Med"},{"issue":"12","key":"12683_CR42","doi-asserted-by":"publisher","first-page":"e225","DOI":"10.1111\/jdv.13555","volume":"30","author":"F Drago","year":"2016","unstructured":"Drago F, Ciccarese G, Rebora A. Recurrent Jarisch-Herxheimer reaction in late latent syphilis. J Eur Acad Dermatol Venereol. 2016;30(12):e225\u20136.","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"7","key":"12683_CR43","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1136\/jnnp.57.7.865","volume":"57","author":"U Zifko","year":"1994","unstructured":"Zifko U, Lindner K, Wimberger D, Volc B, Grisold W. Jarisch-Herxheimer reaction in a patient with neurosyphilis. J Neurol Neurosurg Psychiatry. 1994;57(7):865\u20137.","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"1","key":"12683_CR44","first-page":"3","volume":"20","author":"JR Vane","year":"1998","unstructured":"Vane JR, Botting RM. Mechanism of action of antiinflammatory drugs. Int J Tissue React. 1998;20(1):3\u201315.","journal-title":"Int J Tissue React"},{"issue":"8","key":"12683_CR45","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1177\/0269881108093585","volume":"23","author":"MA Ates","year":"2009","unstructured":"Ates MA, Algul A, Gecici O, Semiz UB, Yilmaz O, Gulsun M. Olanzapine treatment in Jarisch-Herxheimer reaction due to neurosyphilis with dementia: a case report. J Psychopharmacol. 2009;23(8):999\u20131000.","journal-title":"J Psychopharmacol"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-12683-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12683-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12683-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:13:11Z","timestamp":1781629991000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-12683-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,27]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["12683"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-12683-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,27]]},"assertion":[{"value":"21 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Shanghai Skin Disease Hospital (no. 2020-27). Given its retrospective nature, the Ethics Committee waived the requirement for informed consent. All patient data were anonymized before analysis.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"405"}}