Jarisch-Herxheimer Reaction in Meningococcal Meningitis

The Jarisch-Herxheimer reaction, characterized by high fever and chills followed by hypotension and sweating, is a recognized complication of treatment of spirochetal infections, such as borreliosis and syphilis, and of bacterial infections, such as brucellosis and tularemia.¹We report a case of this reaction developing during treatment of meningococcal meningitis. Endotoxin Assay.—Plasma endotoxin levels were determined by theLimulusamebocyte lysate test.²Briefly, plasma was incubated with lysate, the protein precipitate was measured by relative light scatter, and this was compared graphically with that produced by endotoxin ofEscherichia coli055:B5. Report of a Case.—A 9-year-old girl was admitted to Baragwanath Hospital, Johannesburg, Republic of South Africa, on Sept 23, 1981, with a history of fever and confusion beginning on the previous day. Examination showed that she had a temperature of 38.2 °C, a pulse rate of 110 beats per minute, and a BP of 120/70