IN NEUROSYPHILIS an early reaction to the administration of spirocheticidal drugs (the Jarisch-Herxheimer reaction) may take one or both of two forms: a transient rise in temperature during the first twenty-four hours after administration of the drug or an exacerbation of mental symptoms or neurologic sign during the first few days.
Febrile reactions have been observed after the administration of arsenical drugs, bismuth and, more recently, penicillin. The literature contains only brief comments concerning the incidence and severity of fever after the use of these drugs.
Symptomatic Herxheimer reactions occur not only after the administration of spirocheticidal drugs but also during fever therapy (especially induced malaria). The variety of manifestations observed is related to the type of neurosyphilis. For example, in patients with dementia paralytica there may occasionally occur exacerbations of the existing psychoses or the development of new symptoms. Confusion, agitation, hallucinations and convulsions may sometimes develop. In persons