Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 Tony- You don't " believe " in herx reactions? I didn't know it was a matter of belief, you being scientific and all. I absolutely agree that the term is being overused to cover any negative reaction to something: candida die-off, neurotoxin, allergic reactions, etc. But let's get real: Jarisch-Herxheimer reaction associated with ciprofloxacin administration for tick-borne relapsing fever. Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans HA, Sectish TC. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. A 14-year-old girl was seen at a community clinic with a chief complaint of abdominal pain and fevers and was treated with oral ciprofloxacin for presumed pyelonephritis. She became tachycardic and hypotensive after her first dose of antibiotic, and she developed disseminated intravascular coagulation. She was admitted to our hospital for presumed sepsis. Her outpatient peripheral blood smear was reviewed, revealing spirochetes consistent with Borrelia sp. To our knowledge this is the first reported case of the Jarisch-Herxheimer reaction to ciprofloxacin. Jarisch-Herxheimer reaction complicating the treatment of chronic Q fever endocarditis: elevated TNFalpha and IL-6 serum levels. Kaplanski G, Granel B, Vaz T, Durand JM. Service de Medicine Interne, INSERM U387, Hopital Sainte-Marguerite, Marseille, France. Jarisch-Herxheimer reaction (J-HR) is an acute febrile reaction which may complicate the initiation of an effective treatment against infections due to intracellular micro-organisms. We report a case of J-HR complicating treatment of chronic Q fever endocarditis with demonstration of elevated serum cytokine concentrations. J Emerg Med. 1998 May-Jun;16(3):437-8. Related Articles, Links Lyme disease complicated by the Jarisch-Herxheimer reaction. Maloy AL, Black RD, Segurola RJ Jr. The Department of Emergency Medicine, Hospital of Saint Raphael, New Haven, Connecticut 06511, USA. A 31-year-old woman diagnosed with Lyme disease was treated with amoxicillin. One hour after the first antibiotic dose, the patient became acutely ill. She developed hypertension, fever, and rigors. Shortly afterward, she became hypotensive and required fluid resuscitation. This systemic illness, the Jarisch-Herxheimer reaction, was first noted in association with antibiotic therapy for neurosyphilis. Thus, the institution of antibiotic therapy may be complicated by the Jarisch-Herxheimer reaction. N Engl J Med. 1996 Aug 1;335(5):311-5. Related Articles, Links Comment in: N Engl J Med. 1996 Aug 1;335(5):347-8. Prevention of Jarisch-Herxheimer reactions by treatment with antibodies against tumor necrosis factor alpha. Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on RE, Warrell DA. Department of Internal Medicine, Black Lion Hospital, Addis Ababa, Ethiopia. BACKGROUND: In patients with louse-borne relapsing fever (Borrelia recurrentis infection), antimicrobial treatment is often followed by sudden fever, rigors, and persistent hypotension (Jarisch-Herxheimer reactions) that are associated with increases in plasma concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin-6, and interleukin-8. We attempted to determine whether sheep polyclonal Fab antibody fragments against TNF-alpha (anti-TNF-alpha Fab) could suppress the Jarisch-Herxheimer reaction. METHODS: We conducted a randomized, double-blind, placebo-controlled trial in 49 patients with proven louse-borne relapsing fever. Immediately before the intramuscular injection of penicillin, the patients received an intravenous infusion of either anti-TNF-alpha Fab or a control solution. RESULTS: Ten of the 20 patients given anti-TNF-alpha Fab had Jarisch-Herxheimer reactions with rigors, as compared with 26 of the 29 control patients (P = 0.006). The controls had significantly greater mean maximal increases in temperature (1.5 vs. 0.8 degrees C, P < 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), and systolic blood pressure (25 vs. 15 mm Hg, P < 0.003), as well as higher mean peak plasma concentrations of interleukin-6 (50 vs. 17 micrograms per liter) and interleukin-8 (2000 vs 205 ng per liter) (P < 0.001 for both comparisons). Levels of TNF-alpha were undetectable after treatment with anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer reactions that occur after penicillin treatment for louse-borne relapsing fever, reduces the associated increases in plasma concentrations of interleukin-6 and interleukin-8, and may be useful in other forms of sepsis. We could go on and on. Really, Tony, I can understand why you think it's " bacterial annoyance. " Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 > Tony- > You don't " believe " in herx reactions? I didn't know > it was a matter of belief, you being scientific and > all. I absolutely agree that the term is being > overused to cover any negative reaction to something: > candida die-off, neurotoxin, allergic reactions, etc. > But let's get real: > > Jarisch-Herxheimer reaction associated with > ciprofloxacin administration for tick-borne relapsing > fever. > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > HA, Sectish TC. > > Department of Pediatrics, Stanford University School > of Medicine, Palo Alto, CA, USA. > > A 14-year-old girl was seen at a community clinic with > a chief complaint of abdominal pain and fevers and was > treated with oral ciprofloxacin for presumed > pyelonephritis. She became tachycardic and hypotensive > after her first dose of antibiotic, and she developed > disseminated intravascular coagulation. She was > admitted to our hospital for presumed sepsis. Her > outpatient peripheral blood smear was reviewed, > revealing spirochetes consistent with Borrelia sp. To > our knowledge this is the first reported case of the > Jarisch-Herxheimer reaction to ciprofloxacin. > > Jarisch-Herxheimer reaction complicating the treatment > of chronic Q fever endocarditis: elevated TNFalpha and > IL-6 serum levels. > > Kaplanski G, Granel B, Vaz T, Durand JM. > > Service de Medicine Interne, INSERM U387, Hopital > Sainte-Marguerite, Marseille, France. > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > reaction which may complicate the initiation of an > effective treatment against infections due to > intracellular micro-organisms. We report a case of > J-HR complicating treatment of chronic Q fever > endocarditis with demonstration of elevated serum > cytokine concentrations. > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > Articles, Links > > Lyme disease complicated by the Jarisch-Herxheimer > reaction. > > Maloy AL, Black RD, Segurola RJ Jr. > > The Department of Emergency Medicine, Hospital of > Saint Raphael, New Haven, Connecticut 06511, USA. > > A 31-year-old woman diagnosed with Lyme disease was > treated with amoxicillin. One hour after the first > antibiotic dose, the patient became acutely ill. She > developed hypertension, fever, and rigors. Shortly > afterward, she became hypotensive and required fluid > resuscitation. This systemic illness, the > Jarisch-Herxheimer reaction, was first noted in > association with antibiotic therapy for neurosyphilis. > Thus, the institution of antibiotic therapy may be > complicated by the Jarisch-Herxheimer reaction. > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > Articles, Links > > Comment in: > N Engl J Med. 1996 Aug 1;335(5):347-8. > > Prevention of Jarisch-Herxheimer reactions by > treatment with antibodies against tumor necrosis > factor alpha. > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > RE, Warrell DA. > > Department of Internal Medicine, Black Lion Hospital, > Addis Ababa, Ethiopia. > > BACKGROUND: In patients with louse-borne relapsing > fever (Borrelia recurrentis infection), antimicrobial > treatment is often followed by sudden fever, rigors, > and persistent hypotension (Jarisch-Herxheimer > reactions) that are associated with increases in > plasma concentrations of tumor necrosis factor alpha > (TNF-alpha), interleukin-6, and interleukin-8. We > attempted to determine whether sheep polyclonal Fab > antibody fragments against TNF-alpha (anti-TNF-alpha > Fab) could suppress the Jarisch-Herxheimer reaction. > METHODS: We conducted a randomized, double-blind, > placebo-controlled trial in 49 patients with proven > louse-borne relapsing fever. Immediately before the > intramuscular injection of penicillin, the patients > received an intravenous infusion of either > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > of the 20 patients given anti-TNF-alpha Fab had > Jarisch-Herxheimer reactions with rigors, as compared > with 26 of the 29 control patients (P = 0.006). The > controls had significantly greater mean maximal > increases in temperature (1.5 vs. 0.8 degrees C, P < > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > and systolic blood pressure (25 vs. 15 mm Hg, P < > 0.003), as well as higher mean peak plasma > concentrations of interleukin-6 (50 vs. 17 micrograms > per liter) and interleukin-8 (2000 vs 205 ng per > liter) (P < 0.001 for both comparisons). Levels of > TNF-alpha were undetectable after treatment with > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > reactions that occur after penicillin treatment for > louse-borne relapsing fever, reduces the associated > increases in plasma concentrations of interleukin-6 > and interleukin-8, and may be useful in other forms of > sepsis. > > We could go on and on. > Really, Tony, I can understand why you think it's > " bacterial annoyance. " > > Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 Jim I was watching a program on big pharmaceutical companies and there monitoring the globe for drug testing oppurtunities. Africa gets an outbreak of meningitis and along go the scientists with there new quinolone trevofloxacin(i think, but definately in the quinolone family). Anyways to the amazement of the local doctors who have limited resources and accept help with this overwhelming problem they continue to use trevofloxacin even when the patients condition is deteriorating and many people die including young children.Watching people being violently ill and poeople dieng isn't my idea of herx or anythgiung related to it. You just quoted many examples of overwhelming infection and all the treatment options are 100% wrong in the medical literature, for sepsis/ meningitis you'll put a patient inintially on IV chloremphenicol to save his life unti; you can determine the organisms and there susceptability to safer antimicrobials.So for seriosu infections,_WHEN DIAGNOSED, you go in with chlorempohenicol, high dose penicillin or high dose cephalasporin IV's. You don't walk into hospital and someone hands you a keflex expecting the job to be done.Actually handing you an amoxacillin and watching your symptoms, some stupid herx literate doc will call it a herx. The whole program on trevofloxacin had the loacl doctors pissed how simple drugs could have save the locals yet they persisted with a failed quinolone therapy. Also no-one uses quinolones in modern medicine for seriosu infections possably due to these types of outcomes.I also recxall many posts here on cipro causing neck stiffness a strong sign of meninigitis and sepsis.There's something about cipro and it's kill action, it's like the bacteria are stunned and recover quickly when the drug has worn off in many cases. So again you haven't convinced me by going to the literature, I somehow learned to view the litearature differently when I realised I qualified for a disseminated infection and the treatment was alway's 100% wrong so I fixed myself. tony > > Tony- > > You don't " believe " in herx reactions? I didn't know > > it was a matter of belief, you being scientific and > > all. I absolutely agree that the term is being > > overused to cover any negative reaction to something: > > candida die-off, neurotoxin, allergic reactions, etc. > > But let's get real: > > > > Jarisch-Herxheimer reaction associated with > > ciprofloxacin administration for tick-borne relapsing > > fever. > > > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > > HA, Sectish TC. > > > > Department of Pediatrics, Stanford University School > > of Medicine, Palo Alto, CA, USA. > > > > A 14-year-old girl was seen at a community clinic with > > a chief complaint of abdominal pain and fevers and was > > treated with oral ciprofloxacin for presumed > > pyelonephritis. She became tachycardic and hypotensive > > after her first dose of antibiotic, and she developed > > disseminated intravascular coagulation. She was > > admitted to our hospital for presumed sepsis. Her > > outpatient peripheral blood smear was reviewed, > > revealing spirochetes consistent with Borrelia sp. To > > our knowledge this is the first reported case of the > > Jarisch-Herxheimer reaction to ciprofloxacin. > > > > Jarisch-Herxheimer reaction complicating the treatment > > of chronic Q fever endocarditis: elevated TNFalpha and > > IL-6 serum levels. > > > > Kaplanski G, Granel B, Vaz T, Durand JM. > > > > Service de Medicine Interne, INSERM U387, Hopital > > Sainte-Marguerite, Marseille, France. > > > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > > reaction which may complicate the initiation of an > > effective treatment against infections due to > > intracellular micro-organisms. We report a case of > > J-HR complicating treatment of chronic Q fever > > endocarditis with demonstration of elevated serum > > cytokine concentrations. > > > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > > Articles, Links > > > > Lyme disease complicated by the Jarisch-Herxheimer > > reaction. > > > > Maloy AL, Black RD, Segurola RJ Jr. > > > > The Department of Emergency Medicine, Hospital of > > Saint Raphael, New Haven, Connecticut 06511, USA. > > > > A 31-year-old woman diagnosed with Lyme disease was > > treated with amoxicillin. One hour after the first > > antibiotic dose, the patient became acutely ill. She > > developed hypertension, fever, and rigors. Shortly > > afterward, she became hypotensive and required fluid > > resuscitation. This systemic illness, the > > Jarisch-Herxheimer reaction, was first noted in > > association with antibiotic therapy for neurosyphilis. > > Thus, the institution of antibiotic therapy may be > > complicated by the Jarisch-Herxheimer reaction. > > > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > > Articles, Links > > > > Comment in: > > N Engl J Med. 1996 Aug 1;335(5):347-8. > > > > Prevention of Jarisch-Herxheimer reactions by > > treatment with antibodies against tumor necrosis > > factor alpha. > > > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > > RE, Warrell DA. > > > > Department of Internal Medicine, Black Lion Hospital, > > Addis Ababa, Ethiopia. > > > > BACKGROUND: In patients with louse-borne relapsing > > fever (Borrelia recurrentis infection), antimicrobial > > treatment is often followed by sudden fever, rigors, > > and persistent hypotension (Jarisch-Herxheimer > > reactions) that are associated with increases in > > plasma concentrations of tumor necrosis factor alpha > > (TNF-alpha), interleukin-6, and interleukin-8. We > > attempted to determine whether sheep polyclonal Fab > > antibody fragments against TNF-alpha (anti-TNF-alpha > > Fab) could suppress the Jarisch-Herxheimer reaction. > > METHODS: We conducted a randomized, double-blind, > > placebo-controlled trial in 49 patients with proven > > louse-borne relapsing fever. Immediately before the > > intramuscular injection of penicillin, the patients > > received an intravenous infusion of either > > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > > of the 20 patients given anti-TNF-alpha Fab had > > Jarisch-Herxheimer reactions with rigors, as compared > > with 26 of the 29 control patients (P = 0.006). The > > controls had significantly greater mean maximal > > increases in temperature (1.5 vs. 0.8 degrees C, P < > > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > > and systolic blood pressure (25 vs. 15 mm Hg, P < > > 0.003), as well as higher mean peak plasma > > concentrations of interleukin-6 (50 vs. 17 micrograms > > per liter) and interleukin-8 (2000 vs 205 ng per > > liter) (P < 0.001 for both comparisons). Levels of > > TNF-alpha were undetectable after treatment with > > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > > reactions that occur after penicillin treatment for > > louse-borne relapsing fever, reduces the associated > > increases in plasma concentrations of interleukin-6 > > and interleukin-8, and may be useful in other forms of > > sepsis. > > > > We could go on and on. > > Really, Tony, I can understand why you think it's > > " bacterial annoyance. " > > > > Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 Tony, You know where some of us don't see eye to eye with you i, you often quote the general traditional medicine. You talk about getting the right perscription in the hospital. You mentioned big drug companies. Personally, I don't give a diddly squat what those particular entities have to say about my health. For the vast majority of my life those practicing tradional medicine have caused my family nothing but pure hell. My husband first ended up in the hospital for an entire month, because some stupid doctor couldn't diagnose appendecitis. I fought numerous doctos for 6 weeks, insisting my 5 year old daughter had some sort of sinus infection that caused her pupils to not react equally and her eye lid to swell shut. They gave here every painful and expensive test under the sun with the exception of a sinus exray which I kept begging for. Finally I DEMANDED through tears a sinus exray, and low and belhold, what do you think all these briliant doctors found......not just a sinus infection, but, a MASSSIVE sinus infection. They put her in the hospital immediately on massive IV ABx. The infection had been eating away at her optic nerve all those weeks. It took years for the damage to her eye to correct itself and to this day, 21 years later, at times you can still see the damage. My mom had undiagnosed bladder cancer that for 2 years. The doctors kept insisting it was nothing more then a bladder infection. Did they check.....no. She went outside of her insurance and paid money out of her own pocket to find she didn't have a bladder infection but CANCER. Then we have my dad, who layed in a bed screaming all day and the nurse felt he was faking it so would not call for a doctor. She instead said that his doctor would be in after he finished with his patients at the office. When the doctor arrived he was furious, but it was to late, my dad died less then 24 hours later. This is just scratching the surface, but for me I don't give a rat's patoot what mainstream medicine has to say about much of anything. If we waited for them to find the right answer, my family would ALL be dead. My doctor is what I call cutting edge. He doesn't wait for mainstream to tell him how he should treat his patients. He recognized long ago that they don't have a clue of what they are doing and he has made it his lifes mission to find answers that improve the quality of his patients life. He has always said, " you know they are just " practicing on us " . It matters not to me that the people working in a hospital don't know what a herx is by name. I always find it amuzing when you read about an ABX and it says it may cause in some people a flu like symptom, hello, could that be a herx??? I have had tinnitus for years. At one point I was given Cipro to treat the Mycos. After about 3 days I started feeling rather dizzy. A couple of days later, I woke up with the roon swirling around so fast I couldn't even see a piece of furniture to grab on to. I did some research on Cipro, turns out it tends to accumulate in the inner ear and can cause vertigo. At first I believe it to be nothing more then that, but as the vertigo cleared, so did the tinnitis in my right ear and it dimished greatly in my left. At that point I decided that what had happened was my inner ear is loaded with these little buggers. Since the Cipro hits hard in the ear, there was apparently a massive die off, and that then leads to toxic buildup and then the HERX. Now if it was as use say, that the little buggers were merely fighting back, then why did the tinnitis get better? Your theory doesn't hold water in this instance. It is far more reasonable to see it was a herx. -- In infections , " dumbaussie2000 " <dumbaussie2000@y...> wrote: > Jim > I was watching a program on big pharmaceutical companies and there > monitoring the globe for drug testing oppurtunities. Africa gets an > outbreak of meningitis and along go the scientists with there new > quinolone trevofloxacin(i think, but definately in the quinolone > family). Anyways to the amazement of the local doctors who have > limited resources and accept help with this overwhelming problem > they continue to use trevofloxacin even when the patients condition > is deteriorating and many people die including young > children.Watching people being violently ill and poeople dieng isn't > my idea of herx or anythgiung related to it. > You just quoted many examples of overwhelming infection and all the > treatment options are 100% wrong in the medical literature, for > sepsis/ meningitis you'll put a patient inintially on IV > chloremphenicol to save his life unti; you can determine the > organisms and there susceptability to safer antimicrobials.So for > seriosu infections,_WHEN DIAGNOSED, you go in with chlorempohenicol, > high dose penicillin or high dose cephalasporin IV's. You don't walk > into hospital and someone hands you a keflex expecting the job to be > done.Actually handing you an amoxacillin and watching your symptoms, > some stupid herx literate doc will call it a herx. > The whole program on trevofloxacin had the loacl doctors pissed how > simple drugs could have save the locals yet they persisted with a > failed quinolone therapy. Also no-one uses quinolones in modern > medicine for seriosu infections possably due to these types of > outcomes.I also recxall many posts here on cipro causing neck > stiffness a strong sign of meninigitis and sepsis.There's something > about cipro and it's kill action, it's like the bacteria are stunned > and recover quickly when the drug has worn off in many cases. > So again you haven't convinced me by going to the literature, I > somehow learned to view the litearature differently when I realised > I qualified for a disseminated infection and the treatment was > alway's 100% wrong so I fixed myself. > tony > > > > > > > > Tony- > > > You don't " believe " in herx reactions? I didn't know > > > it was a matter of belief, you being scientific and > > > all. I absolutely agree that the term is being > > > overused to cover any negative reaction to something: > > > candida die-off, neurotoxin, allergic reactions, etc. > > > But let's get real: > > > > > > Jarisch-Herxheimer reaction associated with > > > ciprofloxacin administration for tick-borne relapsing > > > fever. > > > > > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > > > HA, Sectish TC. > > > > > > Department of Pediatrics, Stanford University School > > > of Medicine, Palo Alto, CA, USA. > > > > > > A 14-year-old girl was seen at a community clinic with > > > a chief complaint of abdominal pain and fevers and was > > > treated with oral ciprofloxacin for presumed > > > pyelonephritis. She became tachycardic and hypotensive > > > after her first dose of antibiotic, and she developed > > > disseminated intravascular coagulation. She was > > > admitted to our hospital for presumed sepsis. Her > > > outpatient peripheral blood smear was reviewed, > > > revealing spirochetes consistent with Borrelia sp. To > > > our knowledge this is the first reported case of the > > > Jarisch-Herxheimer reaction to ciprofloxacin. > > > > > > Jarisch-Herxheimer reaction complicating the treatment > > > of chronic Q fever endocarditis: elevated TNFalpha and > > > IL-6 serum levels. > > > > > > Kaplanski G, Granel B, Vaz T, Durand JM. > > > > > > Service de Medicine Interne, INSERM U387, Hopital > > > Sainte-Marguerite, Marseille, France. > > > > > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > > > reaction which may complicate the initiation of an > > > effective treatment against infections due to > > > intracellular micro-organisms. We report a case of > > > J-HR complicating treatment of chronic Q fever > > > endocarditis with demonstration of elevated serum > > > cytokine concentrations. > > > > > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > > > Articles, Links > > > > > > Lyme disease complicated by the Jarisch-Herxheimer > > > reaction. > > > > > > Maloy AL, Black RD, Segurola RJ Jr. > > > > > > The Department of Emergency Medicine, Hospital of > > > Saint Raphael, New Haven, Connecticut 06511, USA. > > > > > > A 31-year-old woman diagnosed with Lyme disease was > > > treated with amoxicillin. One hour after the first > > > antibiotic dose, the patient became acutely ill. She > > > developed hypertension, fever, and rigors. Shortly > > > afterward, she became hypotensive and required fluid > > > resuscitation. This systemic illness, the > > > Jarisch-Herxheimer reaction, was first noted in > > > association with antibiotic therapy for neurosyphilis. > > > Thus, the institution of antibiotic therapy may be > > > complicated by the Jarisch-Herxheimer reaction. > > > > > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > > > Articles, Links > > > > > > Comment in: > > > N Engl J Med. 1996 Aug 1;335(5):347-8. > > > > > > Prevention of Jarisch-Herxheimer reactions by > > > treatment with antibodies against tumor necrosis > > > factor alpha. > > > > > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > > > RE, Warrell DA. > > > > > > Department of Internal Medicine, Black Lion Hospital, > > > Addis Ababa, Ethiopia. > > > > > > BACKGROUND: In patients with louse-borne relapsing > > > fever (Borrelia recurrentis infection), antimicrobial > > > treatment is often followed by sudden fever, rigors, > > > and persistent hypotension (Jarisch-Herxheimer > > > reactions) that are associated with increases in > > > plasma concentrations of tumor necrosis factor alpha > > > (TNF-alpha), interleukin-6, and interleukin-8. We > > > attempted to determine whether sheep polyclonal Fab > > > antibody fragments against TNF-alpha (anti-TNF-alpha > > > Fab) could suppress the Jarisch-Herxheimer reaction. > > > METHODS: We conducted a randomized, double-blind, > > > placebo-controlled trial in 49 patients with proven > > > louse-borne relapsing fever. Immediately before the > > > intramuscular injection of penicillin, the patients > > > received an intravenous infusion of either > > > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > > > of the 20 patients given anti-TNF-alpha Fab had > > > Jarisch-Herxheimer reactions with rigors, as compared > > > with 26 of the 29 control patients (P = 0.006). The > > > controls had significantly greater mean maximal > > > increases in temperature (1.5 vs. 0.8 degrees C, P < > > > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > > > and systolic blood pressure (25 vs. 15 mm Hg, P < > > > 0.003), as well as higher mean peak plasma > > > concentrations of interleukin-6 (50 vs. 17 micrograms > > > per liter) and interleukin-8 (2000 vs 205 ng per > > > liter) (P < 0.001 for both comparisons). Levels of > > > TNF-alpha were undetectable after treatment with > > > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > > > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > > > reactions that occur after penicillin treatment for > > > louse-borne relapsing fever, reduces the associated > > > increases in plasma concentrations of interleukin-6 > > > and interleukin-8, and may be useful in other forms of > > > sepsis. > > > > > > We could go on and on. > > > Really, Tony, I can understand why you think it's > > > " bacterial annoyance. " > > > > > > Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 Jim I am also troubled by syphilis treatment which see's patients treated early with penicillin have no problem, yet late stage syphilis isn't treated with antibiotics because the outcome isn't good. Where does the herx fit inot this. mainstream medicine when it treats syphilis early has no problem yet offer nothing in late stage? Maybe it's the violent reaction (again herxheimer) that makes them realise treatment doesn't work. I believe in the medicate correctly theory rather, than the herxheimer theory-I also believe in what I feel, observe, and apply commonsense to. Remember the same literatue that describes herxheimer, is also adamant that we have a psychiatric condition and there's possabl;y 100's and thousands of articles from that pubmed no-one bothers to bring to these forums because we know it's not true. tyony -- In infections , Jim Kepner <jimk192002@y...> wrote: > Tony- > You don't " believe " in herx reactions? I didn't know > it was a matter of belief, you being scientific and > all. I absolutely agree that the term is being > overused to cover any negative reaction to something: > candida die-off, neurotoxin, allergic reactions, etc. > But let's get real: > > Jarisch-Herxheimer reaction associated with > ciprofloxacin administration for tick-borne relapsing > fever. > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > HA, Sectish TC. > > Department of Pediatrics, Stanford University School > of Medicine, Palo Alto, CA, USA. > > A 14-year-old girl was seen at a community clinic with > a chief complaint of abdominal pain and fevers and was > treated with oral ciprofloxacin for presumed > pyelonephritis. She became tachycardic and hypotensive > after her first dose of antibiotic, and she developed > disseminated intravascular coagulation. She was > admitted to our hospital for presumed sepsis. Her > outpatient peripheral blood smear was reviewed, > revealing spirochetes consistent with Borrelia sp. To > our knowledge this is the first reported case of the > Jarisch-Herxheimer reaction to ciprofloxacin. > > Jarisch-Herxheimer reaction complicating the treatment > of chronic Q fever endocarditis: elevated TNFalpha and > IL-6 serum levels. > > Kaplanski G, Granel B, Vaz T, Durand JM. > > Service de Medicine Interne, INSERM U387, Hopital > Sainte-Marguerite, Marseille, France. > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > reaction which may complicate the initiation of an > effective treatment against infections due to > intracellular micro-organisms. We report a case of > J-HR complicating treatment of chronic Q fever > endocarditis with demonstration of elevated serum > cytokine concentrations. > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > Articles, Links > > Lyme disease complicated by the Jarisch-Herxheimer > reaction. > > Maloy AL, Black RD, Segurola RJ Jr. > > The Department of Emergency Medicine, Hospital of > Saint Raphael, New Haven, Connecticut 06511, USA. > > A 31-year-old woman diagnosed with Lyme disease was > treated with amoxicillin. One hour after the first > antibiotic dose, the patient became acutely ill. She > developed hypertension, fever, and rigors. Shortly > afterward, she became hypotensive and required fluid > resuscitation. This systemic illness, the > Jarisch-Herxheimer reaction, was first noted in > association with antibiotic therapy for neurosyphilis. > Thus, the institution of antibiotic therapy may be > complicated by the Jarisch-Herxheimer reaction. > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > Articles, Links > > Comment in: > N Engl J Med. 1996 Aug 1;335(5):347-8. > > Prevention of Jarisch-Herxheimer reactions by > treatment with antibodies against tumor necrosis > factor alpha. > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > RE, Warrell DA. > > Department of Internal Medicine, Black Lion Hospital, > Addis Ababa, Ethiopia. > > BACKGROUND: In patients with louse-borne relapsing > fever (Borrelia recurrentis infection), antimicrobial > treatment is often followed by sudden fever, rigors, > and persistent hypotension (Jarisch-Herxheimer > reactions) that are associated with increases in > plasma concentrations of tumor necrosis factor alpha > (TNF-alpha), interleukin-6, and interleukin-8. We > attempted to determine whether sheep polyclonal Fab > antibody fragments against TNF-alpha (anti-TNF-alpha > Fab) could suppress the Jarisch-Herxheimer reaction. > METHODS: We conducted a randomized, double-blind, > placebo-controlled trial in 49 patients with proven > louse-borne relapsing fever. Immediately before the > intramuscular injection of penicillin, the patients > received an intravenous infusion of either > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > of the 20 patients given anti-TNF-alpha Fab had > Jarisch-Herxheimer reactions with rigors, as compared > with 26 of the 29 control patients (P = 0.006). The > controls had significantly greater mean maximal > increases in temperature (1.5 vs. 0.8 degrees C, P < > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > and systolic blood pressure (25 vs. 15 mm Hg, P < > 0.003), as well as higher mean peak plasma > concentrations of interleukin-6 (50 vs. 17 micrograms > per liter) and interleukin-8 (2000 vs 205 ng per > liter) (P < 0.001 for both comparisons). Levels of > TNF-alpha were undetectable after treatment with > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > reactions that occur after penicillin treatment for > louse-borne relapsing fever, reduces the associated > increases in plasma concentrations of interleukin-6 > and interleukin-8, and may be useful in other forms of > sepsis. > > We could go on and on. > Really, Tony, I can understand why you think it's > " bacterial annoyance. " > > Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 Agreed. Unless you have experienced this type of herx, it is very hard to understand, hence 99% of the medical community doesn't even recognize the herx. On the fip side, however, of the doctors that do recognize the herx, many of them were sick with cwd at one time. I say line 'em all up and give 'em a shot of cwd in a joint as part of their final exams. When they heal themselves, they pass. If this was part of the curriculum, we wouldn't be sick. LOL Agreed. Most doctors want to take the easy road. If you don't fit in their " easy-box " , they want to pass you off for the next doc to worry about. When you say (and this happened to me), " I think I have a resistant bug " , a typical response from a doc that doesn't want to deal with such a thing is, " hahaha, I doubt it " . If you say the same thing to a good, caring doc that is really interested in healing you, the reply will be more along the lines of, " that may be " (also happened to me). When you find a " that could be, let's see what we can find " doctor, hang on. Run from the others, and give them a bad report every chance you get. With any luck, it will negatively affect them. Is this not what they deserve? > > > > Tony- > > > > You don't " believe " in herx reactions? I didn't know > > > > it was a matter of belief, you being scientific and > > > > all. I absolutely agree that the term is being > > > > overused to cover any negative reaction to something: > > > > candida die-off, neurotoxin, allergic reactions, etc. > > > > But let's get real: > > > > > > > > Jarisch-Herxheimer reaction associated with > > > > ciprofloxacin administration for tick-borne relapsing > > > > fever. > > > > > > > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > > > > HA, Sectish TC. > > > > > > > > Department of Pediatrics, Stanford University School > > > > of Medicine, Palo Alto, CA, USA. > > > > > > > > A 14-year-old girl was seen at a community clinic with > > > > a chief complaint of abdominal pain and fevers and was > > > > treated with oral ciprofloxacin for presumed > > > > pyelonephritis. She became tachycardic and hypotensive > > > > after her first dose of antibiotic, and she developed > > > > disseminated intravascular coagulation. She was > > > > admitted to our hospital for presumed sepsis. Her > > > > outpatient peripheral blood smear was reviewed, > > > > revealing spirochetes consistent with Borrelia sp. To > > > > our knowledge this is the first reported case of the > > > > Jarisch-Herxheimer reaction to ciprofloxacin. > > > > > > > > Jarisch-Herxheimer reaction complicating the treatment > > > > of chronic Q fever endocarditis: elevated TNFalpha and > > > > IL-6 serum levels. > > > > > > > > Kaplanski G, Granel B, Vaz T, Durand JM. > > > > > > > > Service de Medicine Interne, INSERM U387, Hopital > > > > Sainte-Marguerite, Marseille, France. > > > > > > > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > > > > reaction which may complicate the initiation of an > > > > effective treatment against infections due to > > > > intracellular micro-organisms. We report a case of > > > > J-HR complicating treatment of chronic Q fever > > > > endocarditis with demonstration of elevated serum > > > > cytokine concentrations. > > > > > > > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > > > > Articles, Links > > > > > > > > Lyme disease complicated by the Jarisch-Herxheimer > > > > reaction. > > > > > > > > Maloy AL, Black RD, Segurola RJ Jr. > > > > > > > > The Department of Emergency Medicine, Hospital of > > > > Saint Raphael, New Haven, Connecticut 06511, USA. > > > > > > > > A 31-year-old woman diagnosed with Lyme disease was > > > > treated with amoxicillin. One hour after the first > > > > antibiotic dose, the patient became acutely ill. She > > > > developed hypertension, fever, and rigors. Shortly > > > > afterward, she became hypotensive and required fluid > > > > resuscitation. This systemic illness, the > > > > Jarisch-Herxheimer reaction, was first noted in > > > > association with antibiotic therapy for neurosyphilis. > > > > Thus, the institution of antibiotic therapy may be > > > > complicated by the Jarisch-Herxheimer reaction. > > > > > > > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > > > > Articles, Links > > > > > > > > Comment in: > > > > N Engl J Med. 1996 Aug 1;335(5):347-8. > > > > > > > > Prevention of Jarisch-Herxheimer reactions by > > > > treatment with antibodies against tumor necrosis > > > > factor alpha. > > > > > > > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > > > > RE, Warrell DA. > > > > > > > > Department of Internal Medicine, Black Lion Hospital, > > > > Addis Ababa, Ethiopia. > > > > > > > > BACKGROUND: In patients with louse-borne relapsing > > > > fever (Borrelia recurrentis infection), antimicrobial > > > > treatment is often followed by sudden fever, rigors, > > > > and persistent hypotension (Jarisch-Herxheimer > > > > reactions) that are associated with increases in > > > > plasma concentrations of tumor necrosis factor alpha > > > > (TNF-alpha), interleukin-6, and interleukin-8. We > > > > attempted to determine whether sheep polyclonal Fab > > > > antibody fragments against TNF-alpha (anti-TNF-alpha > > > > Fab) could suppress the Jarisch-Herxheimer reaction. > > > > METHODS: We conducted a randomized, double-blind, > > > > placebo-controlled trial in 49 patients with proven > > > > louse-borne relapsing fever. Immediately before the > > > > intramuscular injection of penicillin, the patients > > > > received an intravenous infusion of either > > > > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > > > > of the 20 patients given anti-TNF-alpha Fab had > > > > Jarisch-Herxheimer reactions with rigors, as compared > > > > with 26 of the 29 control patients (P = 0.006). The > > > > controls had significantly greater mean maximal > > > > increases in temperature (1.5 vs. 0.8 degrees C, P < > > > > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > > > > and systolic blood pressure (25 vs. 15 mm Hg, P < > > > > 0.003), as well as higher mean peak plasma > > > > concentrations of interleukin-6 (50 vs. 17 micrograms > > > > per liter) and interleukin-8 (2000 vs 205 ng per > > > > liter) (P < 0.001 for both comparisons). Levels of > > > > TNF-alpha were undetectable after treatment with > > > > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > > > > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > > > > reactions that occur after penicillin treatment for > > > > louse-borne relapsing fever, reduces the associated > > > > increases in plasma concentrations of interleukin-6 > > > > and interleukin-8, and may be useful in other forms of > > > > sepsis. > > > > > > > > We could go on and on. > > > > Really, Tony, I can understand why you think it's > > > > " bacterial annoyance. " > > > > > > > > Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 TONY WROTE: " I am also troubled by syphilis treatment which see's patients treated early with penicillin have no problem, yet late stage syphilis isn't treated with antibiotics because the outcome isn't good. " PAUL RESPONDS: Tony, perhaps you should read this: http://cmr.asm.org/cgi/reprint/8/1/1?view=reprint & pmid=7704889 Among other things, this review notes that the most sensitive test for neurosyphilis misses 50% of cases. Applying Tony's rule - 'Treat the bugs you can culture, stupid!' - would deny treatment to each and every one of those patients. > > Tony- > > You don't " believe " in herx reactions? I didn't know > > it was a matter of belief, you being scientific and > > all. I absolutely agree that the term is being > > overused to cover any negative reaction to something: > > candida die-off, neurotoxin, allergic reactions, etc. > > But let's get real: > > > > Jarisch-Herxheimer reaction associated with > > ciprofloxacin administration for tick-borne relapsing > > fever. > > > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > > HA, Sectish TC. > > > > Department of Pediatrics, Stanford University School > > of Medicine, Palo Alto, CA, USA. > > > > A 14-year-old girl was seen at a community clinic with > > a chief complaint of abdominal pain and fevers and was > > treated with oral ciprofloxacin for presumed > > pyelonephritis. She became tachycardic and hypotensive > > after her first dose of antibiotic, and she developed > > disseminated intravascular coagulation. She was > > admitted to our hospital for presumed sepsis. Her > > outpatient peripheral blood smear was reviewed, > > revealing spirochetes consistent with Borrelia sp. To > > our knowledge this is the first reported case of the > > Jarisch-Herxheimer reaction to ciprofloxacin. > > > > Jarisch-Herxheimer reaction complicating the treatment > > of chronic Q fever endocarditis: elevated TNFalpha and > > IL-6 serum levels. > > > > Kaplanski G, Granel B, Vaz T, Durand JM. > > > > Service de Medicine Interne, INSERM U387, Hopital > > Sainte-Marguerite, Marseille, France. > > > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > > reaction which may complicate the initiation of an > > effective treatment against infections due to > > intracellular micro-organisms. We report a case of > > J-HR complicating treatment of chronic Q fever > > endocarditis with demonstration of elevated serum > > cytokine concentrations. > > > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > > Articles, Links > > > > Lyme disease complicated by the Jarisch-Herxheimer > > reaction. > > > > Maloy AL, Black RD, Segurola RJ Jr. > > > > The Department of Emergency Medicine, Hospital of > > Saint Raphael, New Haven, Connecticut 06511, USA. > > > > A 31-year-old woman diagnosed with Lyme disease was > > treated with amoxicillin. One hour after the first > > antibiotic dose, the patient became acutely ill. She > > developed hypertension, fever, and rigors. Shortly > > afterward, she became hypotensive and required fluid > > resuscitation. This systemic illness, the > > Jarisch-Herxheimer reaction, was first noted in > > association with antibiotic therapy for neurosyphilis. > > Thus, the institution of antibiotic therapy may be > > complicated by the Jarisch-Herxheimer reaction. > > > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > > Articles, Links > > > > Comment in: > > N Engl J Med. 1996 Aug 1;335(5):347-8. > > > > Prevention of Jarisch-Herxheimer reactions by > > treatment with antibodies against tumor necrosis > > factor alpha. > > > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > > RE, Warrell DA. > > > > Department of Internal Medicine, Black Lion Hospital, > > Addis Ababa, Ethiopia. > > > > BACKGROUND: In patients with louse-borne relapsing > > fever (Borrelia recurrentis infection), antimicrobial > > treatment is often followed by sudden fever, rigors, > > and persistent hypotension (Jarisch-Herxheimer > > reactions) that are associated with increases in > > plasma concentrations of tumor necrosis factor alpha > > (TNF-alpha), interleukin-6, and interleukin-8. We > > attempted to determine whether sheep polyclonal Fab > > antibody fragments against TNF-alpha (anti-TNF-alpha > > Fab) could suppress the Jarisch-Herxheimer reaction. > > METHODS: We conducted a randomized, double-blind, > > placebo-controlled trial in 49 patients with proven > > louse-borne relapsing fever. Immediately before the > > intramuscular injection of penicillin, the patients > > received an intravenous infusion of either > > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > > of the 20 patients given anti-TNF-alpha Fab had > > Jarisch-Herxheimer reactions with rigors, as compared > > with 26 of the 29 control patients (P = 0.006). The > > controls had significantly greater mean maximal > > increases in temperature (1.5 vs. 0.8 degrees C, P < > > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > > and systolic blood pressure (25 vs. 15 mm Hg, P < > > 0.003), as well as higher mean peak plasma > > concentrations of interleukin-6 (50 vs. 17 micrograms > > per liter) and interleukin-8 (2000 vs 205 ng per > > liter) (P < 0.001 for both comparisons). Levels of > > TNF-alpha were undetectable after treatment with > > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > > reactions that occur after penicillin treatment for > > louse-borne relapsing fever, reduces the associated > > increases in plasma concentrations of interleukin-6 > > and interleukin-8, and may be useful in other forms of > > sepsis. > > > > We could go on and on. > > Really, Tony, I can understand why you think it's > > " bacterial annoyance. " > > > > Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 I talk about sections of the hospital system where people actually get the full diagnosis, this is not occuring 90% of the time, it's just you read someone's life story of treating serious infections and you realise he's observations are far far different to the rest of the clowns. I know the system sucks but you gotta work with what is in front of you and you can get both hands on.Your sinus example is exactly what I would believe, a massive, repeat massive infection is in many on these forums and they ramble about something totally different that 99% of medicine can't diagnose or treat effectively.Imagine they get there massive sinus problem diagnosed and are treated effectively they have everyone in there corner with that diagnosis, unfortunately the mycoplasma stories, and other poor stories are brought up which makes it impossable to go with. > > > > Tony- > > > > You don't " believe " in herx reactions? I didn't know > > > > it was a matter of belief, you being scientific and > > > > all. I absolutely agree that the term is being > > > > overused to cover any negative reaction to something: > > > > candida die-off, neurotoxin, allergic reactions, etc. > > > > But let's get real: > > > > > > > > Jarisch-Herxheimer reaction associated with > > > > ciprofloxacin administration for tick-borne relapsing > > > > fever. > > > > > > > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > > > > HA, Sectish TC. > > > > > > > > Department of Pediatrics, Stanford University School > > > > of Medicine, Palo Alto, CA, USA. > > > > > > > > A 14-year-old girl was seen at a community clinic with > > > > a chief complaint of abdominal pain and fevers and was > > > > treated with oral ciprofloxacin for presumed > > > > pyelonephritis. She became tachycardic and hypotensive > > > > after her first dose of antibiotic, and she developed > > > > disseminated intravascular coagulation. She was > > > > admitted to our hospital for presumed sepsis. Her > > > > outpatient peripheral blood smear was reviewed, > > > > revealing spirochetes consistent with Borrelia sp. To > > > > our knowledge this is the first reported case of the > > > > Jarisch-Herxheimer reaction to ciprofloxacin. > > > > > > > > Jarisch-Herxheimer reaction complicating the treatment > > > > of chronic Q fever endocarditis: elevated TNFalpha and > > > > IL-6 serum levels. > > > > > > > > Kaplanski G, Granel B, Vaz T, Durand JM. > > > > > > > > Service de Medicine Interne, INSERM U387, Hopital > > > > Sainte-Marguerite, Marseille, France. > > > > > > > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > > > > reaction which may complicate the initiation of an > > > > effective treatment against infections due to > > > > intracellular micro-organisms. We report a case of > > > > J-HR complicating treatment of chronic Q fever > > > > endocarditis with demonstration of elevated serum > > > > cytokine concentrations. > > > > > > > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > > > > Articles, Links > > > > > > > > Lyme disease complicated by the Jarisch-Herxheimer > > > > reaction. > > > > > > > > Maloy AL, Black RD, Segurola RJ Jr. > > > > > > > > The Department of Emergency Medicine, Hospital of > > > > Saint Raphael, New Haven, Connecticut 06511, USA. > > > > > > > > A 31-year-old woman diagnosed with Lyme disease was > > > > treated with amoxicillin. One hour after the first > > > > antibiotic dose, the patient became acutely ill. She > > > > developed hypertension, fever, and rigors. Shortly > > > > afterward, she became hypotensive and required fluid > > > > resuscitation. This systemic illness, the > > > > Jarisch-Herxheimer reaction, was first noted in > > > > association with antibiotic therapy for neurosyphilis. > > > > Thus, the institution of antibiotic therapy may be > > > > complicated by the Jarisch-Herxheimer reaction. > > > > > > > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > > > > Articles, Links > > > > > > > > Comment in: > > > > N Engl J Med. 1996 Aug 1;335(5):347-8. > > > > > > > > Prevention of Jarisch-Herxheimer reactions by > > > > treatment with antibodies against tumor necrosis > > > > factor alpha. > > > > > > > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > > > > RE, Warrell DA. > > > > > > > > Department of Internal Medicine, Black Lion Hospital, > > > > Addis Ababa, Ethiopia. > > > > > > > > BACKGROUND: In patients with louse-borne relapsing > > > > fever (Borrelia recurrentis infection), antimicrobial > > > > treatment is often followed by sudden fever, rigors, > > > > and persistent hypotension (Jarisch-Herxheimer > > > > reactions) that are associated with increases in > > > > plasma concentrations of tumor necrosis factor alpha > > > > (TNF-alpha), interleukin-6, and interleukin-8. We > > > > attempted to determine whether sheep polyclonal Fab > > > > antibody fragments against TNF-alpha (anti-TNF-alpha > > > > Fab) could suppress the Jarisch-Herxheimer reaction. > > > > METHODS: We conducted a randomized, double-blind, > > > > placebo-controlled trial in 49 patients with proven > > > > louse-borne relapsing fever. Immediately before the > > > > intramuscular injection of penicillin, the patients > > > > received an intravenous infusion of either > > > > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > > > > of the 20 patients given anti-TNF-alpha Fab had > > > > Jarisch-Herxheimer reactions with rigors, as compared > > > > with 26 of the 29 control patients (P = 0.006). The > > > > controls had significantly greater mean maximal > > > > increases in temperature (1.5 vs. 0.8 degrees C, P < > > > > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > > > > and systolic blood pressure (25 vs. 15 mm Hg, P < > > > > 0.003), as well as higher mean peak plasma > > > > concentrations of interleukin-6 (50 vs. 17 micrograms > > > > per liter) and interleukin-8 (2000 vs 205 ng per > > > > liter) (P < 0.001 for both comparisons). Levels of > > > > TNF-alpha were undetectable after treatment with > > > > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > > > > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > > > > reactions that occur after penicillin treatment for > > > > louse-borne relapsing fever, reduces the associated > > > > increases in plasma concentrations of interleukin-6 > > > > and interleukin-8, and may be useful in other forms of > > > > sepsis. > > > > > > > > We could go on and on. > > > > Really, Tony, I can understand why you think it's > > > > " bacterial annoyance. " > > > > > > > > Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 21, 2005 Report Share Posted May 21, 2005 What did you want me to pull up? I was reffering to late stage syphillis and how they don't treat it.Myself I advised someone recently to get there father ON heavy duty IV's of penicillin for his late stage syphillis (dignosed) as opposed to no therapy offered by his doctors.This lady was very wealthy so money was no option. But again I couldn't work out why they don't treat, maybe the herx reaction or undermedicating is worse than disease progression. (basically what I had a gut feeling was going on). tony > > > Tony- > > > You don't " believe " in herx reactions? I didn't know > > > it was a matter of belief, you being scientific and > > > all. I absolutely agree that the term is being > > > overused to cover any negative reaction to something: > > > candida die-off, neurotoxin, allergic reactions, etc. > > > But let's get real: > > > > > > Jarisch-Herxheimer reaction associated with > > > ciprofloxacin administration for tick-borne relapsing > > > fever. > > > > > > Webster G, Schiffman JD, Dosanjh AS, Amieva MR, Gans > > > HA, Sectish TC. > > > > > > Department of Pediatrics, Stanford University School > > > of Medicine, Palo Alto, CA, USA. > > > > > > A 14-year-old girl was seen at a community clinic with > > > a chief complaint of abdominal pain and fevers and was > > > treated with oral ciprofloxacin for presumed > > > pyelonephritis. She became tachycardic and hypotensive > > > after her first dose of antibiotic, and she developed > > > disseminated intravascular coagulation. She was > > > admitted to our hospital for presumed sepsis. Her > > > outpatient peripheral blood smear was reviewed, > > > revealing spirochetes consistent with Borrelia sp. To > > > our knowledge this is the first reported case of the > > > Jarisch-Herxheimer reaction to ciprofloxacin. > > > > > > Jarisch-Herxheimer reaction complicating the treatment > > > of chronic Q fever endocarditis: elevated TNFalpha and > > > IL-6 serum levels. > > > > > > Kaplanski G, Granel B, Vaz T, Durand JM. > > > > > > Service de Medicine Interne, INSERM U387, Hopital > > > Sainte-Marguerite, Marseille, France. > > > > > > Jarisch-Herxheimer reaction (J-HR) is an acute febrile > > > reaction which may complicate the initiation of an > > > effective treatment against infections due to > > > intracellular micro-organisms. We report a case of > > > J-HR complicating treatment of chronic Q fever > > > endocarditis with demonstration of elevated serum > > > cytokine concentrations. > > > > > > J Emerg Med. 1998 May-Jun;16(3):437-8. Related > > > Articles, Links > > > > > > Lyme disease complicated by the Jarisch-Herxheimer > > > reaction. > > > > > > Maloy AL, Black RD, Segurola RJ Jr. > > > > > > The Department of Emergency Medicine, Hospital of > > > Saint Raphael, New Haven, Connecticut 06511, USA. > > > > > > A 31-year-old woman diagnosed with Lyme disease was > > > treated with amoxicillin. One hour after the first > > > antibiotic dose, the patient became acutely ill. She > > > developed hypertension, fever, and rigors. Shortly > > > afterward, she became hypotensive and required fluid > > > resuscitation. This systemic illness, the > > > Jarisch-Herxheimer reaction, was first noted in > > > association with antibiotic therapy for neurosyphilis. > > > Thus, the institution of antibiotic therapy may be > > > complicated by the Jarisch-Herxheimer reaction. > > > > > > N Engl J Med. 1996 Aug 1;335(5):311-5. Related > > > Articles, Links > > > > > > Comment in: > > > N Engl J Med. 1996 Aug 1;335(5):347-8. > > > > > > Prevention of Jarisch-Herxheimer reactions by > > > treatment with antibodies against tumor necrosis > > > factor alpha. > > > > > > Fekade D, Knox K, Hussein K, Melka A, Lalloo DG, on > > > RE, Warrell DA. > > > > > > Department of Internal Medicine, Black Lion Hospital, > > > Addis Ababa, Ethiopia. > > > > > > BACKGROUND: In patients with louse-borne relapsing > > > fever (Borrelia recurrentis infection), antimicrobial > > > treatment is often followed by sudden fever, rigors, > > > and persistent hypotension (Jarisch-Herxheimer > > > reactions) that are associated with increases in > > > plasma concentrations of tumor necrosis factor alpha > > > (TNF-alpha), interleukin-6, and interleukin-8. We > > > attempted to determine whether sheep polyclonal Fab > > > antibody fragments against TNF-alpha (anti-TNF-alpha > > > Fab) could suppress the Jarisch-Herxheimer reaction. > > > METHODS: We conducted a randomized, double-blind, > > > placebo-controlled trial in 49 patients with proven > > > louse-borne relapsing fever. Immediately before the > > > intramuscular injection of penicillin, the patients > > > received an intravenous infusion of either > > > anti-TNF-alpha Fab or a control solution. RESULTS: Ten > > > of the 20 patients given anti-TNF-alpha Fab had > > > Jarisch-Herxheimer reactions with rigors, as compared > > > with 26 of the 29 control patients (P = 0.006). The > > > controls had significantly greater mean maximal > > > increases in temperature (1.5 vs. 0.8 degrees C, P < > > > 0.001), pulse rate (31 vs. 13 per minute, P < 0.001), > > > and systolic blood pressure (25 vs. 15 mm Hg, P < > > > 0.003), as well as higher mean peak plasma > > > concentrations of interleukin-6 (50 vs. 17 micrograms > > > per liter) and interleukin-8 (2000 vs 205 ng per > > > liter) (P < 0.001 for both comparisons). Levels of > > > TNF-alpha were undetectable after treatment with > > > anti-TNF-alpha Fab. CONCLUSIONS: Pretreatment with > > > sheep anti-TNF-alpha Fab suppresses Jarisch-Herxheimer > > > reactions that occur after penicillin treatment for > > > louse-borne relapsing fever, reduces the associated > > > increases in plasma concentrations of interleukin-6 > > > and interleukin-8, and may be useful in other forms of > > > sepsis. > > > > > > We could go on and on. > > > Really, Tony, I can understand why you think it's > > > " bacterial annoyance. " > > > > > > Jim Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.