Jarisch-Herxheimer Reaction

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http://www.x-l.net/Lyme/HERX.html

Lyme Disease

What is a Herxheimer Reaction?

By Donna Herrell

Founder, Lyme Disease

Information Resource

Overview:

The herxheimer reaction, nicknamed " herx " , otherwise

referred to as Jarisch-Herxheimer (J-H) is a phenomenon originally

observed in the treatment of Syphilis, but later found in other

illness [1]. In general terms, it is described as a temporary increase

of symptoms when anti-syphilitic drugs (antibiotics) are administered.

What is known or speculated about Lyme disease

herxheimers are based heavily on the reactions seen in Syphilis. [2-3]

This is due to the fact both diseases are caused by a bacteria known

as a spirochete, the former being Treponema pallidum, the latter

Borrelia burgdoferi (B.. However, the herxheimer reactions in Lyme

disease are not identical to those seen in Syphilis, especially in

terms of timing, frequency and duration as noted below. [1-5]

In Lyme disease it is thought that the cause of

herxheimers are the result of endotoxin release. [2,5] That is

toxin(s) within the spirochete that are released as the B.b are killed

or broken down. This may be a result of the toxin(s) itself or the

body’s immune response to such.

Symptoms:

As mentioned, the general description is a temporary

increase in symptoms, but also included is the development of new

ones. More specifically the most common events include: increased

joint or muscle pain, headaches, chills, fever (usually low grade),

hypotension, uticaria (hives) and rash. [1-5] A multitude of other

symptoms have been described.

Worth noting is that hives and rash are sometimes

mistaken for an allergic reaction. [2] It is up to one’s physician to

determine this. However, with close observation and proper treatment

(see Treatment) may prevent unnecessary cessation of therapy.

In more severe cases of J-H, a reduction of the

dosage or temporarily cessation of the treatment has been recommended

[5].

Timing, Frequency and Duration:

This is individualistic and herxheimers can occur

within days to weeks after the institution of antibiotic therapy. In

some patients they occur only once or twice (if at all) and with

others continue throughout the course of treatment, usually lessening

in severity.

They can occur and are more often described in

cycles (example: every 4 weeks) and have been reported to last from

days to weeks. It can be very beneficial to document any exacerbation.

Some physicians use this as a guideline for treatment. Further, it may

help differentiate herxheimers from the normal symptoms or progression

of Lyme disease.

Treatment:

Herxheimer reactions can be very difficult on

patients and affect compliance with therapy so supportive measures

should be sought or utilized to lessen discomfort if needed. The use

of aspirin, NSAIDs (non-steroidal anti-inflammatory drugs), pain

medication, muscle relaxers, hot baths or others remedies can be

appropriate. Of note, some have found Benadryl helpful even in the

absence of rash or hives.

The good news is that the herxheimer is thought to

indicate that the antibiotics are indeed working and that following

each worsening may bring about more improvement. Though the lack of a

herxheimer reaction should not cause anxiety if symptoms are

improving.

Other considerations:

Something often overlooked but can present with

similar symptoms is Candida (yeast) infection. Treatment with

acidophilus and if needed prescription medications such as Nystatin or

Diflucan can be utilized.

Sources of Information:

1.Lyme Disease 1991 - Patient/Physician Perspectives

from the U.S. and Canada The Jarisch-Herxheimer Reaction H.

Katzel M.D.

2.Managing Lyme Disease 1996 ph J Burrascano M.D.

3.Principles and Practice of Infectious Diseases 4th

Ed. Mandell, and

4.Seronegative chronic relapsing neuroborreliosis.

Lawrence C, Lipton RB, Lowy FD, Coyle PK Eur Neurol 1995;35(2):113-117

5.The New Lyme Disease 1998 ph J Burrascano M.D.

See Jarisch-Herxheimer / Jarisch-Herxheimer-like Reactions

Lyme disease, Tick-borne Relapsing Fever and Allergy

Document and reference collection (in progress) November

15, 1999

http://www.x-l.net/Lyme/abstracts/herx/herx.collection.html

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--

Kiana Rossi

bornfree@...

[Guest guest]

Okay, so this can happen over and over? My son was well for a few days and now

is complaining of severe hand and knee pain starting all over again. How do you

know if this is just the lyme itself or a herx reaction?

Or does it not matter?

The dr told me to keep a journal of all my sons pain.

thanks for any insight

Judy

________________________________

From: mycave76 <cave76g@...>

Sent: Monday, October 19, 2009 10:08:28 AM

Subject: [ ] Jarisch-Herxheimer reaction

 

Here are just a very few published, mostly peer reviewed articles, with

sources and citations given.

J Emerg Med. 1998 May-Jun;16(3) :437-8.

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.

PMID: 9610974 [PubMed - indexed for MEDLINE

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Herxheimer's reaction definition - medical

Herx·hei·mer's reaction (hûrks & #712;h & #299; & #716; m & #601;rz,

h & #277;rks & # 712;-)

noun

An inflammatory reaction in tissues infected by spirochetes, as in

syphilis or Lyme disease, induced in certain cases by treatment with

salvarsan, mercury, or antibiotics. Also called Jarisch-Herxheimer

reaction.

http://www.yourdictionary.com/medical/herxheimer-s-reaction

[My note: Mercury or salvarsan were old treatments and NOT recommended. ]

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[My note: The excerpt below is mainly about RA---- but the 'herx' is the

same.]

Education / Brochure Sheets / Jarisch-Herxheimer Reaction

Jarisch-Herxheimer Reaction

The Jarisch -Herxheimer, or Herxheimer reaction, was named for the

German dermatologist, Karl Herxheimer (1844-1947). Dorlands Medical

Dictionary refers to the Herxheimer reaction as a transient, short-term,

immunological reaction commonly seen following antibiotic treatment of

early and later stage [infectious] diseases which [may be] manifested by

fever, chills, headache, myalgias (muscle pain), and exacerbations of

cutaneous lesions. The reaction has been attributed to liberation of

endotoxins-like substances or of antigens (a substance which causes an

immune reaction) from the killed or dying microorganisms.

A TRANSIENT SHORT-TERM, IMMUNOLOGICAL REACTION

What does this mean in layman's terms? The Herxheimer flare reaction may

be the first indication that the antibiotic is reaching its target and

is therefore considered a good sign. In his original book, The Road

Back, the late McPherson Brown, MD noted that the reaction caused

a temporary worsening of symptoms.

The amount of medication may be directly related to the intensity of the

flare. Medications which have no effect on mycoplasma (or other

microbes) do not provoke this reaction nor do these medications

generally have a favorable long-term effect on the disease. Unlike the

RA flare, which can last for weeks or even months, the Herxheimer flare

reaction is often of short duration. (Scleroderma patients who do not

exhibit inflammatory components to their disease generally do not report

a Herxheimer of clinical significance. )

Large doses of antibiotics may initially caused a worsening or flare

reaction in many of the rheumatic diseases. The rheumatic diseases which

are most hypersensitive (rheumatoid arthritis, lupus, psoriatic

arthritis, etc.) have shown similar, distinct and often severe flare

reactions from even a low dose of antibiotic. According to Dr. Brown,

when the resulting released toxins go to the joints, joint pain is the

result; when they go to the brain, depression may result.

Dr. Brown found the Herxheimer effect showed a number of important

principles at work. It demonstrated that the disease was a

hypersensitive reaction, not to the drug itself, but to the toxins that

a microbe creates in response to the drug's presence. And, it opened the

way to a chemical attack (with medications) on the whole area of

arthritis and rheumatic diseases.

Dr. Brown found that rheumatic diseases are often associated with a high

degree of tissue sensitivity.

It was soon observed that a more potent antibiotic would produce a more

marked flare reaction because of this tissue sensitivity. By keeping the

dosage low, it was possible to gradually remove the microorganisms from

the tissues without causing major clinical worsening of the disease. If

these microorganisms were truly present and responsible for the

hypersensitivity reaction, long term, low dose treatment would result in

clinical improvement of symptoms in patients.

Dr. Brown recognized he was not dealing with an ordinary infectious

problem where microbial invasion was the prominent feature. The reaction

of the patient to the infectious organism was as important as the

organism itself.

http://www.roadback .org/index. cfm/fuseaction/ education. display/display_ i\

d/91.html

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A Google search (jarisch herxheimer reaction lyme disease) produced

these citations.

http://www.ncbi. nlm.nih.gov/ sites/entrez

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Dr. Burrascano mentions the Jarisch-Herxheimer reaction in his

guidelines.

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