The Herxheimer Reaction, nicknamed
"herx", otherwise referred to as Jarisch-Herxheimer is a
phenomenon originally observed in the treatment of Syphilis, but later
found in other illness. It is described as a temporary increase of
symptoms when drugs antibiotics are administered. What is known or
speculated about Lyme disease Herxheimers are based heavily on the
reactions seen in syphilis. This is due to the fact both diseases are
caused by a bacteria known as a spirochete. However the Herxheimer
Reactions in Lyme disease are not identical to those seen in syphilis,
especially in terms of timing, frequency and duration.
In Lyme disease it is thought that
the cause of Herxheimers are the result of endotoxin release, that is
toxins within the spirochete that are released as the Bb are killed or
broken down. This may be a result of the toxins itself or the body's
immune response to such.
Try looking up the following:
Mangin M, Observations of Jarisch-Herxheimer Reaction in Sarcoidosis
Patients. JOIMR 2004;2(1):1
Meislin Harvey W, Bremer Jr. Joseph C. Jarisch-herxheimer reaction
case report. J Amer Coll Emer Phys. 1976 Oct;5(10):779-781.
Maloy AL, Black RD,
Segurola Jr. RJ. Lyme Disease Complicated by the Jarisch-Herxheimer
Reaction. 1998 May-June;16(3):437-438.
Teklu B, Habte-Michael A, Warrell DA, et al. Meptazinol Dimishes the
Jarisch-Herxheimer Reaction of Relapsing Fevers. Lancet. 1983 Apr
Schofield TPC, Oxon BA, Talbot JM, et al. Leucopenia and Fever in
the "Jarisch-Herxheimer" Reaction of Louse-Borne Relapsing Fever.
1968 Jan 13;291:58-62.
Quismorio Jr. FP, Rea T, Chandor S, et al. Lucio's phenomenon: An
immune complex deposition syndrome in lepromatous leprosy. Clin
Immun Immunopath. 1978 Feb;9(2):184-193.
Claman HN, Karr M, Kohler MF, et al.. Systemic (allergic?)
vasculitis. J Allergy Clin Immunol. 1974 Jul;54(1):54-64
Jarisch-Herxheimer Reaction. Road Back Foundation 2007.
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), drop in blood pressure, hives and rash. A multitude of other
symptoms have been described.
Frequency, and Duration:
This is individualistic and
Herxheimer Reactions can occur within days to weeks after the onset 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
It can be very beneficial to document or keep a chart of these exacerbations. Some physicians
use this as a guideline for treatment. Further it may help differentiate Herxheimers
from the normal symptoms or progression of Lyme disease.
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 Benedryl 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.
In the cyclic nature of recovery it is seen that following each worsening
there may be more improvement.
However the lack of Herxheimer Reaction is not cause to be anxious if
symptoms are improving.
to Lyme Disease