LymeNet Europe

information and discussion about Lyme disease
Home Information Lyme news Forum  

What is true about the Jarisch-Herxheimer reaction?

Medical topics related to Lyme disease that do not fit in the section "Science", with information about the diagnosis, treatment, etc.

What is true about the Jarisch-Herxheimer reaction?

Postby Martian » Thu 23 Aug 2007 3:28

There is contradicting information about the Jarisch-Herxheimer reaction. For example, some say herxes can only exist in the first days/weeks of ABX treatment, while others say it can continue for weeks or months, and return later. So what to believe, and how to distinguish herxes from adverse reactions or normal waxing and waning?

There are lots of opinions about herxes, some based on experience, but I haven't seen any scientific study about herxes during treatment of Lyme disease. Does anyone know of such studies? I am also wondering what exactly causes the herxes, and if herxes are "mandatory" during a successful treatment of Lyme disease.
Martian
 
Posts: 1749
Joined: Thu 26 Jul 2007 18:29
Location: Friesland, the Netherlands

Re: What is true about the Jarisch-Herxheimer reaction?

Postby minx » Wed 3 Oct 2007 22:33

I found the following abstract from the "early years" of the Borrelia Burgdorferi.
"Endotoxicity" of the Lyme disease spirochete.
Fumarola, D; Munno, I; Miragiotta, G
Infection. Vol. 11, no. 6, 345 p. 1983.

A treponema or a Borrelia -like spirochete recently isolated from Ixodes ticks has been implicated as the etiologic agent of lyme disease, as systemic illness characterized by an inflammatory skin disorder (erythema chronium migrans). Apart from these reports, virtually nothing is known about the factor(s) responsible for disease production by the causative organism. Since many members of the spirochetes exhibit an endotoxin-like activity, the authors have investigated the activity of the lyme disease spirochete in the Limulus endotoxin assay in order to learn more about the organism's biological profile. Although only whole cells were tested, the strain was consistently positive in the Limulus lysate assay at a concentration of 1:10 super(5) bacteria per ml. The presence of an endotoxin-like property may explain in part the virulence of the organisms during infection in humans and the variable severity of the illness.


This one is of a later date:

Journal of Experimental Medicine, Vol 175, 1207-1212, Copyright © 1992 by Rockefeller University Press

Detection of plasma tumor necrosis factor, interleukins 6, and 8 during the Jarisch-Herxheimer Reaction of relapsing fever

Y Negussie, DG Remick, LE DeForge, SL Kunkel, A Eynon and GE Griffin
Division of Communicable Diseases, St. George's Hospital Medical School, London, United Kingdom.

The Jarisch-Herxheimer Reaction (J-HR) is a clinical syndrome occurring soon after the first adequate dose of an antimicrobial drug to treat infectious diseases such as Lyme disease, syphilis, and relapsing fever. Previous attempts to identify factors mediating this reaction, that may cause death, have been unsuccessful. We conducted a prospective trial in Addis Ababa, Ethiopia on 17 patients treated with penicillin for proven louse-borne relapsing fever due to Borrelia recurrentis to evaluate the association of symptoms with plasma levels of tumor necrosis factor (TNF), interleukins 6, and 8 (IL-6 and -8). 14 of the 17 (82%) patients experienced a typical J-HR consisting of rigors, a rise in body temperature (1.06 +/- 0.2 degrees C) peaking at 2 h, leukopenia (7.4 +/- 0.6 x 10(-3) cells/mm3) at 4 h, a slight decrease, and then rise of mean arterial blood pressure. Spirochetes were cleared from blood in 5 +/- 1 h after penicillin. There were no fatalities, but constitutional symptoms were severe during J-HR. Plasma TNF, IL-6, and -8 were raised in several patients on admission, but a seven-, six-, and fourfold elevation of these plasma cytokine concentrations over admission levels was detected, respectively, occurring in transient form coincidental with observed pathophysiological changes of J-HR. Elevated plasma cytokine levels were not detected in the three patients who did not suffer J-HR. We conclude that the severe pathophysiological changes characterizing the J-HR occurring on penicillin treatment of louse-borne relapsing fever are closely associated with transient elevation of plasma TNF, IL-6, and -8 concentrations.


And a summary dated this century:

Proposed mechanisms and preventative options of Jarisch–Herxheimer reactions

* M. W. Pound*†*Department of Pharmacy Practice, Campbell University School of Pharmacy, Buies Creek, NC,†Department of Pharmacy, Cape Fear Valley Health System, Fayetteville, NC and PharmD BCPS and
* D. B. May*‡*Department of Pharmacy Practice, Campbell University School of Pharmacy, Buies Creek, NC,‡Department of Pharmacy, Duke University Medical Center, Durham, NC, USA PharmD BCPS

*
*Department of Pharmacy Practice, Campbell University School of Pharmacy, Buies Creek, NC,
†Department of Pharmacy, Cape Fear Valley Health System, Fayetteville, NC and
‡Department of Pharmacy, Duke University Medical Center, Durham, NC, USA

Melanie W. Pound, Department of Pharmacy Practice, Campbell University School of Pharmacy, PO Box 1090, Buies Creek, NC 27506, USA. Tel.: 910 609 6688; fax: 910 609 7548; e-mail: mpound@capefearvalley.com
Summary


Objective: To review the aetiologies and preventative methods associated with Jarisch–Herxheimer reactions (JHR).

Data sources: Ovid Medline® (1966–June Week 1 2004) was utilized to assess biomedical literature; a review of the bibliographies of articles was also performed.

Data synthesis: JHR often occurs with the treatment of spirochete infections. However, the mechanism by which the reaction takes place is not clearly defined.

Conclusion: Studies suggest with conflicting evidence that the JHR is caused by release of endotoxin-like material from the spirochete as well as cytokine elevation in the body. It appears the type of drug and the rate of spirochete clearance from the body have little effect on the incidence of the reaction. Many pretreatment options have been explored with limited efficacy with the exception of anti-tumour necrosis factor antibodies
.
minx
 
Posts: 96
Joined: Fri 27 Jul 2007 13:50

Re: What is true about the Jarisch-Herxheimer reaction?

Postby LymeEnigma » Sun 28 Oct 2007 20:13

There are people who use Dr. Burrascano's (ILADS) guidelines as the end-all be-all of Lyme and co-infection treatment. While I'm sure that these guidelines have their merits, they seem to have spurred a dogma of sorts among some of the more disillusioned patients. One of these dogmas surrounds the herx.

Burrascano claims: "It has been observed that symptoms will flare in cycles every four weeks. It is thought that this reflects the organism's cell cycle, with the growth phase occurring once per month (intermittent growth is common in Borrelia species). As antibiotics will only kill bacteria during their growth phase, therapy is designed to bracket at least one whole generation cycle. This is why the minimum treatment duration should be at least four weeks. If the antibiotics are working, over time these flares will lessen in severity and duration. The very occurrence of ongoing monthly cycles indicates that living organisms are still present and that antibiotics should be continued.

With treatment, these monthly symptom flares are exaggerated and presumably represent recurrent Herxheimer-like reactions as Bb enters its vulnerable growth phase then are lysed."


The above statement is the basis behind the belief that all symptoms Lyme patients experience during antibiotic treatment are the result of Jarisch-Herxheimer (J-H) reaction, that J-H recurs monthly, and that it can last for weeks at a time. For those of you who believe this to be true, I have a few questions:

* If Borrelia are so slow to reproduce (taking about 24 hours to do what many bacteria can do in minutes), then what is providing the continuous heavy supply of bacteria needed to keep up with the die-off that would be required to cause such extended herx reactions? Where are all of these bacteria coming from?

* Have you charted your symptoms before and after starting antibiotic treatment? Have you noticed that your symptoms follow a four-week cycle, regardless of whether or not you're currently on antibiotic treatment?

* Have you considered the connection between hormonal fluctuations and "monthly herxes"?

Jarisch-Herxheimer reaction generally involves fever over 101 Fahrenheit, chills, and severe body aches. It typically occurs within the first few days of treatment, and can last up to several hours. Those who believe they are experiencing an extended J-H reaction could be suffering from serum sickness, or simply be in a bad part of their Lyme's normal monthly cycle, but it is very unlikely that the person is "herxing." Some people could be doing irreparable harm to their bodies by attempting to "push through a bad herx," while their suffering might not even be a herx at all.
User avatar
LymeEnigma
 
Posts: 1512
Joined: Sun 28 Oct 2007 19:26
Location: The Nevada Desert, USA

Re: What is true about the Jarisch-Herxheimer reaction?

Postby Nick » Sun 28 Oct 2007 22:07

I think most of the 'herxes' experienced during AB treatment (and also reported during some alternative Lyme treatments) are not true JH reactions by definition. We have already discussed this some times on the Dutch lymenet ...

I agree that it is very unlikely that the 'flare' is a direct result of bacterial die-off (however, there could be many Bb present if we assume they go intracellular - difficult to be sure about that). If you look at the blood videos of some Lyme patients it is clear that spirochetes are sometimes present in big numbers. I would like to see a study that checks die-off by measuring Bb remains e.g. with daily PCR urine or antigen tests during AB treatment - if the flare is direct result of die-off there should be a correlation between symptoms and bacterial remains in blood, urine etc.

regarding the cycle: I don't have a clear (regular) symptom flare cycle myself, but I think it exists both with and without AB treatment. I have heard about cycles from about 3 to 6 weeks from various sources, and I doubt that would be related to the host hormonal system, especially with males (although I can't exclude the possibility). It seems more likely to me that it is related to a Bb cycle, and we have a good candidate for that: Bb sl cycles some of its outer proteins in a cycle of probably weeks, just like the Bb for relapsing fever (I think it is B Hermsii?) cycles some of its outer proteins (antigenes) about once a week to evade the immune system - which coincides pretty well with the 'flares' in relapsing fever. The severity of the flare could be result of interaction with our own immune system (even when very little Bb are present - there are good explanations for that ).
Nick
 
Posts: 299
Joined: Wed 19 Sep 2007 19:10
Location: Zeeland, Netherlands

Re: What is true about the Jarisch-Herxheimer reaction?

Postby Cobwebby » Mon 29 Oct 2007 2:54

My LLMD says actually a small percentage of patients Herx-like 30%.

I take that to mean Herxing is Optional. :)
The greater part of our happiness or misery
depends on our dispositions,
and not on our circumstances.
Martha Washington
Cobwebby
 
Posts: 1712
Joined: Mon 29 Oct 2007 1:55

Re: What is true about the Jarisch-Herxheimer reaction?

Postby cave76 » Mon 29 Oct 2007 4:41

LE said:

****f Borrelia are so slow to reproduce (taking about 24 hours to do what many bacteria can do in minutes), then what is providing the continuous heavy supply of bacteria needed to keep up with the die-off that would be required to cause such extended herx reactions? Where are all of these bacteria coming from?****

DUH!!! I never thought of that! DUH!

(I'm one of the people who never had a 'herx' that could be plotted a la Burrascano. Or else I was in a years long 'herx')
cave76
 
Posts: 3182
Joined: Sun 12 Aug 2007 2:27

Re: What is true about the Jarisch-Herxheimer reaction?

Postby LymeEnigma » Mon 29 Oct 2007 5:33

Nick, I like your reasoning with the outer surface proteins. Know of any good articles I could read to learn more? 8-)
User avatar
LymeEnigma
 
Posts: 1512
Joined: Sun 28 Oct 2007 19:26
Location: The Nevada Desert, USA

Re: What is true about the Jarisch-Herxheimer reaction?

Postby itsy » Mon 29 Oct 2007 22:35

Knowning a lot of what I dealth with has been good old fashion intollerence and/or allerigic reactions...

But I did experience the Herx. Of course, 30+ years of infection, if anyone was going to feel bacteria die, it would be me. I got something similar to a cold/virus thing...fever, sinus drainage...miserable. Also, some emotional uproar. That was with Doxy. Then, once the herx was gone, I got an awful skin reaction. I lasted on low dose doxy about 8-12 weeks.

Switched to tetracycline for a month. I vomitted. A lot. No, a LOT. Bad. For a month.

Switched to Biaxin. Got pseudo-something or another colitis within 24 hours. Stopped Biaxin. Pooped green for a week.

Switched to Azithromycin. Felt pretty dang good. Then I broke out in hives.

NOW she wants me on Mino. But I already have hyperpigmentation. Really I don't want more. I am hideous enough.

If there are any other you can think of that might work better, I would appreciate it. :D
itsy
 
Posts: 786
Joined: Mon 29 Oct 2007 22:03

Re: What is true about the Jarisch-Herxheimer reaction?

Postby Michelle M » Mon 29 Oct 2007 22:46

How 'bout high-dose Amoxicillin + Probenecid? Pretty easy on the stomach. Goes where infection is. Worked for me for many months!
Michelle M
 
Posts: 13
Joined: Mon 29 Oct 2007 18:01

Re: What is true about the Jarisch-Herxheimer reaction?

Postby itsy » Tue 30 Oct 2007 18:18

Michelle...

Thanks. Allergic to the -cillians. I'll try the Mino for now...we'll see.....
itsy
 
Posts: 786
Joined: Mon 29 Oct 2007 22:03

Next

Return to Medical

Who is online

Users browsing this forum: Ahrefs [Bot] and 3 guests