Herxheimer reaction

The Herxheimer reaction (also known as Jarisch-Herxheimer or herx) occurs when large quantities of toxins are released into the body as bacteria (typically Spirochetal bacteria) die, due to antibiotic treatment.

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Typically the death of these bacteria and the associated release of endotoxins occurs faster than the body can remove the toxins via the natural detoxification process performed by the kidneys and liver. It is manifested by fever, chills, headache, myalgias, and exacerbation of cutaneous lesions. Duration in syphilis is normally only a few hours but can be much longer in other diseases. The intensity of the reaction reflects the intensity of inflammation present.

The Herxheimer Reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, Interleukin-6 and Interleukin-8.^[1][2]

Both Adolf Jarisch, an Austrian dermatologist, and Karl Herxheimer, a German dermatologist, are credited with the discovery of the Herxheimer reaction.

History

Both Jarish and Herxheimer observed reactions in patients with syphilis treated with mercury. The reaction was first seen following treatment in early and later stages of syphilis treated with Salvarsan, mercury, or antibiotics. It is seen in 50% of patients with primary syphilis and about 90% of patients with secondary syphilis.

The reaction is also seen in other diseases, such as borreliosis (Lyme disease^[3][4] and tick-borne relapsing fever^[5]), brucellosis, typhoid fever, and trichinellosis and Q fever.

References

1. ^ Vidal V, Scragg IG, Cutler SJ, Rockett KA, Fekade D, Warrell DA, Wright DJ, Kwiatkowski D. Variable major lipoprotein is a principal TNF-inducing factor of louse-borne relapsing fever. Nat Med. 1998 Dec;4(12):1416-20.
2. ^ Kaplanski G, Granel B, Vaz T, Durand JM. Jarisch-Herxheimer reaction complicating the treatment of chronic Q fever endocarditis: elevated TNFalpha and IL-6 serum levels. J Infect. 1998 Jul;37(1):83-4.
3. ^ Maloy A, Black R, Segurola R. "Lyme disease complicated by the Jarisch-Herxheimer reaction.". J Emerg Med 16 (3): 437-8. PMID 9610974.
4. ^ Lawrence C, Lipton R, Lowy F, Coyle P (1995). "Seronegative chronic relapsing neuroborreliosis.". Eur Neurol 35 (2): 113-7. PMID 7796837.
5. ^ Dworkin M, Anderson D, Schwan T, Shoemaker P, Banerjee S, Kassen B, Burgdorfer W (1998). "Tick-borne relapsing fever in the northwestern United States and southwestern Canada.". Clin Infect Dis 26 (1): 122-31. PMID 9455520.