Butler T. Am J Trop Med Hyg. 2017.

The Jarisch-Herxheimer Reaction After Antibiotic Treatment of Spirochetal Infections: A Review of Recent Cases and Our Understanding of Pathogenesis.

Within 24 hours after antibiotic treatment of the spirochetal infections syphilis, Lyme disease, leptospirosis, and relapsing fever (RF), patients experience shaking chills, a rise in temperature, and intensification of skin rashes known as the Jarisch-Herxheimer reaction (JHR) with symptoms resolving a few hours later. Case reports indicate that the JHR can also include uterine contractions in pregnancy, worsening liver and renal function, acute respiratory distress syndrome, myocardial injury, hypotension, meningitis, alterations in consciousness, seizures, and strokes. Experimental evidence indicates it is caused by nonendotoxin pyrogen and spirochetal lipoproteins. Mediation of the JHR in RF by the pro-inflammatory cytokines tumor necrosis factor (TNF), interleukin (IL)-6, and IL-8 has been proposed, consistent with measurements in patients’ blood and inhibition by anti-TNF antibodies. Accelerated phagocytosis of spirochetes by polymorphonuclear (PMN) leukocytes before rise in cytokines is responsible for removal of organisms from the blood, suggesting an early inflammatory signal from PMNs. Rarely fatal, except in neonates and in pregnancy for African women whose babies showed high perinatal mortality because of low birth weight, the JHR can be regarded as an adverse effect of antibiotics, necessary for achieving a cure of spirochetal infections.

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Herxing for the Lyme/MSIDS patient varies from person to person.  For me, shortly after taking antibiotics I feel like a balloon that someone’s let the air out of.  Seriously, I could sleep forever.  But, I’m 4 years into this.  Upon my first dose (3 different antibiotics – pulsed MWF) I shuffled between the bed and the bathtub to soak in Epsom salts.  Like a hippo, I would submerge all but my nose to breathe as my head, neck, and spine felt as if I’d been kicked by a horse and then dropped from a 20 story building.  No amount of Ibuprophen would touch this.  Only antibiotics and time.

Researching a lot myself, I finally asked – no, retract that – begged for my LLMD to give me minocycline daily with two other antibiotics that collectively kill all three forms of borrelia, as I knew it is one of the best antibiotics for crossing the blood brain barrier.  I wondered if I’d ever wake up without an excruciating headache.  The insomnia and pain were unbearable.

Finally, years later, I had an MRI to see if I had Chiari as that was about the only thing that could explain the pain. Per usual for Lyme/MSIDS patients, the tests were normal, and yet the pain went on unabated.

Finally, over time, and taking minocycline daily, it went away.

From my experience this is how this stuff rolls; symptoms peel away 1 layer at a time leaving the patient with what Wisconsin’s most experienced Lyme doctor describes as their, “hallmark symptom.”  Mine is spine and neck pain and stiffness, and occipital headaches.  One spot, to the right of my spine at about the T6-T7 can really take me to my knees.  I’ve met a few other patients with the exact same symptoms.

But for every patient, the “hallmark” symptoms vary, which is often a reason the powers that be can’t put their finger on it and want to create a one size fits all approach to an illness that looks differently on everyone.




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