| Herxheimer reaction | |
|---|---|
| Classification and external resources | |
| ICD-10 | T78.2 |
| ICD-9 | 995.0 |
The Herxheimer reaction resembles bacterial sepsis and can occur after initiation antibacterials such as penicillin or tetracycline, or treatment of tick-borne relapsing fever. An association has been found between the release of heat-stable proteins from spirochetes and the reaction. The same can be true for candida die-off when toxins from the dying candida leak into the body. Typically, the death of these bacteria and the associated release of endotoxins occurs faster than the body can remove the toxins. It manifests as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia (muscle pain), and exacerbation of skin lesions. The intensity of the reaction indicates the severity of inflammation. Reaction commonly occurs within two hours of drug administration, but is usually self-limiting. Prophylaxis and treatment with an anti-inflammatory agent may stop progression of the reaction. Oral aspirin every four hours for 1–2 days, or 60 mg of prednisone orally or intravenously has been used as an adjunctive treatment.
The Herxheimer reaction is classically associated with penicillin treatment of syphilis. Duration in syphilis is normally only a few hours. The reaction is also seen in other diseases caused by spirochetes, such as borreliosis (Lyme disease and tick-borne relapsing fever) and leptospirosis, and in Q fever.[1] Similar reactions have also been reported to occur in bartonellosis (including cat scratch disease),[2][3] brucellosis,[4] typhoid fever,[5] and trichinosis.[6]
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.[7][8]
Both Adolf Jarisch,[9] an Austrian dermatologist, and Karl Herxheimer,[10] a German dermatologist, are credited with the discovery of the Jarisch-Herxheimer reaction. Both Jarisch 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.[1]