Herxheimer in borreliosis

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This information was from a book called " Lyme Disease " by Lora Mermin

The Herxheimer-type Reaction is somewhat different in Lyme....Because

Lyme

is caused by a spirochete, much of what we learn and think about Lyme

borreliosis comes from our experience with syphilis. In the early

stages

of killing the Lyme spirochete (Borrelia burgdorferi) with

antibiotics

this Hexheimer type Reaction can be found if looked for.

Appparently it comes at different times. With I.V. antibiotics it

may be

noted within days of treatment; with oral antibiotics it may be

noted

within days to weeks of treatment. When these antibiotics begin to

destroy the Lyme spirochete, a toxin is given off causing either

direct

reations or indirect actions through stimulation of the immune

system. The

symptoms can vary from systemic reactions such as a low blood

pressure,

fever,chills and hives, to more specific symptoms such as increase in

joint

pain, headaches, rash or in general, a reversal or worsening of the

Lyme

symptom complex.

Jarisch-Hexheimer Reaction should be watched for when treating Lyme

borreliosis patients, and the patient should be adequately warned

about

this phenomenom. Mistaking the Herxheimer reaction for an allergic

reaction to antibiotics or serum sickness or some other catastrophe

might

lead to prematurely stopping the antibiotics on the part of the

physician

on non-compliance in taking the medications on the part of the

patient.

When starting antibiotics, one expects to feel better, not worse.

But if

warned that there may be a period where symptoms recur or flare up

during

this reaction , better compliance can be expected. Herxheimer

reactions

are at least ten times more common than true allergic reactions to

antibiotics.

Steroids are not recommended at this time for Herxheimer Reaction in

Lyme

patients. The best treatment is knowledge of the process so that

panic

attacks, anxiety and worry do not occur. Benadryl, which is an

antihistamine, can be used to lessen the symtoms, and sometimes

changing

the dose and/or timing of the antibiotics is needed to make the

reaction

less symptomatic.

So next time you start antibiotics, ask your physician whether or not

you

should expect a Herxheimer Reaction to occur. It may be a learning

experience for both of you, I'm not aware of any deaths from

Herxheimer

Reaction in treating Lyme borreliosis. So give me a Herxheimer

Reaction

over an allergic reaction any time. "

In the Book, Everything You Need to Know About Lyme Disease by

Vanderhoof- Forschner on page 53. She talks about what happens if

the

eighth cranial nerve is affected by Lyme, " ..Equilibrium disturbances

such

as dizziness, vomiting, or reeling are also associated with nerve

dysfunction " . With a Herxheimer Reaction symptoms get worse before

they

get better. I know more than two people that experienced vomiting

while

on IV antibiotics as part of a Herxheimer. They are now better.

This is from the 5/93 update to Lyme disease 1991- it is taken

from Dr.

Burrascano's 5th edition of Lyme Disease Treatment

Guidelines:.... " In

virtually all patients, when antibiotics are begun, symptoms flare in

a

Jarisch Herxheimer-like fashion. This will usually occur within the

first

five days and usually lasts from several days to two weeks. A late

ocurring or prolonged Herxheimer often predicts that more aggressive

or

prolonged treatment will be needed. Be sure to have the patients

expect

increased symptoms initially and stick to the treatment. Don't

mistake a

Herxheimer-like reaction as either a treatment failure or an allergic

reaction.

" When IV antibiotics are given for more than three weeks, it is

common for

a very SEVERE flare of symptoms to accur at the fourth week, similar

to a

serum sickness reaction. This can be associated with leukopenia

and/or

elevations in liver enzymes. You must follow these patients closely,

and

decrease the dose temporarily or interrupt treatment for one to three

days,

then resume carefully with s lower dose initially. This reaction

only

seems to occur in those with longstanding, highly symptomatic

disease. It

is IMPORTANT to expect this reaction, and quickly cut the dose, for

if

you are able to continue therapy and get the patients through this

rough

time, and continue IV meds through to the sixth week, then they

dramatically improve. Those whose treatment is stopped and not

restarted

at this point usually need retreatment in the future due to ongoing

or

recurrent symptoms. "

Some quotes about the Herxheimer from another very Lyme literate

doctor..

What is a Herxheimer reaction?

Answer: The term was originally used to describe a reaction that

occurred

6-10 hours after the initial treatment for syphilis. It consisted of

transient fever and a brief exacerbation of visible lesions. It is

thought

that this is caused by either an allergic response to antigens or

foreign

substances released by the organism when it is killed or that these

substances may have endotoxic properties. Much the same situation

occurs

during the treatment of Lyme disease. Patients encounter a variety

of

symptoms which may include fever, chills, rash and increased

symptomatology. Usually this reaction is seen with IV therapy but it

can

(does-my words) occur during oral antibiotic therapy as well. The

point at

which it happens during therapy varies from one antibiotic to another

but

generally it does not occur prior to day 10. However, it is

important that

you ask your doctor about this so that you will know what to expect.

Q. How can a Lyme patient be certain that he/she is experiencing a

Herx

reaction and not an allergic reaction?

A: This is very difficult. Herx reactions are very common during

treatment of Lyme disease. It usually consists of fever, chills,

sweats,

joint and muscle pain (me again-sounds like a fibromyalgia attack! I

couldn't resist.) and exacerbation of symptoms. It occurs in

approximately 50% of patients in varying degrees of severity.

However,

this symptom complex is very similar to a type of allergic reaction

that is

antiboby dependent, called serum sickness.

Originally serum sickness occured when large amounts of antiserum

prepared in horses or rabbits were injected into patients to protect

them

from various diseases particularly during the period from 1900-1940.

But

this reaction is also encountered with penicillin and other drugs.

Typically it occurs 3 days to 3 weeks after injection and the patient

experiences fever, enlarged lymph nodes and spleen, and painful

joints.

Since a large amount of antigen or foreign substance is injected,

there is

still a considerable amount of antigen available once antibody

production

begins. This excess of free antigen is able to bind to newly formed

antibodies and form Ag-Ab complexes. In turn these complexes bind a

substance found in the blood called complement and attract

polymorphonuclear leukocytes (white blood cells). Lysosomal

(digestive)

enzymes are released which cause tissue damage with destructive

inflammation of small blood vessels (vasculitis). Free complement in

the

blood is depressed at the height of the reaction. This can be

detected by

a blood test. Once the complexes are destroyed, free antibodies

appear and

symptoms abate. But if the offending substance continues to be

administered, the vasculitis will result in chronic inflammmation.

Since the Herxheimer reaction seen in Lyme disease also involves

a

reaction to a foreign substance (either one released by the organism

once

it is killed or an endotoxin), it is important to carefully monitor

the

patient once the reaction begins. Also, since the reaction is fueled

by

excess antigen it can be controlled by decreasing the amount of

antibiotic

that is used. This in turn decreases the amount of antigen or

toxin. If

it is determined that this is not a detrimental situation it is

important

not to stop therapy. It can be altered as described above but not

stopped.

Once the patient has safely passed through this period he or she

often

experiences a lessening of symptoms since reaction is often elicited

in

response to spirochetal demise. "

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