The Jarisch-Herxheimer reaction is a natural reaction of the body. The body reaction occurs when antibiotics are given to fight bacterial infections and is caused by bacterial decay-related endotoxins. Glucocorticoids are usually used for treatment.
What is a Jarisch-Herxheimer reaction?
During decay, bacteria release chemical compounds also known as endotoxins. These decay products of bacteria cause physiological reactions in a person. One of these is the Jarisch-Herxheimer reaction, also known as Herx. The name comes from dermatologists Jarisch Sr. and Herxheimer, who first observed symptoms of the reaction when treating syphilis. Bacteria are usually induced to break down with antibiotics as a result of therapy. The endotoxins released in this process stimulate the release of inflammatory messengers, as characterized by the Jarisch-Herxheimer reaction. The symptoms of the reaction include fever and headache. The symptomatology can last from hours to several days. Ultimately, the symptoms are a sign of successful control of infectious diseases. The reaction apparently does not occur in the context of every infectious disease, but appears to be limited to certain bacteria.
Causes
The cause of the Jarisch-Herxheimer reaction is the endotoxin- and thus bacterial decay-induced release of inflammatory mediators. Inflammatory mediators are biochemical substances that initiate and keep inflammatory reactions of tissues going. In addition to histamine and bradykinin, inflammatory mediators include prostaglandins, leukotrienes and ECF. These mediators have different effects on the body and its natural processes. If a certain blood level is exceeded, the substances can thus cause reactions such as fever and nausea or alter blood flow. A large proportion of all symptoms are attributed to tumor necrosis factor and interleukin-1 from stimulated macrophages as part of the reaction. The Jarisch-Herxheimer reaction occurs predominantly due to spirochete endotoxins. These endotoxins are released, for example, during antibiotic therapy of syphilis, Lyme disease, and typhus abdominalis. In Lyme disease, the reaction occurs in up to 60 percent of all patients. In neurosyphilis, on the other hand, it affects only a vanishingly small percentage of all patients.
Symptoms, complaints, and signs
As part of the Jarisch-Herxheimer reaction, typical symptoms such as sudden fever with chills and symptomatic exacerbations of the original infectious disease present. In addition, if antibiotic treatment is effective, vasoconstriction often occurs as a result of the Herxheimer reaction. As a consequence, blood pressure rises. In addition, pallor and chills occur. In the further course, the symptoms often turn into the opposite. The vessels dilate and the skin reddens with a drop in blood pressure. Headache, muscle and bone or joint pain may occur. Patients often complain of fatigue and exhaustion. The longer the reaction lasts, the more at risk patients are for depression, fatigue, andattention deficit disorder. The symptoms of a Jarisch-Herxheimer reaction typically last a few hours, but theoretically can last for days. In particularly severe reactions, decompensation of the circulatory system may occur in extreme cases. In this context, the development of shock states cannot be ruled out as part of the reaction.
Diagnosis and course of the disease
The diagnosis of a Jarisch-Herxheimer reaction is made by the physician on the basis of the typical symptoms against a background of bacterial antibiotic treatment. If a patient knowingly suffers from a bacterial infection with the above-mentioned pathogens, is treated with antibiotics, and shows the characteristic symptoms of the reaction, the diagnosis is already considered confirmed. The prognosis of patients depends on the severity of the reaction and the bacterial infection. While some patients do not show any reaction to the endotoxins of the bacteria, in other cases a severe state of shock may occur. This is especially the case when patients are otherwise debilitated and the bacteria have spread throughout the body in enormous numbers.The more bacteria die, the more endotoxins are released. Thus, the severity of the Jarisch-Herxheimer reaction also increases not least with the number of bacteria.
Complications
As a rule, Jarisch-Herxheimer reaction is not a complication or a complaint. This reaction is natural and occurs primarily as a result of taking antibiotics. Most sufferers of this reaction experience symptoms similar to those of the common flu. There are usually chills, a general weakness and fatigue. The patient’s ability to cope with stress also decreases enormously. The joints and muscles may ache and redness of the skin continues to occur. The patient’s quality of life is considerably reduced by the Jarisch-Herxheimer reaction. It is not uncommon for depression and other psychological upsets to occur. Often, patients also suffer from a concentration disorder and a coordination disorder. Furthermore, some sufferers may also experience a state of shock. This should be examined and treated by a physician. In most cases, the symptoms of the Jarisch-Herxheimer reaction subside after a few hours, so that there are no particular complications. Therefore, treatment is usually not necessary. If the symptoms persist over a longer period of time, they can be limited with the help of medication. Life expectancy is not altered by the Jarisch-Herxheimer reaction.
When should one go to the doctor?
Because Jarisch-Herxheimer reaction is a natural reaction of the body, it is not mandatory to see a doctor. The symptoms occur as a defense against pathogens and germs. Normally, they disappear within a short time even without medical care. Nevertheless, in the event of an increase in existing symptoms or a longer duration of the present illness, a visit to the doctor can be made at any time. This is especially true if the affected person wants to actively support his organism with an existing underlying disease. This shortens the healing process. Depending on the existing illness, a doctor can be consulted if there are signs such as fever, fatigue, dizziness or a general feeling of indisposition. If there is pain, fatigue or internal weakness, an optimal therapy to combat the pathogens is worked out in cooperation with a doctor. In case of a decrease of the usual performance level, concentration disorders or interruptions of attention, an improvement can be achieved by administering medication. A general feeling of illness is already sufficient to call on the support of a doctor in combating existing bacteria. If the affected person suffers from chills, sleep disturbances or complaints of the bones and joints, he should consult a doctor. If exhaustion persists for several days or if there is a collapse of the circulation, a visit to the doctor is strongly advised.
Treatment and therapy
Jarisch-Herxheimer reaction cannot be treated causally. The death of the bacteria is mandatory in the treatment of a bacterial infection. Thus, for example, it is not possible to avoid the administration of antibiotics simply because the endotoxins of the decaying bacteria might cause a physical reaction in the form of the Jarisch-Herxheimer reaction. Since bacterial infections in the worst case scenario result in sepsis and thus a life-threatening condition, the risk of a Jarisch-Herxheimer reaction is accepted when treating the infection. If the reaction starts at all, the patient’s condition can at least be treated symptomatically. Glucocorticoids are usually given to prevent worsening or attenuation of symptoms. This measure takes place before the actual administration of antibiotics and thus corresponds to preventive prophylaxis. If symptoms occur nevertheless, an antipyretic is applied in most cases. Discontinuation of antibiotic therapy is usually not necessary. An exception is the state of shock preceded by a particularly severe Jarisch-Herxheimer reaction. Increased fluid intake is often recommended to patients. Baths are also often suitable as supportive measures. Most important in treatment is appropriate use of cortisone. If neuroborreliosis is suspected, the administration of cortisone may not only aggravate the Lyme disease.The expected Jarisch-Herxheimer reaction may also be stronger.
Outlook and prognosis
The prognosis of Jarisch-Herxheimer reaction is described as favorable. The symptoms occur as side effects from the administration of medications. These are antibiotics that are used for bacterial infection. As soon as the medication prescribed by the doctor is discontinued and the absorbed active substances of the preparations are broken down and excreted by the organism, the symptoms are alleviated. The sooner the prescribed medication can be discontinued in consultation with the attending physician, the faster the regression of the symptoms that have occurred will occur. However, the preparations should not be discontinued on one’s own responsibility, since an underlying disease is present that must continue to be treated. The treatment plan is optimized by the physician on the basis of the Jarisch-Herxheimer reaction, so that a complete recovery can continue to be striven for. The longer the affected person takes the antibiotics and the longer the organism’s reaction to them lasts, the more likely secondary diseases or disorders become. In severe cases, mental illness or a state of shock may result. For this reason, for a good prognosis, it is necessary to consult the doctor already at the first irregularities such as exhaustion, fatigue or pain of joints, bones or muscles. This is the only way to ensure that the affected person can receive the fastest possible help.
Prevention
Prevention is crucial in Jarisch-Herxheimer reaction and has now become the medical standard for antibiotic administration in the setting of various infections. Prophylactic administration of glucocorticoids is usually used for prevention.
Follow-up
In most cases, the measures of direct aftercare are very limited in Jarisch-Herxheimer reaction, so that the person affected by this disease is primarily dependent on a rapid diagnosis and also on a rapid treatment of the disease, so that further complications or other complaints do not occur. An early diagnosis always has a very positive effect on the further course of the disease and can also prevent a further worsening of the symptoms. In most cases, Jarisch-Herxheimer reaction is treated by taking antibiotics. The affected person should always ensure that the antibiotics are taken regularly and in the correct dosage in order to alleviate the symptoms properly. In the case of children, parents must monitor the correct intake. In case of uncertainty or questions, a doctor should always be consulted first. Furthermore, an increased intake of fluids can also have a positive effect on the further course of the Jarisch-Herxheimer reaction. Contact with other sufferers of this disease can also be very useful, as this can often lead to an exchange of information that can alleviate the symptoms.
What you can do yourself
While the doctor treats the cause of Jarisch-Herxheimer reaction, the patient can treat the individual symptoms himself through a series of measures and home remedies. For fever and chills, bed rest and gentleness apply. Body temperature should be checked regularly. Muscle, bone or joint pain can be relieved by gentle sedatives such as St. John’s wort. Moderate exercise, but also cool compresses or a shower, can help against fatigue and exhaustion. To rule out complications, the physician must approve the use of these measures in advance. The physician will also recommend a change in diet to the patient. Increased fluid intake can at least attenuate the symptoms. Warm baths and relaxation measures are also recommended. The most important measure, however, is medical monitoring. Neuroborreliosis can only be detected and treated at an early stage through close monitoring by a specialist. Clarification of the cause is essential for the choice of medication, which is why medical diagnosis is the first priority. If signs of antibiotic poisoning appear, further self-help measures should be refrained from. The patient should immediately go to a hospital and have the Jarisch-Herxheimer reaction treated medically.
