Table of contents:

1. A few words about bacterial toxins
2. Where does the Jarisch-Herxheimer reaction come from?
3. Symptoms of Jarisch-Herxheimer reaction
4. Who is at risk of developing a Jarisch-Herxheimer reaction?
5. What should you do if you observe unusual symptoms after administration of an antibiotic?

A few words about bacterial toxins

Bacteria, or micro-organisms, can cause a range of diseases. The action of bacteria on the human body is based on the synthesis of toxins, which can be of two types: as toxins secreted into the external environment (so-called exotoxins) and as toxins present in the cell membrane of Gram-negative bacteria, as so-called endotoxins.

Where does the Jarisch-Herxheimer reaction come from?

The Jarisch-Herxheimer reaction is also known as the Lukasiewicz-Jarisch-Herxheimer or Herx reaction. The reaction is the body's response to toxins that are released from bacteria that have been killed after antibiotic treatment. Bacteria produce toxins, which they release into the body, thereby causing a disease state. Antibiotics have a killing effect on bacteria, but unfortunately it happens that the toxin is also released from dead microorganisms.

Once the toxin enters the body, it gradually undergoes numerous metabolic transformations in the liver and then reaches the kidneys. When the liver and kidneys are unable to cope with the amount of toxin in the body, the Jarisch-Herxheimer reaction mentioned above occurs.

Symptoms of the Jarisch-Herxheimer reaction

Symptoms that may suggest a Herx reaction include:

• fever,
• headache,
• severe chills,
• muscle and bone pain of varying severity,
• itching,
• skin lesions,
• nausea,
• vomiting,
• swollen eyelids,
• neck pains,
• shallow breathing,
• tingling,
• sensation of paralysis,
• heaviness of the limbs.

Blood tests show elevated levels of the inflammatory factors CRP, TNF and interleukin-6 and interleukin-8. CRP is the C-reactive protein, which is a glycoprotein that appears in the body when the body is fighting inflammation. TNF is a factor that influences the increased activity of lymphocytes. Interleukins are so-called pleiotropic cytokines, or immune system molecules that regulate the body's defence processes.

Jarisch-Herxheimer reaction, photo: panthermedia

It is particularly dangerous in patients being treated for syphilis. The toxin secreted by the syphilis spirochetes can cause a temporary worsening of the lesions associated with syphilis. Patients may develop seizures, paralysis-like symptoms, spasms, cyanosis and changes in blood pressure.

Who is at risk of developing a Jarisch-Herxheimer reaction?

Herx syndrome occurs most commonly in patients with syphilis, primary typhoid fever, leptospirosis, brucellosis, Lyme disease, leprosy, tuberculosis. The virulent bacteria causing the aforementioned disease entities can secrete significant amounts of toxin, which affects the patient's body. Depending on the disease entity diagnosed, the timing of the reaction and its severity can vary. For example, the bacteria that cause Lyme disease die relatively slowly, so that the release of the toxin into the body may be longer, so that symptoms appear later than in patients with, for example, syphilis.

What should you do if you observe unusual symptoms after taking an antibiotic?

If during treatment you observe the appearance of:

• a sudden increase in your symptoms,
• the occurrence of symptoms mentioned earlier in this article.

Go to your GP or to the Hospital Emergency Department. Your doctor will carry out additional tests to rule out other causes of deterioration. In extreme cases, the Jarisch-Herxheimer reaction may require the implementation of additional treatment. Remember - do not underestimate the appearance of worrying symptoms. Prompt treatment brings significant improvement in the condition in a relatively short period of time.