Some patients taking antibiotics suffer from Lyme disease treatment symptoms which are colloquially known as ‘herxing’. This is referred to in medical terms as a Jarisch-Herxheimer reaction and may also be considered a ‘healing crisis’, ‘flare up’, or ‘die off’ although these may create confusion about the actual state of a patient’s condition.
The Jarisch-Herxheimer reaction was named after two European dermatologists who were working on treatment for patients with syphilis, which is an infection caused by a spirochaete, similarly to Lyme disease. Adolf Jarisch, an Austrian doctor, reported this reaction in 1895 and Karl Herxheimer, a German doctor, detailed it in 1902. The treatment symptoms could be strikingly similar to the illness itself with headaches, skin lesions, joint or muscular pain, chills, fever, excessive sweating, cold hands and feet, swollen lymph glands, and gastrointestinal symptoms such as nausea, diarrhoea, and constipation. Some patients also experienced changes in blood pressure (either a drop or an elevation), and others had hives, itching, and rash development.
Why ‘Herxing’ Happens
The traditional explanation for the Jarisch-Herxheimer reaction is that as the spirochaetes die during treatment they release toxins, perhaps as a last-ditch attempt at stopping the body from eradicating the infection. This explanation is beginning to be questioned however and a different theory of what causes herxing in Lyme disease is under discussion in some circles. Special detoxification diets are sometime recommended by alternative medical doctors for those undergoing Lyme disease treatment. Symptoms may be ameliorated by helping ensure that the liver, kidneys, and the digestive tract are healthy, that patients stay hydrated, and that compromising activities such as smoking, alcohol consumption, and poor diet are addressed so as to reduce the toxic burden on the body. Where ‘herxing’ occurs patients may feel so unwell as to require the cessation of treatment for a short period before re-commencing with lower levels of antibiotics. In some cases the symptoms may be mistaken as an allergic reaction to the antibiotics and patients may then be given a multitude of different antibiotics as each one produces a similar effect. Careful assessment of the symptoms is essential therefore in order to facilitate timely and appropriate treatment for Lyme disease.
How Common are Lyme Disease Treatment Symptoms?
Some ‘herxing’ only occurs temporarily and many patients actually feel it is necessary or desirable for this reaction to happen to demonstrate that the antibiotics are working. This is not usually the case however, with most studies that have reported such symptoms only ever finding it in a handful of patients. Luger (et al, 1995) observed the Jarisch-Herxheimer reaction in 12% of patients treated for Lyme disease, Maloy (1998) documented the reaction in a patient treated with amoxicillin which resulted in acute illness an hour after the first antibiotic does; symptoms were hypertension, fever, and rigors and the patient (a 31yr old woman) required fluid resuscitation due to severe hypotension (low blood pressure). Strominger (1994) also observed ‘herxing’ in a case study involving a 58yr old woman who had neurologic and neuroophthalmologic symptoms of Lyme disease, including a radiculomyelitis, cranial neuritis and mild right optic neuropathy. Intravenous ceftriaxone treatment led to a Jarisch-Herxheimer reaction where the patient experienced encephalopathy, mild fever, worsening radiculomyelitis, and deterioration of vision. The reaction was alleviated through administration of intravenous methylprednisolone and symptoms subsided over 72hrs.
Is Herxing Necessary for a Lyme Disease Cure?
Herxing is not considered necessary for successful Lyme disease treatment and patients may wish to question the motives of those telling them it is a required stage of recovery. Such misinformation may lead a patient who has had successful treatment for Lyme disease infection to undergo further, unnecessary, treatment with more powerful antibiotics in an attempt to provoke a Jarisch-Herxheimer reaction. If herxing does occur in a patient being treated for Lyme disease then the symptoms are usually only present in the first 24hours of treatment and are manageable by bed rest and medication such as aspirin. Some patients report ‘herxing’ occurring in cycles however, beginning days, weeks, or even months into treatment. Although this has been considered extremely unlikely to be associated with the antibiotic treatment itself, an appreciation of the possibility of the lyme disease bacteria ‘hiding’ from the immune system in a cystic form may go some way towards providing a mechanism by which herxing occurs in cycles. There is, as yet, no clear evidence to support this hypothesis, but neither has it been adequately quashed.
Something of a myth has built up around herxing, with some patients viewing it almost like an exorcism that must be gone through to rid the body of Lyme disease. Where such symptoms occur these are more likely to be a result of inappropriately prescribed antibiotic therapy, or another underlying illness, perhaps one misdiagnosed as Lyme disease in some cases. In assuming that these are Lyme disease treatment symptoms, patients risk delaying treatment for serious illnesses or unwanted antibiotic reactions. Any neurological symptoms, severe gastrointestinal upset, palpitations, vomiting, or blurred vision need to be investigated by a qualified medical doctor and should not be presumed to be ‘herxing’.
The extent, and rapidity, of healing from Lyme disease depends on a number of factors such as the length of the infection, the seriousness and extent of their symptoms, the patient’s reaction to antibiotics, and the quality of support they receive from family, friends, and the medical profession during and after treatment. Where a patient has had a lengthy and arduous process of diagnosis with numerous tests and interventions prior to Lyme disease treatment their emotional and financial resources are often at a low ebb, making it difficult to assess whether fatigue, anxiety, cognitive problems, and aches and pains are due to the condition, Lyme disease treatment symptoms, persistent infection or co-infection, or simply exhaustion on the patient’s part.
Continue Reading –> UPDATE: Why Herxing Happens
Maloy AL, Black RD, Segurola RJ Jr. Lyme disease complicated by the Jarisch-Herxheimer reaction. J Emerg Med. 1998 May-Jun;16(3):437-8.
Strominger MB, Slamovits TL, Herskovitz S, Lipton RB. Transient worsening of optic neuropathy as a sequela of the Jarisch-Herxheimer reaction in the treatment of Lyme disease. J Neuroophthalmol. 1994 Jun;14(2):77-80.
Luger SW, Paparone P, Wormser GP, Nadelman RB, Grunwaldt E, Gomez G, Wisniewski M, Collins JJ. Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans. Antimicrob Agents Chemother. 1995 Mar;39(3):661-7.