posted
The term "jarisch-herxheimer reaction" is named after two european dermatologists, Dr. Karl Herxheimer and Dr. Adolf Jarisch, who documented an acute, transitory worsening of symptoms following the initiation of treatment for syphilis around the turn of the century (1895-1905).
At that time, syphilis was treated with mercury or arsenic preparations, as antibiotics were not yet available. The same phenomenon was later observed with antibiotic treatment, and in other spirochetal infections.
The mechanism involved has never been definitively & clearly explained. Although often attributed to "die-off", one must keep in mind that when this interpretation was originally made, it was before there was widespread understanding of the fact that spirochetes change forms. We now know that finding fewer spirochetes doesn't necessarily mean they died; instead, it may mean they converted to other, less easily detectable forms.
Dr. Alan Barbour, in a published paper some years ago, hypothesized that the massive release of blebs into the tissues by spirochetes exposed to antibiotics might trigger a reactive immune response, which may account for the Herxheimer phenomenon.
Since we now know that Lyme disease spirochetes change form into cysts or other extremely tiny forms, it seems reasonable to revisit the original interpretation of a "Herx".
Dr. Barbour may have been right that it occurs when spirochetes release massive amounts of blebs into the tissues. And they may do this concurrent with changing forms from the spirochete form to non-spirochetal forms ... forms which are less pathogenic, which would explain why a patient feels partially improved after the "herx" clears.
If so, a "Herx" may not actually represent die-off, but rather the an immune response triggered by blebs released during the conversion of spirochetes to non-spiral forms.
Some other notes: (1) "Herx" is not a synonym for feeling worse. There are many other reasons why a person may feel worse at times during treatment, including direct toxicity from medications/treatments, nutrient deprivation caused by antimicrobials, adverse or allergic reactions to drugs, failure of therapy, emergence of secondary infections, etc.
Feeling worse for a long time without experience a period of improvement, could indicate something else going on.
(2) Feeling worse after treating other infections like candida, or after sudden/extreme diet changes does not necessarily indicate "die-off".
First of all, virtually all fungal treatments (including azole antifungals) are fungistatic, meaning they inhibit growth but do not directly kill fungi.
Secondly, fungi can also produce a large number of different biochemicals and mycotoxins, and can affect blood sugar levels etc. Release of these biochemicals can definitely make you feel poorly ... but this doesn't necessarily mean the organism itself is being killed off.
Thirdly, most fungi can easily survive short (and maybe even long) periods of nutrient deprivation.
-------------------- Please consult your physician before making any changes to your diet, medications, or supplements. I am not a healthcare professional and nothing I write should be construed as medical advice. Posts: 166 | From USA | Registered: Dec 2014
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Phoiph
Frequent Contributor (1K+ posts)
Member # 41238
posted
Sonitina...
I appreciate this clarification, as the term "herx" is used very loosely. It is very common for people to immediately attribute any negative change in the way they feel during a therapy to a "herx".
Another erroneous misconception, in my opinion, is the common practice of attributing any negative change while undergoing therapy to the "flaring of ________" (fill in the blank with any microbe/pathogen).
Automatically attributing a reaction to a "herx" or a "pathogen flare" can keep one from considering other possible important causes, such as drug reaction/toxicity, etc., as you have explained above.
Alternatively, these assumptions may cause one to stop a useful therapy by misinterpreting the reaction as causing a "pathogen flare".
Posts: 1880 | From Earth | Registered: Jul 2013
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posted
Phoiph, Yes, I think one must be careful about too hastily assuming that feeling worse indicates a "herx". Sometimes it does of course, but other possibilities should always be considered. Otherwise, if the worsening is actually for some other reason, a patient may continue to decline.
Worsening due to adverse effects of drugs/treatments or reactions to them (and not only antimicrobials) is *commonly* missed. Adverse drug reactions can manifest with symptoms that are nearly indistinguishable from infection. You can even have elevated white blood cells from them.
Slow-growing secondary infections are also easy to miss, and some do not show up on any routine tests (e.g. Malassezia yeast). For example, fungal infections can slowly build over years or even decades, and can be a hidden factor in triggering allergic reactions to antibiotics, symptoms that overlap with Lyme, or cause malaise, depression, and general ill health.
It's important to keep a detailed log of any significant symptom changes, med or supplement changes, diet changes, etc to review with your doctor.
S.
-------------------- Please consult your physician before making any changes to your diet, medications, or supplements. I am not a healthcare professional and nothing I write should be construed as medical advice. Posts: 166 | From USA | Registered: Dec 2014
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posted
I agree with Sonatina that what most people call a herx, is actually an immune response. Or better yet, a transition from the anti-inflammatory Th2 immune state to a pro-inflammatory Th1 state. Most people dont realize that almost all of the symptoms you experience are actually caused by the immune system. "Herxes" included.
Die off causes more exposure of the (dead) bacteria to the immunesystem, which causes pro-inflammatory cytokines to be produced. And then you have a Th1 response.
Adverse drug reactions do need to be considered, but after being on a lot of abxs i find that the amount of adverse reactions are quite low, and most often easily recognized. Like neuropathy from flagyl/tinidazole or tendon pain from levofloxacin.
Posts: 381 | From The Netherlands | Registered: Nov 2013
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
Could you give us the citation for the Barbour article you mentioned? I was not aware that he ever recognized alternate forms of the lyme bacteria.
Posts: 2888 | From USA | Registered: Mar 2004
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
Never mind, I found this on pubmed. But it is very old and he may no longer be telling the truth on this subject, like a lot of the others who published the truth early on and then did a 180 and denied it all.
posted
Barbour didn't acknowledge the interpretation cystic forms as a viable form of the organism that converts to/from the spirochete form. But he did document and photograph the formation of "spherical structures" and blebs. And there's one study where he speculated about the blebbing being a potential cause/trigger for the Jarish-Herxheimer reaction. --I'll try to find that one for you.
This is not the study I was thinking of but (in the meantime) here's another one he published on B. hermsii:
"A prominent electron microscope finding was the abundance of small membranous blebs or vescicles in the penicillin-treated culture. Blebbing is said to occur when spirochetes are under 'adverse conditions'."
-------------------- Please consult your physician before making any changes to your diet, medications, or supplements. I am not a healthcare professional and nothing I write should be construed as medical advice. Posts: 166 | From USA | Registered: Dec 2014
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-------------------- Please consult your physician before making any changes to your diet, medications, or supplements. I am not a healthcare professional and nothing I write should be construed as medical advice. Posts: 166 | From USA | Registered: Dec 2014
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Keebler
Honored Contributor (25K+ posts)
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LIVER & KIDNEY SUPPORT & and several HERXHEIMER support links, too. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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CD57
Frequent Contributor (1K+ posts)
Member # 11749
posted
Interesting Sonatina etc. I was just re-reading Buhner coinfection book where he talks about bartonella having low endo-toxicity, so he says that when people talk about a "herx" when treating bartonella, it's really not this at all, because of the low endotoxicity.
However, that doesn't seem to hold up when treating this pathogen, because the internet is full of posts about 'bartonella herxs".
I personally attribute a "herx" to feeling worse, after which you feel slightly better.
When you are experiencing "something else" (which is how I would classify my whole treatment, it feels like a "perma FLARE" as my symptoms are 24/7,) I think this could be an immune response to pissed off bugs that are not actually being killed, but are swarming trying to find new ground. But is Is this even possible? It's a very UNEMPOWERED way to live.
Posts: 3528 | From US | Registered: Apr 2007
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Razzle
Frequent Contributor (1K+ posts)
Member # 30398
posted
I personally don't believe a treatment is helping unless certain symptoms that existed prior to beginning treatment decrease or go away while taking the treatment (abx, herb, etc.).
I've wasted way too much time on stuff that only made my hands stop hurting, but did not touch any of my other symptoms. I can make my hands stop hurting with Nettles, why would I want to use expensive, toxic Abx to do the same thing!?!
Agree w/ above posts.
-------------------- -Razzle Lyme IgM IGeneX Pos. 18+++, 23-25+, 30++, 31+, 34++, 39 IND, 83-93 IND; IgG IGeneX Neg. 30+, 39 IND; Mayo/CDC Pos. IgM 23+, 39+; IgG Mayo/CDC Neg. band 41+; Bart. (clinical dx; Fry Labs neg. for all coinfections), sx >30 yrs. Posts: 4166 | From WA | Registered: Feb 2011
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