Lyme disease and other tick-borne diseases have long been misunderstood and often misdiagnosed. Fortunately, medical technology has advanced, and people now have more options for diagnosing and treating them than ever before.
Most tick-borne diseases, including Lyme, are caused by bacteria spread by a tick bite. This is why antibiotics are often the first line of defense for treatment, especially when caught early on.
Antibiotic treatment can also come with its own side effects, like in the case of a Herxheimer reaction. Let’s examine this side effect, what to do about it, and when to be concerned.
What is a Herxheimer reaction?
The Jarisch-Herxheimer reaction was first identified by two dermatologists, Adolf Jarisch and Karl Herxheimer, while studying syphilis. It’s often colloquially referred to as simply a Herxheimer reaction, or a “Herx.”
Tick-borne disease treatment typically includes the use of antibiotic treatments to kill microbes. When antibiotic treatments kill bacteria, those bacteria can release toxins. A Herxheimer reaction occurs when someone has an adverse reaction to these toxins. This reaction usually starts within two hours of starting antibiotic treatment.
Symptoms of a Herxheimer reaction
What does a Herxheimer reaction do to you? Here are some of the symptoms:
- Flu-like symptoms
- Fever and chills
- Nausea and vomiting
- Headache
- Hypotension (low blood pressure)
- Hyperventilation
- Tachycardia (a heart rate over 100 beats a minute)
- Flushing
- Myalgia
- Worsening of skin lesions
Some Lyme disease symptoms are similar to those of a Herx, making it difficult to distinguish between them and causing many cases to be underreported. It also can be concerning when you’re already receiving treatment and then experience what appear to be worsening symptoms.
What causes a Herx?
It is understood that a Herx is caused by the toxins from bacteria that are killed off during treatment, but why does this happen?
Researchers and medical providers still don’t fully understand the Herxheimer reaction, but they have a theory. Bacteria dying off and releasing toxins can cause the body to have an inflammatory response.
During this immune reaction, cytokines and lipoproteins enter the bloodstream. Cytokines are proteins that help control inflammation in the body.
What can be confusing is that a Herx is when the immune system creates a reaction to the toxins, not to the microbe that caused the infection in the first place. Another misconception is that this is an allergic reaction to antibiotics, which is also false.
How common is a Herx reaction?
How common is a Herx reaction? More than you may expect.
Herx reactions have been well-identified in patients with Lyme disease and are likely for those with Tick-Borne Relapsing Fever (TBRF). Somewhere between 7-30% of Lyme patients treated with antibiotics experience a Herx, and 39% for those with Tick-Borne Relapsing Fever. But what about other tick-borne diseases?
Herx Reactions and Bartonellosis
There have been a few reported cases of a Herx reaction in people with Bartonellosis. Other cases have also been found in those with Babesiosis, but those were most likely due to a co-infection with Lyme since a parasite, not bacteria, causes Babesiosis.
Again, it’s difficult to say just how common they are because so many of the symptoms are similar to those of Lyme and other tick-borne diseases.
Should I be concerned?
While the Herxheimer reaction can be uncomfortable, it is generally considered a positive sign that the antibiotic treatment is working. It indicates that the body is responding to the dying bacteria and the inflammatory response is a result of the release of toxins.
Fortunately, these symptoms typically resolve within 24 hours; However, in some cases, the reaction can be severe and may require medical attention. It can be life-threatening if a significant drop in blood pressure leads to acute organ injury or failure.
There is no available treatment for a Herx, so providers instead treat the symptoms and may keep patients for observations. They are generally watching for abnormalities of vital signs to help prevent any complications. Aggressive treatment may include IV support, vasopressors, corticosteroids, and transient dialysis.
Some people experience recurring Herx reactions. They may happen with a week or two in between them. However, these typically lessen in intensity and length with each one.
Tick-borne disease testing
Tick-borne diseases can be nerve-wracking to deal with, but it’s important to be as proactive as possible. That means seeking the most accurate and reliable testing available, like those offered by IGeneX. The sooner you can test and receive a proper diagnosis, the better your chances are of getting proper treatment and making a full recovery.