Jarisch-Herxheimer Reaction

According to growtheology.com, 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 endotoxins caused by bacterial breakdown. Glucocorticoids are usually used for treatment.

Jarisch-Herxheimer Reaction

What is a Jarisch-Herxheimer reaction?

Typical symptoms such as sudden fever with chills and symptomatic aggravation of the original infectious disease appear as part of the Jarisch-Herxheimer reaction.

When bacteria break down, they release chemical compounds also known as endotoxins. These bacterial breakdown products cause physiological reactions in a human being. One of them is the Jarisch-Herxheimer reaction, also known as Herx.

The name comes from dermatologists Jarisch Sr. and Herxheimer, who observed the first symptoms of the reaction when treating syphilis. Bacteria are usually brought to the therapy-related decay with antibiotics. The endotoxins released in the process stimulate the release of inflammatory messengers, as characterized by the Jarisch-Herxheimer reaction.

Symptoms of the reaction include fever and headache. Symptoms can last from hours to several days. Ultimately, the symptoms are an indication of the successful fight against infectious diseases. The reaction does not appear to occur with every infectious disease, but seems to be limited to certain bacteria.


The cause of the Jarisch-Herxheimer reaction is the release of inflammatory mediators caused by endotoxin and thus bacterial decay. Inflammatory messengers are biochemical substances that initiate inflammatory reactions in tissue and keep them 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 cause reactions such as fever and nausea or change blood circulation. Most of the symptoms are attributed to the response to tumor necrosis factor and interleukin-1 from stimulated macrophages.

The Jarisch-Herxheimer reaction occurs primarily due to spirochete endotoxins. These endotoxins are released, for example, during antibiotic therapy for syphilis, borreliosis and abdominal typhus. In Lyme disease, the reaction occurs in up to 60 percent of all patients. In the case of neurosyphilis, on the other hand, it affects only a negligibly small percentage of all patients.

Symptoms, Ailments & Signs

Typical symptoms such as sudden fever with chills and symptomatic aggravation of the original infectious disease appear as part of the Jarisch-Herxheimer reaction. With effective antibiotic treatment, the Herxheimer reaction also often leads to vasoconstriction. As a result, blood pressure rises.

Pallor and chills also occur. In the further course, the symptoms often turn into the opposite. The vessels expand and the skin reddens with a drop in blood pressure. Head, muscle and bone or joint pain may occur. Patients often complain of tiredness and exhaustion.

The longer the reaction lasts, the more vulnerable patients are to depression, fatigue, and attention deficit disorder. The symptoms of a Jarisch-Herxheimer reaction typically last a few hours, but can theoretically last for days.

In extreme cases, particularly severe reactions can result in decompensation of the circulatory system. In this context, the development of states of shock as part of the reaction cannot be ruled out.

Diagnosis & course of disease

The diagnosis of a Jarisch-Herxheimer reaction is made by the doctor on the basis of the typical symptoms against the background of a bacteria-related 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 confirmed.

Patient prognosis depends on the severity of the reaction and the bacterial load. While some patients show no reaction to the bacterial endotoxins, others may experience severe shock. This is especially the case when patients are otherwise weakened and the bacteria have spread throughout the body in enormous numbers. As more bacteria die, more endotoxins are released. The severity of the Jarisch-Herxheimer reaction also increases, not least with the number of bacteria.


As a rule, the Jarisch-Herxheimer reaction is not a complication or a complaint. This reaction is natural and occurs primarily when taking antibiotics. Most of those affected suffer from this reaction with symptoms that are similar to an ordinary flu.

It usually comes with chills, general weakness and exhaustion. The patient’s resilience also decreases enormously. The joints and muscles may ache and the skin will continue to be red. The patient’s quality of life is significantly reduced by the Jarisch-Herxheimer reaction. It is not uncommon for depression and other psychological upsets to occur.

Often the patients also suffer from a concentration disorder and a coordination disorder. Some sufferers can also go into shock. This should be examined and treated by a doctor. In most cases, the symptoms of the Jarisch-Herxheimer reaction subside after just a few hours, so there are no particular complications.

Treatment is therefore usually not necessary. If the symptoms persist for a longer period of time, they can be limited with the help of medication. Life expectancy is not changed by the Jarisch-Herxheimer reaction.

When should you go to the doctor?

Since the Jarisch-Herxheimer reaction is a natural reaction of the body, a doctor’s visit is not absolutely necessary. The symptoms appear as a defense against pathogens and germs. Normally, they disappear again within a short time without medical care. Nevertheless, a doctor’s visit can be made at any time in the event of an increase in existing symptoms or a longer duration of the present illness.

This applies in particular if the person concerned wants to actively support their organism with an existing underlying disease. This shortens the healing path. Depending on the disease, a doctor can be consulted if signs such as fever, tiredness, dizziness or general malaise appear. If there is pain, exhaustion or inner weakness, an optimal therapy to combat the pathogens is developed in cooperation with a doctor.

In the event of a decrease in the usual level of performance, concentration disorders or interruptions in attention, an improvement can be achieved by administering medication. A general feeling of illness is enough to seek the support of a doctor in combating existing bacteria. If the affected person suffers from chills, difficulty sleeping or problems with the bones and joints, he should consult a doctor. If states of exhaustion last for several days or if the circulatory system collapses, a doctor’s visit is urgently recommended.

Treatment & Therapy

The Jarisch-Herxheimer reaction cannot be treated causally. Killing the bacteria is imperative in treating a bacterial infection. This means that antibiotics cannot be dispensed with just because the endotoxins of the decaying bacteria could cause a physical reaction in the form of the Jarisch-Herxheimer reaction.

Since, in the worst case, bacterial infections can lead to sepsis and thus a life-threatening condition, the risk of a Jarisch-Herxheimer reaction is accepted when treating the infection. If the reaction begins at all, the patient’s condition can at least be treated symptomatically. Glucocorticoids are usually given to prevent a worsening or weakening of the symptoms.

This measure takes place before the actual administration of antibiotics and thus corresponds to preventive prophylaxis. If symptoms nevertheless occur, an antipyretic is used in most cases. Discontinuation of antibiotic therapy is usually not necessary. An exception is the state of shock, which is preceded by a particularly severe Jarisch-Herxheimer reaction.

Patients are often advised to increase their fluid intake. Baths are also often suitable as supportive measures. Appropriate use of cortisone is particularly important during treatment. If neuroborreliosis is suspected, the administration of cortisone can not only aggravate the borreliosis. The expected Jarisch-Herxheimer reaction can also be stronger.

Outlook & Forecast

The prognosis of the Jarisch-Herxheimer reaction is described as favorable. The symptoms occur as side effects from the administration of medication. These are antibiotics used to treat a bacterial infection. As soon as the medicine prescribed by the doctor is discontinued and the absorbed active ingredients of the preparations have been broken down and excreted by the organism, the symptoms are alleviated. The sooner the prescribed medication can be discontinued in consultation with the treating doctor, the faster the regression of the symptoms that have occurred.

However, the preparations should not be discontinued on one’s own responsibility, as there is an underlying disease that must continue to be treated. The treatment plan is optimized by the doctor based on the Jarisch-Herxheimer reaction, so that a full recovery can continue to be sought.

The longer the person concerned takes the antibiotics and the longer the organism’s reaction to them lasts, the more likely it is that secondary diseases or disorders will occur. In severe cases, it can lead to mental illness or a state of shock. For this reason, for a good prognosis, consultation with the doctor is necessary as soon as the first irregularities such as exhaustion, exhaustion or pain in joints, bones or muscles occur. This is the only way to ensure that the person concerned can get help as quickly as possible.


Prevention is crucial for the Jarisch-Herxheimer reaction and has now established itself as the medical standard for the administration of antibiotics for various infections. As a rule, the prophylactic administration of glucocorticoids is used for prevention.


In most cases, the measures of direct aftercare for the Jarisch-Herxheimer reaction are very limited, so that the person affected with this disease is primarily dependent on a quick diagnosis and also on a quick treatment of the disease so that there are no further Complications or other problems occur. Early diagnosis always has a very positive effect on the further course of the disease and can also prevent further deterioration of the symptoms.

In most cases, treatment of Jarisch-Herxheimer reaction is by taking antibiotics. The person concerned should always ensure that they take the antibiotics regularly and also take the right dosage in order to properly alleviate the symptoms. In the case of children, the parents must control the correct intake. If anything is unclear or if you have any questions, always consult a doctor first.

Furthermore, an increased intake of liquids can have a positive effect on the further course of the Jarisch-Herxheimer reaction. Contact with other people affected by this disease can also be very useful, as it is not uncommon for information to be exchanged that can alleviate the symptoms.

You can do that yourself

While the doctor treats the cause of the Jarisch-Herxheimer reaction, the patient can treat the individual symptoms themselves with a number of measures and home remedies.

In the case of fever and chills, bed rest and rest apply. Body temperature should be checked regularly. Muscle, bone or joint pain can be relieved with gentle sedatives such as St. John’s wort. Moderate exercise helps against tiredness and exhaustion, but also cool pads or a shower. In order to rule out complications, the doctor must agree to the use of these measures beforehand. The doctor will also recommend the patient to change their diet. Increased fluid intake can at least alleviate the symptoms. Warm baths and relaxation measures are helpful.

The most important measure, however, is medical supervision. Neuroborreliosis can only be recognized and treated at an early stage if it is closely monitored by a specialist. Clarifying the cause is essential for the choice of medication, which is why the medical diagnosis is the top priority. If there are signs of antibiotic poisoning, further self-help measures should be refrained from. The patient should go to a hospital immediately and get medical treatment for the Jarisch-Herxheimer reaction.