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Severe Jarisch Herxheimer reaction (J-HR) precipitated by antibiotic treatment of louse-borne relapsing fever (LBRF) is associated with a transient, marked rise in circulating tumour necrosis factor alpha (TNF alpha), interleukin 6 (IL-6) and interleukin 8 (IL-8). Ovine polyclonal anti-TNF alpha antibody fragments (Fab) were used in a randomized double blind placebo controlled trial in an attempt to prevent this reaction. Within 4 h after penicillin, in controls (n = 29), a several-fold rise in cytokines occurred, concomitant with a fall in spirochaetes and maximal clinical manifestations of the J-HR. An intravenous infusion of anti-TNF alpha Fab, 30 min before penicillin in 20 patients reduced peak plasma levels of IL-6 and IL-8 (but not IL-1 beta) compared with controls (p = 0.01 and < 0.001, respectively) and the incidence of the J-HR, indicating some neutralization of TNF alpha. An apparent fall in TNF alpha reflected interference of anti-TNF alpha in the immunoassay.


Journal article



Publication Date





213 - 221


Adolescent, Adult, Child, Cytokines, Double-Blind Method, Female, Humans, Immunoglobulin Fragments, Immunoradiometric Assay, Infusions, Intravenous, Interleukin-1, Interleukin-6, Interleukin-8, Male, Middle Aged, Penicillins, Relapsing Fever, Systemic Inflammatory Response Syndrome, Tumor Necrosis Factor-alpha