These are often casually. but inaccurately, referred to as “herx” reactions, or scientifically as “herxheimer-like” alluding to the Jarisch-Herxheimer reaction to bacterial toxins specifically from syphilis. All gram-negative bacteria, of which Cpni is one, have contain Lipopolysaccharidei endotoxinsi as well as HSPi's (heat shock proteins) which are released as a matter of course during infection and are in part responsible for the on-going symptoms of the infection.
When these bacterial are killed en masse during treatment, they release relatively large amounts of endotoxin, causing significant symptoms especially during initial phases of treatment, as well as when an additional antibiotic agent is added to the protocol. If the amount of endotoxin exceeds the body's ability to get rid of it, these toxic effects can be life threatening. But even in less threatening amounts, the endotoxins and the resulting reactions can cause oxidative stress and damage to body organs.
Wheldon believes the immediate reactions, characterized by shivering, influenzal symptoms and general malaise, are indicative of the endotoxin itself. Dorlands Medical Dictionary adds that the condition is a short term immunological reaction which causes fever, chills, muscle pain, headaches, and skin lesions.
Dr. Powell identifies chronic signals of endotoxin in constantly feeling cold especially in extremities or body core, feeling that you can't warm up, etc.
The recommended supplementsi are crucial to help the body counter endotoxin reactions, and the oxidative damage they can cause body tissues and organs.
The endotoxin stimulates a powerful cytokine reaction by the immune system, which activates macrophages and brings with it inflammation. Next the compliment cascade, and release of histamine and more inflammation. Next the coagulation cascade and more inflammation, along with lowered blood pressure. It is likely that widespread muscle, joint and connective tissue pain, dis-coordination, deep fatigue, brain fog, bowel and other organ distress, nausea, are an indication of the endotoxin-cytokine cascade when abxi treatment is initiated.
"LPSi is an incredibly potent initiator of immune cascades...you really don't need much to cause a lot of harm... We know that once the endotoxin signaling process has begun, the damage done by endotoxin is actually damage done by the immune system. Cytokinesi released in high concentrations produce overwhelming amounts of ROSi and RNS, leading to free radical production and catastrophic tissue damage. Equally overwhelming amounts of antioxidants are required in sustained concentrations to both prevent and combat this..." http://www.acnem.org/journal/24-1_april_2005/endotoxin.htm#15
The main signal of cytokine reaction is inflammation: pain, swelling, brain fog, pain, pain, pain.
As noted, the supplementsi are crucial here as well for preventing the damage of our runaway immune system. Some patients may require anti-inflammatory medications to manage these cytokine cascades.
*Thanks to Ron for the phrase, "That "Kissed by a Dementor" kind of feeling."
Dr. David Wheldoni's succinct summary of the different reactions to Cpni and its treatment helps in sorting out the different responses and what to do about them. I've moved this from his comment in another members blog post to a page of it's own here in the Cpn Treatment Handbook.
Jim K (Editor in Chief)
Five Ways of Feeling Lousy
I am inclined to think that there are five major mechanisms behind those unpleasant side effects of chronic large-load infection with C pneumoniae which worsen in the short-term with antichlamydial treatment.
a) Lipid peroxidation may likely get worse in the short-term as bacterial products are released both by breaking down EBs and by apoptosisi of infected cells. Antioxidantsii and B vitaminsi (including B12) may help with this. I find melatoninii at night helpful.
b) Release of endotoxinsii. These evoke a nonspecific host reaction. Antioxidants and Vitamin Di may be very helpful. Vitamin D has many immunomodulatory properties aside from calcium regulation. (The Vitamin D page is very helpful: thanks Marie.)
c) Disturbance of the haem synthesis pathway. Although called 'porphyriai', this is a slightly misleading word here. The haem-pathway disturbance found with this infection is probably very complex and likely involves many steps as the metabolites cross and re-cross the mitochondrial membranes. It's important to realize that mitochondria were once separate, free-living creatures, and the mitochondrial membrane is the interface between two interdependent kingdoms: it is the waist of a 'biochemical hourglass'. I don't profess to be a biochemist, but it seems to me that this disturbance of the mitochondrial / host interface here is not really like the medically described porphyriasii. I suppose one might say that it most closely resembles Porphyria Cutanea Tarda, except that in PCT skin lesions are usually the first symptoms. PCT-like skin lesions are uncommon in in my experience in this infection. One suspects that this infection may disturb several steps in the haem production pathway. Testing for haem precursors is well-described by Basil; in my experience you can have normal porphobilinogen and delta aminolaevulanic acid levels in profoundly 'porphyric' urine. I found glucose, high fluid intake and propranolol very helpful. Some people find charcoal invaluable.
d) Release of bacterial antigens. As bacteria die they release numerous antigens. Some are likely to be specific. Do you recall the old Typhoid / Paratyphoid A and B vaccine? If you are of a certain age you may vividly remember the murky fluid in the barrel of the glass syringe (syringe made by 'Record'; needles re-usable, with a 'Glydin' pattern tip.) But the effect of the blunt needle was as nothing compared to the effect of the vaccine. A feeling of general ill-being commonly occurred after this 'jab', particularly when it was repeated. The after-effects were so unpleasant it was rumoured that the British Army used to administer the stuff to recruits just before they went on weekend leave. C pneumoniae, like Salm typhi, is a Gram negative organism. When we give antibioticsii to kill intracellularii C pneumoniae we are creating in effect a sequence of crude, whole-germ immunisations. One might expect that Vitamin D would help with this, and also curcumin. Looking on the bright side, we may be protecting ourselves from further widespread infectionsii with this organism.
e) Functional Vitamin B12 deficiency. The Vanderbilt workers have found that in this infection antibodies incidentally binding to Vitamin B12 are induced. This means that B12 may have a normal concentration in the blood but effectively cannot get into nerves. Flooding the system with B12, either by injection or oral methyl cobalamin, can produce profound effects; these seem to be quite short-term, suggesting that supplemental B12 is quickly bound.
So, we have at least five mechanisms for feeling lousy: possibly a number of them are working in synergy at the same time.
This being said, I wouldn't want to put anyone off taking treatment because of the fear of reactions. If we don't deal with these germs they'll likely deal with us.