Prevention of Jarisch–Herxheimer Reactions by Treatment with Antibodies against Tumor Necrosis Factor α

Louse-borne relapsing fever, caused by Borrelia recurrentis spirochetes, has been responsible for massive epidemics in North Africa, the Middle East, and Europe during this century. The epidemic at the end of World War II involved some 10 million people. 1 There is a potential for future epidemics wherever war and the movement of refugees or immigrants threaten a breakdown in public health. Since the mortality rate for untreated louse-borne relapsing fever has reached 70 percent in some epidemics, 1 antimicrobial treatment is essential. Although effective in eliminating spirochetes, this treatment precipitates a potentially life-threatening febrile inflammatory reaction in a majority of patients. . . .