The effect of antibody against TNFα on cytokine response in Jarisch-Herxheimer reactions of louse-borne relapsing fever

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 (TNFα), interleukin 6 (1L-6) and interleukin 8 (IL-8). Ovine polyclonal anti-TNFα 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-TNFα Fab, 30 min before penicillin in 20 patients reduced peak plasma levels of 1L-6 and IL-8 (but not IL-1β) compared with controls (p = 0.01 and < 0.001, respectively) and the incidence of the J-HR, indicating some neutralization of TNFα. An apparent fall in TNFα reflected interference of anti-TNFα in the immunoassay.