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Mechanisms underlying Herxheimer reactions Managing Herxheimer reactions often comes down to one of these three reactions: Immune response activation Central nervous system hypersensitivity Release of pro-inflammatory cytokines Toxicity from microbial cell components Clinical manifestations of Herxheimer reactions Flu-like symptoms (e.g., fever, fatigue, muscle aches) Worsening of existing symptoms New or increased neurological symptoms Importantly, new symptoms shouldnt be interpreted as a Herxheimer reaction initially

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In this case, CCs invade the tissue space between pre-existing vessels by migrating along the abluminal surface of those vessels which eventually results in the incorporation of those pre-existing vessels into the tumor [84]

Tinnitus-related neural activity: Theories of generation, propagation, and centralization

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