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Richard Horowitz describes the Jarisch-Herxheimer (JH) flare as a temporary worsening of the symptoms of Lyme disease that occurs when the Lyme spirochete is being killed off by antibiotics, creating inflammationThese JH reactions produce cytokines (TNF-alpha, IL-6, and IL-8), which then create inflammatory symptoms, including increased fever, muscle and joint pain, headaches, cognitive impairment, and a general worsening of the underlying symptomology