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doi: 10.1016/j.jacc.2006.11.039 64

Unlike the textbook JHR, which often lasts only 24 hours 1, Herx-like symptoms related to the treatment of gut dysbiosis or chronic low-grade bacterial, parasitic, or fungal infections may: Appear several days into treatment Last several days or even weeks Recur periodically, when treating infections that cycle between dormant and active phases This broader, experience-based perspective recognizes that not all Herx reactions follow the same predictable pattern, and many are milder but longer-lasting, especially when associated with gut pathogens

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It is possible for macrophages to release a range of substances, including fibrotic factors such as TGF-2, anti-inflammatory cytokines such as IL-10, and mediators of inflammation such as IL-1, IL-6, and TNF