The Herxheimer reaction resembles bacterial sepsis and can occur after initiation antibacterials such as penicillin or tetracycline, or treatment of tick-borne relapsing fever. An association has been found between the release of heat-stable proteins from spirochetes and the reaction. The same can be true for candida die-off when toxins from the dying candida leak into the body. Typically, the death of these bacteria and the associated release of endotoxins occurs faster than the body can remove the toxins. It manifests as fever, chills, rigor, hypotension, headache, tachycardia, hyperventilation, vasodilation with flushing, myalgia (muscle pain), and exacerbation of skin lesions. The intensity of the reaction indicates the severity of inflammation. Reaction commonly occurs within two hours of drug administration, but is usually self-limiting. Prophylaxis and treatment with an anti-inflammatory agent may stop progression of the reaction. Oral aspirin every four hours for 1–2 days, or 60 mg of prednisone orally or intravenously has been used as an adjunctive treatment.