All are true regarding Jarisch-Hexiemer's reaction, except

(C) Ophthalmic involvement worsens # Jarisch-Herxheimer reaction:> The Herxheimer reaction (also known as or Herx) occurs when large quantities of toxins are released into the body as bacteria (typically Spirochete bacteria) die, due to antibiotic treatment or rapid detoxification.> Typically the death of these bacteria and the associated release of endotoxins occur faster than the body can remove the toxins via the natural detoxification process performed by the kidneys and liver.> It is manifested by fever, chills, headache, myalgia (muscle pain), and exacerbation of skin lesions.> Duration in syphilis is normally only a few hours but can be much longer, up to months or years, for other diseases.> The intensity of the reaction reflects the intensity of inflammation present.> The Herxheimer reaction has shown an increase in inflammatory cytokines during the period of exacerbation, including tumor necrosis factor alpha, interleukin-6 and interleukin-8.> The reaction is also seen in other diseases, such as borreliosis (Lyme disease and tick-borne relapsing fever, bartonellosis, brucellosis, typhoid fever, and trichinellosis and Q fever).