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Why the Herxheimer Reaction Timeline Varies Several factors may influence timing and duration: Bacterial load Immune response Type and timing of treatment Presence of coinfections Coinfections such as Babesia may alter how symptoms appear and evolve during treatment

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The biosynthesis of sphingolipids entails the conversion of L-serine and palmitoyl-CoA into ceramide, which is a crucial substrate for the generation of other sphingolipids, such as ceramide-1-phosphate (C1P) and sphingosine

doi: 10.1038/ncb1024