INFECTIONS ASSOCIATED WITH STEROID USE

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INTRODUCTION

Corticosteroid use has dramatically increased in the last decade. Cortisone was first isolated from the adrenal cortex in 1935, and first synthesized in the mid 1940s. In 1948, cortisone was first used for the treatment of rheumatoid arthritis (RA). In the 1950s, steroid use for the treatment of asthma became widespread. Steroids are widely used for the treatment of many rheumatologic diseases including systemic lupus erythematosus (SLE), RA, sarcoidosis, temporal arteritis, and other

EFFECTS OF STEROIDS ON THE IMMUNE SYSTEM

Corticosteroids are biologically active synthetic analogs of the steroid hormones produced in the adrenal cortex and have both glucocorticoid (metabolic) and mineralocorticoid (electrolyte regulating) effects. Steroids are used in clinical practice both for replacement therapy and for treatment of a wide array of diseases, because of their antiinflammatory or immunosuppressive action.

Corticosteroids inhibit superoxide production that results in a decrease in hydrogen peroxide generation and

ROUTE, DOSE, AND DURATION OF STEROID USE

Infections associated with corticosteroids are dependent on the route of administration, dose, and duration of therapy. Inhaled steroids have the lowest risk of causing infection. The most common infectious complication is oropharyngeal candidiasis. Candida albicans and non–C. albicans species are the most common isolates from the oropharynx of patients on inhaled steroid preparations.6, 51, 61, 70 Some systemic absorption can occur by way of absorption from the lungs, and secondary to

TYPES OF INFECTIONS

Patients receiving chronic steroids have an increased susceptibility to all types of infection. Although a wide spectrum of both common and opportunistic infection have been reported, the largest number of infections are caused by the pyogenic bacteria (Table 2). The most common pathogens are Staphylococcus, streptococci, and the Enterobacteriaceae. Patients on chronic steroids are at increased risk of developing surgical wound infections and wound dehiscence since steroids interfere with

PREVENTION OF INFECTION

The use of low-dose trimethoprim-sulfamethoxazole in organ transplantation markedly reduces the risk of developing Pneumocystis pneumonia, Listeria infection, toxoplasmosis, nocardiosis, and urinary tract infections. Acyclovir prophylaxis decreases the incidence of HSV and herpes zoster infection in bone marrow transplant recipients. Administration of CMV hyperimmune globulin and ganciclovir has been used to prevent CMV reactivation in renal transplant recipients. Patients with positive

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    Address reprint requests to Natalie C. Klein, MD Infectious Disease Division Winthrop-University Hospital Mineola, New York, 11501

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    State University of New York School of Medicine, Stony Brook, New York; and Infectious Disease Division, Winthrop-University Hospital, Mineola, New York

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