Infections associated with steroid use

State University of New York School of Medicine, Stony Brook, New York, USA.
Infectious Disease Clinics of North America (Impact Factor: 2.73). 07/2001; 15(2):423-32, viii. DOI: 10.1016/S0891-5520(05)70154-9
Source: PubMed


Patients receiving chronic steroids have an increased susceptibility to many different types of infections. The risk of infection is related to the dose of steroid and the duration of therapy. Although pyogenic bacteria are the most common pathogens, chronic steroid use increases the risk of infection with intracellular pathogens such as Listeria, many fungi, the herpes viruses, and certain parasites. Clinicians should consider both common and unusual opportunistic infections in patients receiving chronic steroids.

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    • "The use of steroid also affects the development of infection. Dexamethasone-based regimens decrease in cell-mediated immunity and could increase the risk of infection by encapsulated bacterial organisms, viruses, or fungi [13]. Hyperglycemia induced by steroid could play a role of increased susceptibility of infection [14]. "
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    ABSTRACT: The association between hyperglycemia and infections during induction chemotherapy has been reported in a number of hematologic disorders. This retrospective study evaluated the incidence of hyperglycemia during induction therapy in 155 patients with newly diagnosed multiple myeloma (MM) and its effect on serious infections during the first 60 days of induction. A total of 20 (12.9%) patients developed overt hyperglycemia (≥200 mg/dL) during induction therapy. Serious infections occurred in 28 (18.1%) of 155 patients and infection-related mortality within 2 months after treatment was 0.6% (1 patient). In a univariate analysis, overt hyperglycemia, poor performance status (≥2), International Staging System III, lymphopenia (<500/ μ L), and elevated serum creatinine (≥2 mg/dL) were found to be associated with serious infections. In multivariate analysis, only overt hyperglycemia (HR 7.846, 95% CI 2.512-24.503, P < 0.001) and poor performance status (HR 5.801, 95% CI 1.974-17.050, P = 0.001) remained significant. In conclusion, this study demonstrated an association between hyperglycemia and serious infections during induction therapy in patients with MM.
    04/2014; 2014:413149. DOI:10.1155/2014/413149
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    • "Use of prednisone for greater than 3 weeks or of a dose greater than 16 mg/day is associated with opportunistic infections [88]. Patients receiving >50 mg/day had a fourfold increased risk [89], related to inhibition of T cell mediated immune responses [89], as CD4 + and CD8 + T cells apoptose upon glucocorticoid exposure [90]. When glucocorticoids are required, use of the lowest possible dose to achieve a clinical response for the shortest duration of time will reduce infection risk [88]. "
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    ABSTRACT: Infectious agents are considered to be crucial environmental factor in the etiopathogenesis of systemic lupus erythematosus (SLE). Infections may serve as initial trigger to the development of autoimmunity and carry an overall greater risk of morbidity and mortality than the general population. Initial presentation of SLE can mimic infections, and in turn infections can mimic disease flares in established SLE. Infections due to predisposition by commonly used immunosuppressive therapies are a significant cause of morbidity and mortality. In this review, viral, bacterial, fungal, and parasitic infections that contribute to the etiology of SLE, potentially mimic or precipitate flares, create diagnostic dilemmas, complicate treatment, or protect against disease, are discussed. Infection risks of current immunosuppressive therapies used in the treatment of SLE are outlined. Strategies to prevent infection, including vaccines, prophylactic antibiotic therapies, toll-like receptor antagonism, and antioxidant treatment that may decrease disease burden and improve quality of life in lupus patients will be discussed.
    International Reviews Of Immunology 01/2014; 33(4). DOI:10.3109/08830185.2013.863305 · 4.10 Impact Factor
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    • "coli, suivis des staphylocoques (10 %) et streptocoques (7 %). Cette répartition est comparable à celle de cohortes de maladies systémiques retrouvant 60 à 75 % de pyogènes, ces germes étant favorisés à la fois par une altération immunitaire humorale iatrogène ou une altération de la voie du complément en lien avec la vascularite [13] [14] [15]. Nous n'avons relevé que 9 zonas (6 %), ce qui est inférieur aux études antérieures (12 à 17 %), et cela peut s'expliquer par le caractère rétrospectif de notre étude et par le manque de traç abilité des dossiers [6] [12]. "
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    ABSTRACT: The aim of this study was to assess the infections occurring in a series of 82 patients followed for a systemic necrotizing vasculitis and to determine potential risk factors. We studied retrospectively the medical files of 23 Churg and Strauss syndrome, 18 periarteritis nodosa, 14 microscopic polyangiitis, and 27 granulomatosis with polyangiitis, over a 15-year period. Infection delay corresponded to the period from treatment to first infection or between two infections. A total of 61 patients developed 147 infections. Causal agent was identified in 70 cases, 42 were bacterial, 20 viral and 8 fungal. Bronchopneumonia was the most frequent infection (43 %). Sixty-two percent of infections occurred within 2 years after vasculitis diagnosis. Seven infections were major, requiring intensive care, with one infection-death related. Pneumocystis prophylaxis concerned 75 % of patients on cyclophosphamide. Significant factors reducing infection delay were initial hypergammaglobulinemia, hypoalbuminemia, lymphopenia, as well as cyclophosphamide and methotrexate treatment. Large quantities of corticosteroids, cyclophosphamide or azathioprine increased infection delay. This result underlines the early occurrence of infectious complications during vasculitis course. Infectious events occurring in systemic necrotizing vasculitis are frequent and occurs early in disease course, and could be prevented with simple prophylactic measures. Vasculitis relapse and infection share similarities and this require permanent clinical vigilance.
    La Revue de Médecine Interne 12/2013; · 1.07 Impact Factor
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