Steroids, or corticosteroids, are a class of medications that have potent anti-inflammatory and immunosuppressive properties. Their use in the context of infectious diseases is multifaceted, often requiring a delicate balance between benefit and risk. Below are some key considerations and questions regarding the use of steroids in infectious diseases.
What Role Do Steroids Play in Infectious Diseases?
Steroids are primarily used in infectious diseases to reduce inflammation and modulate the immune response. In certain infections, the host's immune response can be excessive, causing more harm than the pathogen itself. In such cases, steroids can help mitigate this damage by dampening the inflammatory response. This is particularly relevant in diseases like
COVID-19 and
bacterial meningitis.
How Are Steroids Used in COVID-19?
In the context of
COVID-19, steroids such as dexamethasone have been shown to reduce mortality in patients requiring supplemental oxygen or mechanical ventilation. The
RECOVERY Trial demonstrated that low-dose dexamethasone reduced deaths by one-third among ventilated patients and by one-fifth in other patients receiving oxygen. However, steroids are not recommended for patients with mild COVID-19 symptoms who do not require oxygen therapy.
When Are Steroids Contraindicated?
While steroids can be beneficial, their use is contraindicated in certain infectious diseases where immune suppression can exacerbate the condition. For example, in
uncontrolled sepsis without shock, steroids may worsen outcomes by suppressing the immune system's ability to fight the infection. Additionally, steroids should be used cautiously in viral infections like
herpes simplex virus and
varicella zoster virus, where they might prolong viral replication.
What Are the Risks of Steroid Use in Infectious Diseases?
The primary risk of using steroids in the context of infectious diseases is immunosuppression. This can lead to secondary infections, including bacterial, fungal, and viral infections. Prolonged steroid use can also result in side effects such as
hyperglycemia, osteoporosis, and adrenal suppression. Monitoring and managing these risks are crucial when prescribing steroids.
Can Steroids Be Used in Bacterial Meningitis?
In
bacterial meningitis, particularly in children and adults with pneumococcal meningitis, steroids are administered to decrease the inflammatory response in the subarachnoid space, thereby reducing neurological complications. Dexamethasone is typically given before or with the first dose of antibiotics to be effective.
What About Steroid Use in Tuberculosis?
In
tuberculous meningitis and pericarditis, steroids can play a role in improving outcomes. They help reduce the inflammatory response associated with these forms of tuberculosis, potentially decreasing mortality and morbidity. However, concomitant antitubercular therapy is essential to effectively treat the underlying infection.
How Do Steroids Affect Fungal Infections?
In the context of fungal infections, steroids can be a double-edged sword. While they may be used to control severe inflammatory responses, they can also predispose patients to invasive fungal infections, such as
aspergillosis. Careful consideration and often prophylactic antifungal therapy are warranted when using steroids in patients at risk for fungal infections.
Is There a Role for Steroids in Parasitic Infections?
Steroids can be beneficial in certain parasitic infections, such as
neurocysticercosis, where inflammation surrounding dying parasites can cause significant symptoms. In such cases, steroids are used to reduce neurological symptoms during antiparasitic treatment.
In conclusion, the use of steroids in infectious diseases requires careful consideration of the underlying infection, the patient's clinical status, and potential risks. While they can offer significant benefits in terms of reducing harmful inflammation, the immunosuppressive effects necessitate careful patient selection and monitoring.
