Description: steroids weaken the immune system. Due to this, they can cure a wide range of diseases. However, this means that the patient has a greater risk of being infected. In general, all types of infections (bacterial, viral, parasitic, fungal) are more frequently observed in patients treated with corticosteroids. Infections can reach all the organs (lungs, gastrointestinal tract, skin, etc) and can appear in many different ways. If you begin experiencing a fever during treatment, contact your physician immediately.

Frequency: there are a few studies on the frequency of infections in patients undergoing corticosteroid therapy. In 1989, one publication claimed that infections were observed in 12.7% of patients treated with corticosteroids versus 8% of patients that were not given the treatment. The risk appears to depend on the type of infection. For example, the risk of bacterial infections is slightly more (6.5% of patients exposed to corticosteroids versus 4.8% of patients not exposed) while the risk of rare infections (e.g. strongyloidiasis, aspergillosis) appears to be higher. However, a recent study showed that the risk of some common infections such as pneumonia was clearly increased in individuals exposed to corticosteroid therapy. Data on viral infections are discussed, but steroids seem to favour certain viral infections (e.g. shingles).

Subjects at risk: the risk of infection increases with the dose of cortisone. Doses that are less than 10-15 mg daily do not seem associated with a higher risk of infections. The elderly and those whit diabetes are also at increased risk. Biologically, a low plasma albumin level seems to be an important risk factor for infections in those prescribed systemic glucocorticoids.

Long versus short-term treatment: the risk of infection is higher from the earliest days of corticosteroid therapy. Patients treated for several days, as well as those treated for several weeks should be concerned.

Prevention/treatment: under certain conditions, preventative treatments may be prescribed (e.g. prevention of strongyloidiasis, vaccines). It should also treat any diseases that predispose the patient to infections before corticosteroids (e.g. dental infections). In addition, any infections observed during corticosteroid therapy should be quickly examined by a physician to ensure the proper next steps are taken.

Screening: before or during treatment with corticosteroids, a careful clinical examination to search for signs of infection needs to take place. If necessary, your physician will ask for additional examinations (e.g. chest X-ray) to be conduced.

Reversibility: the increased risk of infection stops upon discontinuation of treatment with steroids.

Good to know
  • Take your temperature if you feel unusually tired or you experience any unusual symptoms. In case of fever, call your doctor.
  • The appearance of uncommon symptoms (e.g. cough, diarrhea, stomach pain, a burning sensation during urination) should lead you to seek medical advice.
  • If you have any specific history of infection (e.g. tuberculosis during childhood) or if you have travelled or lived for several weeks in Asia or Africa, please inform your doctor.
  • Whenever possible, avoid contact with others suffering from infectious diseases such as chickenpox or flu.
Useful references
  • Ruyssen-Witrand A et al. Infections induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review. Joint Bone Spine. 2010
  • Stuck AE et al. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989
  • Jick SS et al. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum. 2006
  • Fardet L et al. Common infections in patients prescribed systemic glucocorticoids in primary care: a population-based cohort study. Plos Med. 2016