How Do Steroids Affect Immunity?
Steroids like prednisone, dexamethasone, and methylprednisolone are often prescribed to reduce inflammation and suppress overactive immune responses. But they come at a cost - steroids also lower the body's ability to fight infection.
Steroids affect the immune system in several ways:
- Reduce activity of white blood cells that fight infection
- Lower production of antibodies
- Inhibit cytokines that modulate immune response
- Decrease complement proteins that mark pathogens for destruction
- Induce lymphocyte cell death to reduce autoimmunity
This immunosuppression helps control inflammatory diseases, but leaves patients more vulnerable to illnesses and lengthier recovery when sick.
How Long Do the Effects Last?
The immune suppressing effects of steroids depend on the dose, length of treatment, and type of steroid used. In general:
- Immune function is impaired within hours of the first dose.
- Maximum immunosuppression is reached about 7-10 days into treatment.
- Immune suppression lasts for the entire duration of steroid use.
- Full immune recovery takes 7-14 days after stopping steroids.
Thus, the immune system remains compromised for the entire time steroids are being taken, plus about 1-2 weeks after discontinuing them.
Short Courses of Steroids
For short steroid courses like a 6-day methylprednisolone dose pack, immune function may start improving soon after stopping but still take 7-14 days to bounce back fully.
Long-Term Steroid Therapy
With long-term daily or alternate day steroid dosing, the immune system remains suppressed for months or years until the medication is tapered or ceased. This leaves patients chronically at higher infection risk.
Types of Infections
Due to impaired immunity, steroids raise the risk of all types of infections. However, some infections are of greater concern than others when taking steroids.
Bacterial Infections
Steroids blunt neutrophil bacterial killing. This leads to increased risk of bacteria like Staph and Strep causing skin, sinus, lung (pneumonia), bone, joint, and blood stream infections.
Viral Infections
Viruses like influenza, adenovirus, coronavirus, and reactivation of varicella-zoster (shingles) become more problematic due to suppressed viral immunity. Illness duration also increases.
Fungal Infections
Steroids impair cell-mediated antifungal immunity. This allows normally benign fungal colonizers like Candida to overgrow and cause oral thrush, vaginitis, and severe disseminated disease.
Parasitic Infections
Dormant parasitic infections like malaria and Strongyloides can reactivate with steroid treatment. Hyperinfection syndrome may occur when parasites spread unchecked through the body.
Mycobacterial Infections
Steroids reduce the ability to form granulomas that contain TB and other mycobacteria. Reactivation TB is a particular concern with steroid therapy.
Risk Factors
Certain conditions and factors further increase vulnerability to infections when taking steroids:
- Older age
- Diabetes mellitus
- Malnutrition
- Alcoholism
- Other immunosuppression
- Prolonged high dose steroids
Steps to prevent infection are especially important in these high-risk groups using steroids long-term.
Preventing Infection on Steroids
Measures to take when using steroids include:
- Get recommended vaccines like flu, pneumonia, shingles
- Practice good hygiene - handwashing, cover coughs
- Avoid sick contacts
- Use antimicrobial prophylaxis if necessary
- Treat infections promptly with antibiotics
- Monitor for symptoms of infection
- Carry a steroid warning card
Your doctor may adjust your steroid dose or type to provide the minimum effective amount during illness recovery. Never abruptly stop steroids without medical supervision.
Signs of Infection to Watch For
Contact your doctor if experiencing:
- Fever over 100.4°F
- Chills or sweating
- Sore throat
- Productive or persistent cough
- Nasal congestion
- Fatigue or weakness
- Body aches
- Nausea, vomiting, diarrhea
- Skin sores
- Pain with urination
Infections can quickly become serious in someone taking steroids. Prompt antibiotic treatment is key.
Conclusion
Steroids broadly suppress the body's immune defenses, leaving users more prone to infections starting soon after initial dosing. Immunity remains impaired for the entire duration of steroid therapy plus about 1-2 weeks after discontinuation. Knowing what to watch for and taking preventive measures can help minimize risks when using steroids.
FAQs
Are steroids safe to take during an active infection?
No, you should not start steroids if you currently have an active infection. Steroids impair your body's ability to fight infection and could make it worse. Infections need to be treated and resolved before starting steroids.
Can I get vaccines while taking steroids?
Yes, certain vaccines are recommended since steroids increase infection susceptibility. However, live vaccines like MMR and varicella should be avoided. Get flu, pneumonia, shingles, and other killed or inactivated vaccines instead.
How long should I wait to start steroids after an infection?
It is best to allow 1-2 weeks after an infection has fully resolved before starting steroids. This gives your immune system time to recover so it is not immediately suppressed again. Consult your doctor on appropriate timing.
Do topical steroids like creams also suppress immunity?
No, topical steroid creams and ointments only minimally impact immunity. Oral and intravenous steroids that distribute through the whole body are more likely to increase infection risk. However, long-term use of potent topical steroids could potentially have some effects.
What infections are of most concern with steroids?
Bacterial, viral, fungal, parasitic, and mycobacterial infections like TB are key concerns with steroids due to their mechanisms of immune suppression. Pneumonia, urinary tract infections, shingles, thrush, and reactivation of TB or malaria warrant prompt attention.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.
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