Bacterial infection corticosteroids

Frequendy, the treatment of helminthic diseases requites adjunct medication. Allergic reactions are commonly seen as a result of tissue invasion by worms or as a consequence of anthelmintic therapy. Antihistamines and corticosteroids may be necessary adjuncts to therapy. Anemia, indigestion, and secondary bacterial infections can also occur and may requite concomitant therapy with hematopoietic drugs and appropriate antibiotics. 

Neutrophil Segs 40%-60% Bands 3%-5% Phagocytic Leukocytosis Bacterial infections Fungal infections Physiologic stress Tissue injury (e.g. myocardial Infarction) Medications (e.g. corticosteroids) Leukopenia Long-standing infection Cancer Medications (e.g., chemotherapy)... 

Nephrotic patients (especially children) are prone to bacterial infections. Before antibiotics and corticosteroids were introduced into the therapy, pneumonia, peritonitis, and sepsis (usually caused by pneumococci) were the most frequent cause of death of nephrotic children with minimal change disease. Infections are more frequent in nephrotic children and after the age of 20 their prevalence markedly decreases because the majority of adults have antibodies against the capsular antigens of pneumococci. Infections remain an important complication of nephrotic syndrome in developing countries. In developed countries, nephrotic patients treated by immunosuppressive agents may frequently suffer from viral infections (mainly herpesvirus infections, e.g., cytomegalovirus and Epstein-Barr virus infections). 

The factors contributing to this changing pattern of hospital-acquired bacterial infections are varied, but the extensive use of broad-spectrum antibiotics, corticosteroids and immunosuppressive and cytotoxic drugs... 

The normal adrenal cortex responds to severe stress by secreting more than 300 mg/day of cortisol. Intercurrent illness is stress and treatment is urgent, particularly of infections the dose of corticosteroid should be doubled during the illness and gradually reduced as the patient improves. Effective chemotherapy of bacterial infections is specially important. 

Oral corticosteroids have also been used to treat the inflammatory process occurring in the lungs of CF patients. Antibiotics that are administered to treat bacterial infections include aerosolized gentamicin and tobramycine. These antibiotics are most effective against P. aeruginosa and S. aureus infections that occur in the CF patients. 

Antibiotic therapy is generally only indicated for cases of secondary bacterial infection following primary viral pneumonia, especially in the case of late-onset pneumonia. Corticosteroids should not be used routinely, but may be considered for septic shock with demonstrable adrenal insufficiency. 

The risk of exacerbation of viral and bacterial infections after topical and periocular corticosteroid administration has been further emphasized (107 , 108 ). 

Other bacterial infections The mechanisms whereby corticosteroids may lower resistance to bacterial infections have been discussed (46, 118, 26 =). Corticosteroids lower serum IgG (22 ). 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Topical corticosteroids are employed in some cases of bacterial keratitis. The suppression of inflammation may reduce corneal scarring. However, local immunosuppression, increased ocular pressure, and reappearance of the infection are disadvantages to their use. There is no conclusive evidence that they alter clinical outcomes. If the patient is already on topical corticosteroids when the keratitis occurs, discontinue use until the infection is eliminated.19... 

Infections Localized fungal infections with Candida albicans or Aspergillus niger have occurred in the mouth, pharynx, and occasionally in the larynx. The incidence of clinically apparent infection is low, and may require treatment with appropriate antifungal therapy or discontinuance of aerosol steroid treatment. Use inhaled corticosteroids with caution, if at all, in patients with active or quiescent tuberculous infection of the respiratory tract, untreated systemic fungal, bacterial, parasitic or... 

Serious adverse events occur in up to 6% of patients with anti-TNF therapy. The most important adverse effect of these drugs is infection due to suppression of the ThI inflammatory response. This may lead to serious infections such as bacterial sepsis, tuberculosis, invasive fungal organisms, reactivation of hepatitis B, listeriosis, and other opportunistic infections. Reactivation of latent tuberculosis, with dissemination, has occurred. Before administering anti-TNF therapy, all patients must undergo purified protein derivative (PPD) testing prophylactic therapy for tuberculosis is warranted for patients with positive test results. More common but usually less serious infections include upper respiratory infections (sinusitis, bronchitis, and pneumonia) and cellulitis. The risk of serious infections is increased markedly in patients taking concomitant corticosteroids. 

Blood-brain barrier Treatment of central nervous system infections, such as meningitis, depends on the ability of a drug to penetrate into the cerebrospinal fluid (CSF). The blood-brain barrier (see p. 8) ordinarily excludes many antibiotics. However, inflammation facilitates penetration and allows sufficient levels of many (but not all) antibiotics to enter the CSF. [Note For cure of meningitis, it is important that a bactericidal rather than a bacteriostatic effect is achieved in the CSF. Yet, this is not without its problems, since rapid bacteriolysis in the infected CSF will liberate high concentrations of bacterial cell walls and lipopolysaccharide that can exacerbate the inflammation. This has led to the use of adjunctive (simultaneous administration of) corticosteroids, which diminish the inflammatory process and neurologic sequelae.]... 

Impaired immune responses render the subject more liable to bacterial and viral infections. Treat all infection early and vigorously (using bactericidal drugs where practicable) use human gamma globulin to protect if there is exposure to virus infections, e.g. measles, varicella. For example, patients who have not had chickenpox and are receiving therapeutic (as opposed to replacement) doses of corticosteroid are at risk of severe chickenpox they should receive varicella-zoster immunoglobulin if there has been contact with the disease within the previous 3 months. 

The main adverse effect of pimecrolimus is local skin irritation, with a stinging or burning sensation, which occurs in 30% of patients. Typically, children have less skin irritation than adults. Adverse effects such as local immunosuppression and an increased risk of local bacterial and viral infections (notably eczema herpeticum) are less common than with topical glucocorticoids (5). In addition, there is a lack of skin atrophy (6,7). However, topical corticosteroids have the advantage of better skin penetration than pimecrolimus and will therefore continue to be used for more heavily keratinized skin such as in psoriasis (8). 

Diarrhoea is also part of some inflammatory disorders, such as irritable bowel syndrome, ulcerative colitis and Crohn s disease. These may best be relieved by treatment with corticosteroids and aminosalicylates. Diarrhoea is commonly associated with bacterial or other pathogenic infections (e.g. food poisoning) and these may require treatment with antibiotics or other antimicrobials. 

---