Glucocorticoids and invasive fungal infections

Since the 1990s, opportunistic fungal infections have emerged as a substantial cause of morbidity and mortality in profoundly immunocompromised patients. Hypercortisolaemic patients, both those with endogenous Cushing's syndrome and, much more frequently, those receiving exogenous glucocorticoi...

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Bibliographic Details
Published in:The Lancet (British edition) 2003-11, Vol.362 (9398), p.1828-1838
Main Authors: Lionakis, Michail S, Kontoyiannis, Dimitrios P
Format: Article
Language:English
Subjects:
Adrenocortical Hyperfunction - blood
Adrenocortical Hyperfunction - chemically induced
Adrenocortical Hyperfunction - complications
Antibody Formation - drug effects
Biological and medical sciences
Cushing Syndrome - drug therapy
Fungi
Glucocorticoids - adverse effects
Glucocorticoids - therapeutic use
Humans
Hydrocortisone - adverse effects
Hydrocortisone - blood
Immunity (Disease)
Immunomodulators
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Infections
Kidney transplantation
Lymphocytes
Medical sciences
Medical treatment
Mycoses - chemically induced
Mycoses - immunology
Opportunistic Infections - chemically induced
Opportunistic Infections - drug therapy
Opportunistic Infections - immunology
Pharmacology. Drug treatments
Prophylaxis
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Summary:Since the 1990s, opportunistic fungal infections have emerged as a substantial cause of morbidity and mortality in profoundly immunocompromised patients. Hypercortisolaemic patients, both those with endogenous Cushing's syndrome and, much more frequently, those receiving exogenous glucocorticoid therapy, are especially at risk of such infections. This vulnerability is attributed to the complex dysregulation of immunity caused by glucocorticoids. We critically review the spectrum and presentation of invasive fungal infections that arise in the setting of hypercortisolism, and the ways in which glucocorticoids contribute to their pathogenesis. A better knowledge of the interplay between glucocorticoid-induced immunosuppression and invasive fungal infections should assist in earlier recognition and treatment of such infections. Efforts to decrease the intensity of glucocorticoid therapy should help to improve outcomes of opportunistic fungal infections.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(03)14904-5