Adrenal Cortical Hormones and Infection

Animal studies show that cortisone, hydrocortisone or the steroid prednisolone may lower the resistance of a variety of animal species to many infectious agents. The mechanisms by which large doses of these hormones alter host resistance to infection appear to be related to a decrease in the movement and phagocytic activity of polymorphonuclear leukocytes, suppression of antibody formation, and an alteration in the function of the reticulo-endothelial system. Antibiotics, in larger doses than usually employed, will control infectious diseases in cortisone- and hydrocortisone-treated animals and patients. Despite the results of animal studies, the reported incidence of intercurrent infections in humans treated with adrenal cortical hormones appears to be relatively low. Complicating infections may be kept at a minimum if careful histories and physical examinations are employed to detect patients with latent infection on arrested tuberculosis. Patients treated with adrenal cortical hormones should be followed carefully for signs of infection. If the latter is suspected, cortisone therapy should be gradually reduced, and vigorous antimicrobial treatment instituted as soon as diagnostic measures, including specimens for bacteriologic identification, are taken. The use of adrenal cortical hormones in the treatment of active infection is still under investigation and requires further study before final conclusions can be reached. However, the results to date are encouraging in Waterhouse-Friderichsen syndrome, tuberculous meningitis, and various other life-threatening and unusually severe infections. Hence the cautious and discriminate use of these hormones in certain severe infections would appear to be a helpful adjuvant to other therapy.