Steroids and risk of fungal infections
Pro Research Analysisby 
Searched over 200M research papers
Steroid Use and Increased Risk of Fungal Infections
Steroid therapy, both systemic and local, is strongly linked to an increased risk of fungal infections, especially in immunocompromised patients. This risk is seen across various clinical scenarios, including treatment for autoimmune diseases, post-transplant care, and management of severe infections like COVID-19 2347910.
Systemic Steroids and Invasive Fungal Infections
High cumulative doses of systemic steroids are associated with a significant rise in invasive fungal diseases. For example, patients treated for severe acute graft-versus-host disease (GVHD) with high-dose steroids had a 14% incidence of invasive fungal disease, and the risk increased with higher cumulative steroid doses . Similarly, in patients with systemic lupus erythematosus (SLE), steroid use nearly doubled the odds of developing fungal infections, with intravenous steroid therapy being the most critical risk factor for invasive fungal infections (IFIs) 710. These infections are often severe and can be fatal, with high mortality rates reported in SLE patients .
Steroid Use in COVID-19 and Fungal Outbreaks
The overuse of steroids during the COVID-19 pandemic has been directly linked to a surge in cases of mucormycosis (black fungus), particularly in countries like India. Steroid-induced immunosuppression, especially in patients with comorbidities such as diabetes, created an environment where opportunistic fungi could thrive, leading to life-threatening infections 49. Studies highlight the need for cautious steroid management in COVID-19 patients to prevent such secondary fungal infections 49.
Local Steroid Delivery and Fungal Risk
Even local steroid administration, such as intranasal corticosteroids or steroid-eluting stents, can increase the risk of fungal infections. In immunocompromised patients with hematologic malignancies or post-transplant status, intranasal corticosteroid use was associated with a significantly higher risk of invasive fungal sinusitis (IFS) . There are also rare reports of non-invasive fungal infections developing after the use of steroid-eluting stents in otherwise healthy individuals, likely due to local immunosuppression and tissue necrosis .
Combined Steroid and Antibiotic Therapy
The combination of steroids and antibiotics further increases the risk of invasive fungal infections. While antibiotics alone may lead to surface fungal proliferation, the addition of steroids can allow fungi to invade tissues, resulting in more severe infections .
Special Populations and Additional Risk Factors
Certain populations are at even higher risk when exposed to steroids. Hospitalized SLE patients, especially males and those with additional immunosuppressive conditions like HIV or hematologic malignancies, are particularly vulnerable to fungal infections when on steroid therapy 710. In patients receiving novel immunosuppressive drugs (e.g., ibrutinib), the risk of invasive fungal infections is further exacerbated when steroids are used concurrently .
Fungal Infections After Epidural Steroid Injections
Epidural steroid injections have also been associated with outbreaks of fungal meningitis, especially when compounded medications are contaminated. These incidents underscore the importance of strict safety protocols and vigilance in both medical and pharmaceutical practices to prevent such infections .
Conclusion
Steroid therapy—whether systemic, local, or in combination with other immunosuppressive treatments—significantly increases the risk of fungal infections, particularly in immunocompromised individuals. The risk is dose-dependent and is heightened by additional factors such as underlying diseases, comorbidities, and concurrent use of other immunosuppressive agents. Careful risk assessment, judicious use of steroids, and strict infection control measures are essential to minimize the occurrence of these potentially life-threatening infections 12345679+1 MORE.
Sources and full results
Most relevant research papers on this topic