Are there times when your body over-does it in the killing germs department? There’s a new argument that we should, in addition to treatment, be suppressing the human response to mega-infections by giving immune-suppressing drugs (specifically steroids). These studies run counter to the argument that our bodies know what’s best (and don’t tend to overdo things if left to its own - treated - devices). This approach (treatment plus suppression) has been a cornerstone of therapy for very few diseases (AIDS-related pneumocystis pneumonia was one of the first), but in the circumstances where its been done, it’s saved a lot of lives. This review looked at studies where immune-suppression showed a benefit in infection. So what diseases are we talking about?

Here’s the summary; but keep in mind - “all patients also received active antimicrobial agents in addition to placebo or corticosteroids. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to severe hypoxemia, treatment with corticosteroids improved patient survival (group 1 infections). For patients with bacterial arthritis, corticosteroids were also beneficial and reduced long-term disability (group 2 infections). For about a dozen other infections, corticosteroids significantly relieved symptoms (group 3 infections), and clinicians should consider using them if symptoms are substantial. Corticosteroids were harmful in 2 infections, viral hepatitis and cerebral malaria (group 5 infections). We conclude that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.”

Wow. In my book, that’s a lot of human-body overeager germ assaults. Another interesting facet of this review is that the benefits that were identified were in diseases that are pretty unusual - maybe the human body’s scorch and burn approach to germs doesn’t work so well with atypical infections. The authors ought to be commended for keeping a wide-ranging and complicated topic clear and focussed. And, for those of us who are skeptical about “new” uses for drugs, keep in mind that steroids are not big profit items- so there’s not as much of a benefit for pushing them now.

Take home message: if you or a loved one is very ill with an atypical infection (the ones reviewed), ask your doctor about the possible benefits of immune suppression with treatment, even if suppressing the fight against germs seems counter-intuitive. Definitely something to mull over…