title: The effect of steroid use in hospitalized adults with respiratory syncytial virus-related illness.
abstract: BACKGROUND
  Systemic glucocorticosteroids (steroids) are commonly prescribed for patients with exacerbations of COPD during acute viral infections such as respiratory syncytial virus (RSV). The effects of short-term high-dose steroid treatment on viral load and adaptive immunity to RSV have not been examined in adults.
  
  
  OBJECTIVE
  The objectives of this study were to measure peak viral load and duration of viral shedding, serum and nasal cytokines, RSV-specific antibody response, and lymphocyte subsets in patients admitted to the hospital with RSV infection and to compare patients treated with steroids to patients untreated with steroids.
  
  
  METHODS
  Hospitalized adults who tested positive for RSV by reverse transcription-polymerase chain reaction (RT-PCR) on admission had respiratory samples collected for quantitative RT-PCR and cytokine analysis. Serum and nasal secretions were tested for RSV antibody and lymphocyte subsets were analyzed by flow cytometry at 2 days, 2 weeks, and 1 month.
  
  
  RESULTS
  Thirty-three of 50 (66%) patients hospitalized with RSV received systemic steroids for a mean duration of 11 days. Those who received steroids more frequently wheezed and were less often febrile. There were no serious adverse events related to steroids and no significant differences in peak viral load, duration of RSV shedding, nasal cytokines, or lymphocyte subsets in patients treated with steroids and patients untreated with steroids. Antibody responses to RSV were slightly blunted in the steroid-treated group.
  
  
  CONCLUSIONS
  Short courses of systemic steroids in patients hospitalized with RSV infection did not affect viral load or shedding. Humoral immunity may be mildly diminished, and thus potential benefits of systemic steroids must be balanced against potential risks.
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester General Hospital, Rochester, NY; Division of Pulmonary and Critical Care Medicine, Rochester General Hospital, Rochester, NY.
authors.forename: F Eun-Hyung
authors.initials: FE
authors.lastname: Lee
authors.affiliation: Division of Infectious Diseases, Rochester General Hospital, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester General Hospital, Rochester, NY; Department of Medicine, Rochester General Hospital, Rochester, NY.
authors.forename: Edward E
authors.initials: EE
authors.lastname: Walsh
authors.affiliation: Division of Infectious Diseases, Rochester General Hospital, Rochester, NY; University of Rochester School of Medicine and Dentistry, Rochester General Hospital, Rochester, NY; Department of Medicine, Rochester General Hospital, Rochester, NY. Electronic address: ann.falsey@rochestergeneral.org.
authors.forename: Ann R
authors.initials: AR
authors.lastname: Falsey
mesh_terms: D056704:Adaptive Immunity; D000368:Aged; D016207:Cytokines / Q000032:analysis; D005260:Female; D005434:Flow Cytometry; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007297:Inpatients; D008297:Male; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000276:immunology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018709:Statistics, Nonparametric; D016176:T-Lymphocyte Subsets / Q000276:immunology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D016207:Cytokines; D005938:Glucocorticoids; D007070:Immunoglobulin A; D007074:Immunoglobulin G