ADRENOCORTICAL STEROIDS IN THE MANAGEMENT OF SELECTED PATIENTS WITH INFECTIOUS DISEASES

Abstract

Adrenal cortical steroids and adrenocorticotropin (ACTH) were evaluated in 81 selected patients treated between 1950 and 1959 at the University of Minnesota Medical Center. This included an analysis of 2 main groups of patients managed in this manner first, patients with an infection and peripheral vascular collapse, and second, patients suffering from the ill effects of inflammation due to infections or to drugs. Studies were made of 38 patients who had acute bacterial shock, 25 of whom had vascular collapse due to gram-negative endotoxin. Although the mortality rate in the 38 patients was 60%, large doses of steroid did contribute to the recovery of certain patients. It is recommended that 500 to 100 mg of hydrocortisone be administered intravenously within the first 24 hours. Subsequent therapy with hydro-cortisone or one of the analogues can often be confined to smaller closes given orally, and for a period of only a few days. The clinical observations have been substantiated by studies on experimental endo-toxin shock in the laboratory. Inflammation occurring during the course of an infectious disease can be highly deleterious when certain tissues are involved, such as those of the heart and central nervous system. Steroid therapy has been effective in selected cases of tuberculosis, brucellosis, infectious mononucleosis, the complications of mumps, which include orchitis, purpura and encephalomenin-gitis, acute rheumatic fever, hepatitis, trichinosis, and severe drug reactions, especially those due to penicillin. The basic philosophy underlying the selective use of steroids in this medical center is the administration of large doses of adrenal cortical steroid to seriously ill patients for a brief period of time. No undesirable side-effects have been observed when these criteria have been followed. The benefits have far outweighed the possible hazards.