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Medications that Weaken Your Immune System and Fungal Infections

Man pouring pills into his hand.Overall, most serious fungal infections are rare, but they do happen. They are most common among people with weak immune systems. People with certain health conditions may need to take medications with side effects that can weaken your immune system and put you at risk for fungal infections.

Specifically, corticosteroids and TNF (tumor necrosis factor) inhibitors are two types of medications that can increase your chances of getting a fungal infection.1

Some fungal infections can be serious, such as:

Other fungal infections, such as oral candidiasis (thrush), are usually not life threatening.11

 

What you need to know about fungal infections

Fungal infections can range from mild to life-threatening. Some fungal infections are mild skin rashes, but others can have serious complications. Because of this, it’s important for you to seek treatment as soon as possible to avoid serious infection.

Fungal infections can look like bacterial or viral infections. If you’re taking medicine to fight an infection and you aren’t getting better, ask your doctor about testing you for a fungal infection.

Where you live (geography) matters. Some disease-causing fungi are more common in certain parts of the world. If you live in or visit these areas and are taking medications that weaken the immune system, you’re more likely to get these infections than the general population. 7,8,12 For more information on travel-related illnesses, please see the CDC Traveler’s Health site.

The length of your treatment matters. Your healthcare provider can prescribe corticosteroids for short-term use (days to weeks) or long-term use (weeks to months). Long-term corticosteroid use is more likely to increase your chance of getting a fungal infection.

Amount of medication (dose). Higher doses of medications that weaken your immune system are more likely to increase your risk of getting a fungal infection.5,11,13,14

Click on the sections below to see lists of corticosteroids and TNF inhibitors that can increase the chances of getting a fungal infection.

Medications that can increase the chances of getting a fungal infection

Oral Corticosteroids

Corticosteroids taken by mouth can increase your chance of getting a serious fungal infection. Oral corticosteroids include the following:

  • Budesonide (Entocort EC)
  • Cortisone (Cortone)
  • Dexamethasone (Decadron)
  • Hydrocortisone (Cortef)
  • Methylprednisolone (Medrol)
  • Prednisolone (Prelone)
  • Prednisone (Deltasone)
  • Triamcinolone

Inhaled Corticosteroids

Inhaled corticosteroids used to treat asthma can increase your chance of developing oral candidiasis (thrush). Inhaled corticosteroids include the following:

  • Beclomethasone (QVAR®)
  • Budesonide (Pulmicort®, Symbicort®*)
  • Ciclesonide (Alvesco®)
  • Flunisolide (AeroBid®)
  • Fluticasone (Flovent®, Advair®*)
  • Mometasone (Asmanex Twisthaler®, Dulera®*)
  • Triamcinolone (Azmacort®)

*a combination medication that also includes a bronchodilator

TNF Inhibitors

TNF inhibitors can increase your chance of getting a serious fungal infection, particularly histoplasmosis. TNF inhibitors include the following:

  • Adalimumab (Humira®)
  • Certolizumab pegol (Cimzia®)
  • Etanercept (Enbrel®)
  • Golimumab (Simponi®)
  • Infliximab (Remicade®)

Preventing fungal infections while taking corticosteroids or TNF inhibitors

Fungi are difficult to avoid because they are a natural part of the environment. Fungi live outdoors in soil, on plants, trees, and other vegetation. They are also on many indoor surfaces and on your skin. However, there may be some ways for you to lower your chances of getting a serious fungal infection.  

Learn about fungal infections. There are different types of fungal infections. Learning about them can help you and your healthcare provider recognize the symptoms early, which may prevent serious illness.

Get additional medical care if necessary. Fungal infections often resemble other illnesses. Visiting your healthcare provider may help with faster diagnosis and may prevent serious illness.

Protect yourself from the environment. While using these medications, there may be some ways to lower your chances of getting a serious fungal infection by trying to avoid disease-causing fungi in the environment.15,16 It’s important to note that although these actions are recommended, they have not been proven to prevent fungal infections.

  • Try to avoid areas with a lot of dust like construction or excavation sites.
  • Stay inside during dust storms.
  • Stay away from areas with bird and bat droppings. This includes places like chicken coops and caves.
  • Wear gloves when handling materials such as soil, moss, or manure.
  • Wear shoes, long pants, and a long-sleeved shirt when doing outdoor activities such as gardening, yard work, or visiting wooded areas.

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References

  1. Ali T, Kaitha S, Mahmood S, Ftesi A, Stone J, Bronze MS. Clinical use of anti-TNF therapy and increased risk of infections. Drug, healthcare and patient safety 2013;5:79-99.
  2. Bergstrom L, Yocum DE, Ampel NM, et al. Increased risk of coccidioidomycosis in patients treated with tumor necrosis factor alpha antagonists. Arthritis Rheum 2004;50:1959-66.
  3. Mertz LE, Blair JE. Coccidioidomycosis in rheumatology patients: incidence and potential risk factors. Annals of the New York Academy of Sciences 2007;1111:343-57.
  4. Bernard C, Maucort-Boulch D, Varron L, et al. Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases. QJM : monthly journal of the Association of Physicians 2013.
  5. Chen GL, Chen Y, Zhu CQ, Yang CD, Ye S. Invasive fungal infection in Chinese patients with systemic lupus erythematosus. Clinical rheumatology 2012;31:1087-91.
  6. MacDougall L, Fyfe M, Romney M, Starr M, Galanis E. Risk factors for Cryptococcus gattii infection, British Columbia, Canada. Emerg Infect Dis 2011;17:193-9.
  7. Arnold TM, Sears CR, Hage CA. Invasive fungal infections in the era of biologics. Clinics in chest medicine 2009;30:279-86, vi.
  8. Smith JA, Kauffman CA. Endemic fungal infections in patients receiving tumour necrosis factor-alpha inhibitor therapy. Drugs 2009;69:1403-15.
  9. Mekinian A, Durand-Joly I, Hatron PY, et al. Pneumocystis jirovecii colonization in patients with systemic autoimmune diseases: prevalence, risk factors of colonization and outcome. Rheumatology 2011;50:569-77.
  10. Mori S, Sugimoto M. Pneumocystis jirovecii infection: an emerging threat to patients with rheumatoid arthritis. Rheumatology 2012;51:2120-30.
  11. Kennedy WA, Laurier C, Gautrin D, et al. Occurrence and risk factors of oral candidiasis treated with oral antifungals in seniors using inhaled steroids. Journal of clinical epidemiology 2000;53:696-701.
  12. Lortholary O, Charlier C, Lebeaux D, Lecuit M, Consigny PH. Fungal infections in immunocompromised travelers. Clinical Infectious Diseases 2013;56:861-9.
  13. Herbrecht R, Bories P, Moulin J-C, Ledoux M-P, Letscher-Bru V. Risk stratification for invasive aspergillosis in immunocompromised patients. Annals of the New York Academy of Sciences 2012;1272:23-30.
  14. Stuck AE, Minder CE, Frey FJ. Risk of Infectious Complications in Patients Taking Glucocorticosteroids. Review of Infectious Diseases 1989;11:954-63.
  15. Avery RK, Michaels MG, Practice ASTIDCo. Strategies for safe living after solid organ transplantation. American Journal of Transplantation 2013;13 Suppl 4:304-10.
  16. CDC. Guidelines for Preventing Opportunistic Infections Among Hematopoietic Stem Cell Transplant Recipients. MMWR 2000;49:1-128.

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