Steroids and Viral Infections in Kids

Researchers have discovered the wheezing and steroids don't mix when it comes to children. Two studies show that steroids do not change the course of viral infections in children.

The researchers tested 700 children aged 10 months to 5 years old. The study showed that children stayed in hospital the same amount of time regardless if they had steroids or not from viral infections that caused wheezing.
At this time doctors treat wheezing from infections the same as they do in asthmatic children.
The study also showed that steroids didn't change the symptoms over the following seven days.

A second study compared the use of steroids and a placebo in 129 children aged 1 to 6. The children were given one of the two at the first sign of nasal congestion, sore throat or any other symptom that might show an upper respiratory tract infection was coming on. The children received the treatment for up to 10 days twice daily. The drug seemed to help.
Eighteen percent of the children in the placebo group had to have additional steroid drugs. The children that had used steroids needing the additional medication was at eight percent.
The children using steroids grew less though than the ones in the placebo group.

Steroids to Treat Arthritis

Steroids  are synthetic drugs that closely resemble cortisol, a hormone that your body produces naturally. Steroids work by decreasing inflammation and reducing the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions.

Corticosteroids are different from anabolic steroids, which some athletes use to build bigger muscles. Examples of corticosteroid medications include triamcinolone, cortisone, prednisone, and methylprednisolone.
How Are Steroids Given?

Steroids can be given topically (cream or ointment), by mouth (orally), or by injection. When injected, they can be given into a vein or muscle, directly into a joint or bursa (lubricating sac between certain tendons and the bones beneath them) or around tendons and other soft tissue areas.
How Do Steroids Work?

Steroids decrease inflammation and reduce the activity of the immune system. Inflammation is a process by which the body's white blood cells and chemicals protect the body against infection and foreign organisms such as bacteria and viruses.

In certain diseases, however, the body's defense system (immune system) doesn't function properly and is overactive. This may cause inflammation to work against the body's own tissues and cause tissue damage. Inflammation is characterized by redness, warmth, swelling and pain.

Steroids reduce the production of inflammatory chemicals in order to minimize tissue damage. Steroids also reduce the activity of the immune system by affecting the function of white blood cells.
What Conditions Are Treated With Steroids?

Steroids are used to treat a variety of conditions in which the body's defense system malfunctions and causes tissue damage. Steroids are used as the main treatment for certain inflammatory conditions, such as systemic vasculitis (inflammation of blood vessels) and myositis (inflammation of muscle). They may also be used selectively to treat inflammatory conditions such as rheumatoid arthritis, lupus, Sjögren's syndrome, or gout.
What Are the Benefits of Steroids?

When inflammation threatens to damage critical body organs, steroids can be organ saving and, in many instances, life-saving. For example, they may help prevent the progression of kidney inflammation, which can lead to kidney failure in people who have lupus or vasculitis. For these people, steroid therapy may eliminate the need for kidney dialysis or transplant.

Low doses of steroids may provide significant relief from pain and stiffness for people with conditions including rheumatoid arthritis. Temporary use of higher doses of steroids may help a person recover from a severe flare-up of arthritis.

How Do I Know If Steroid Treatment Is Right for Me?

The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, your overall health, and other drugs you are taking. Your doctor also will make sure you understand the potential benefits and risks of steroids before you start taking them. 

Management of HIV in Pregnancy

HIV infection in young children most commonly arises as a result of mother-to-child transmission (MTCT). It is thought that only 1.5-2% of MTCT occurs transplacentally during pregnancy. The vast majority occurs due to maternofetal transmission of blood during parturition or postnatal breast-feeding.

All pregnant women are recommended screening for HIV infection, syphilis, hepatitis B and rubella in every pregnancy at their booking antenatal visit. If a woman declines an HIV test, this should be documented in the maternity notes, her reasons should be sensitively explored and screening offered again at around 28 weeks.

A negative maternal HIV test at booking does not preclude neonatal infection - maternal infection and seroconversion can occur at any time during pregnancy and lactation. This is well-documented in countries with a high prevalence of HIV and has been seen in the UK.

Risk of mother-to-child transmission (MTCT)

This is increased with:

    Higher levels of maternal viraemia.
    HIV core antigens.
    Lower maternal CD4 count.
    Primary HIV Infection occurring during pregnancy.
    Chorioamnionitis.
    Co-existing other sexually transmitted disease (and malaria - possibly).
    Invasive intrapartum procedures, eg fetal scalp electrodes, forceps, ventouse.
    Rupture of membranes (especially if delivery is more than 4 hours after the membranes ruptured).
    Vaginal delivery.
    Preterm birth
    Female babies more likely to be infected early (transplacental/perinatal routes).
    Advanced maternal age.
    The firstborn of twins (born to an HIV-infected mother).

Factors that decrease risk of transmission are:

    Higher levels of neutralising HIV antibody.
    Elective Caesarean section.
    Zidovudine (ZDV)
    Less invasive monitoring and intrapartum procedures.

Management

Mother-to-child transmission (MTCT) of HIV infection can be greatly reduced through early diagnosis of maternal HIV infection.

    Pregnant women should be offered screening for HIV early in pregnancy because appropriate antenatal interventions can reduce MTCT of HIV infection.
    Interventions to reduce MTCT of HIV during the antenatal period include antiretroviral therapy, elective Caesarean section delivery and avoidance of breast-feeding after delivery.
    These interventions can reduce the risk of mother-to child HIV transmission from 25-30% to less than 1%.
    All pregnant women who are HIV-positive should be screened and appropriately treated for genital infections during pregnancy. This should be done as early as possible in pregnancy and repeated at about 28 weeks.
    Presentation with symptoms or signs of pre-eclampsia, cholestasis or other signs of liver dysfunction during pregnancy may indicate drug toxicity, and early liaison with HIV physicians is essential.

Drug therapy

Women who require HIV treatment for their own health should take highly active antiretroviral therapy (HAART) and continue treatment postpartum. They may also require prophylaxis against pneumocystic pneumonia (PCP), depending on their CD4 lymphocyte count.

Women already taking HAART and/or PCP prophylaxis before pregnancy should not discontinue their medication.

    Antiretroviral therapy is given to prevent MTCT and to prevent maternal disease progression. The optimal regimen is determined on a case-by-case basis.
    Zidovudine (ZDV) is indicated for use in pregnancy for prevention of MTCT of HIV but single-agent ZDV therapy which does not suppress plasma viraemia to undetectable levels may allow the emergence of resistant virus.
    Potent combinations of three or more antiretroviral drugs (HAART) have now become the standard of care. Women with advanced HIV should be treated with a HAART regimen. The start of treatment should be deferred until after the first trimester, if possible, and should be continued after delivery.
    For women who do not require HIV treatment for their own health, HAART should be initiated between 20 and 28 weeks and discontinued at delivery. If they have a plasma viral load of less than 10,000 copies/ml and are prepared to be delivered by elective Caesarean section, an acceptable alternative is ZDV monotherapy initiated between 20 and 28 weeks, given orally, 250 mg twice daily, and intravenously started four hours before beginning the Caesarean section, continuing until the umbilical cord has been clamped. ZDV is usually administered orally to the neonate for four to six weeks.
    Combination antiretroviral therapy maximises the chance of preventing transmission and represents optimal therapy for the mother but may increase the risk of drug toxicity to the fetus.
    The use of antiretrovirals to reduce MTCT has resulted in resistant mutations and, in the Paediatric AIDS Clinical Trials Group Protocol, 15% of the women developed nevirapine-resistant mutations by 6 weeks' postpartum.

In sub-Saharan Africa, access to services is improving. In 2008, 45% of HIV-infected pregnant women received antiretroviral treatment compared with 9% in 2004. 

Prevention of Viral Diseases

   Viral diseases are among those which spread from one person to another. Illness develops when a virus enters the body, invades healthy cells and replicates itself. At times, a virus can mutate itself during the replication process, making it more difficult for the body to fight. Viruses depend on other living organisms to survive and are hard to remove once in the body. Few medications fight viruses, making the body's immune system the best protection against infection.

    Viruses range in severity, making some life threatening conditions. Viruses have several groups in which they are categorized based on shape, behaviors and other common characteristics. For instance, the picornaviruses group includes the rhino-viruses which cause the common cold, or the papovaviruses which includes the papilloma virus known to women as HPV. More serious viruses such as HIV and Hepatitis C fall into groups of viruses known to generate their own DNA, enabling them to replicate themselves repeatedly within the body.

    Transmission
    Viruses are transmitted from one person to another through touching, breathing, bites and contact with body fluids (saliva, blood, semen or excrement). The most common form of transmission is by inhaling droplets of a virus in the air you breathe. Shared objects such as spoons, cups, door knobs and pencils that have been exposed can carry droplets of a virus from person to person. Insects and animals can transmit viruses by biting a human or another animal.
    Direct contact with body fluids can cause virus transmission, but only when certain conditions are met. Direct contact requires a significant amount of body fluid to be present, the person to have direct contact with the fluid, have a point of entry for the virus to enter into the body (cuts, scrapes, eyes, mouth) and be susceptible to the virus.

    Effects
    Viruses cause illness and discomfort for the sufferer, many of them are often temporary and usually non-life threatening. Effects of viruses can include symptoms such as dehydration, nausea, vomiting, high fever and weakness. Viruses such as Influenza cannot be cured with medication, but their effects can be kept under control until it finally disappears.
    Viruses, such as strains of Hepatitis, HIV and herpes, do not disappear. Their effects are felt throughout a lifetime for the person infected, sometimes resulting in death.

    Prevention
    Following simple steps can greatly reduce the risk of contracting a virus. Use bandages to cover scrapes, cuts or open sores at all times. Do not eat, drink, touch your mouth, nose or eyes before washing your hands and avoid handling pens, pencils or other items that belong to others. Never drink from someone else's beverage containers or eat from another persons soiled utensils. Frequent hand washing is highly recommended with soap and warm running water or an alcohol based sanitizing hand gel.

    Cleaning
    Bleach based products are extremely effective in killing 99.9% of germs and viruses in, and around, the home. If the cost of bleach based cleansers is an issue, 1 1/2 cups of chlorine bleach to a gallon of fresh water will clean with the same effectiveness. You may add a few drops of dish detergent to the mixture for a soapy consistency.
    Regular cleaning is recommended for door handles, bathroom sinks, toilets and toothbrush holders in an effort to reduce the chances of contracting a strain of flu or the common cold.