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WEDNESDAY, Oct. 20 (HealthDayNews) -- A steroid that's used to treat ailments ranging from arthritis to cancer can also increase the survival odds of tuberculosis patients by 30 percent.

However, treatment with the drug, dexamethasone, doesn't appear to reduce the risk of severe disability resulting from the infection, reports a study in the Oct. 21 issue of the New England Journal of Medicine.

"This trial suggests that adults with tuberculosis meningitis should be given dexamethasone at the earliest opportunity," said one of the study's authors, Guy Thwaites, a research fellow at Oxford University in England. "Dexamethasone should not be reserved for those with more severe disease as previously suggested, but given to all."

Tuberculosis is a serious bacterial infection that can be fatal. Nearly 9 million people worldwide develop tuberculosis every year, and almost 2 million die annually from the disease, according to the World Health Organization.

Tuberculosis often affects the lungs, and one of the most common symptoms of the disease is a cough. However, the tuberculosis bacterium can affect many parts of the body. A serious complication of the disease is tuberculosis meningitis, which is a swelling of the membranes of the brain caused by the tuberculosis bacterium.

"Death or severe neurologic impairment is the outcome in most patients [with tuberculosis meningitis], despite antituberculosis therapy," Dr. Vincent Quagliarello, a professor of medicine at Yale University, wrote in an accompanying editorial in the same issue of the journal.

Medications to treat tuberculosis are available, but they must be taken for long periods of time -- as long as six months or more. And, as Quagliarello pointed out, these medications are not always effective.

Previous studies on the use of steroids in conjunction with anti-tuberculosis medicines were too small to be conclusive, according to the Thwaites study.

For the current study, 545 people with tuberculosis meningitis were randomly assigned to receive either dexamethasone or a placebo. All were older than 14 and lived in Vietnam.

Disability was assessed through questionnaires that asked whether the study participants needed help performing everyday activities, such as eating, washing, or using the toilet. If they couldn't perform such tasks on their own, they were considered severely disabled.

Treatment with dexamethasone lowered the risk of death by 31 percent, according to the study.

Thwaites said exactly how dexamethasone reduces mortality is unclear. "It has long been assumed that its beneficial effect is due to its anti-inflammatory properties, but evidence for this has been very difficult to obtain," he said.

Nearly 14 percent of the people in the placebo group reported being severely disabled, while just over 18 percent in the dexamethasone group did.

Quagliarello said he suspects one of the reasons why steroid treatment didn't appear to reduce disability may be due to the study design.

He said that using steroids always has some risks, and that the medication has the potential to suppress the immune system, but added that the "benefits here outweigh the risks."

More information

To learn more about tuberculosis, visit the U.S. Centers for Disease Control and Prevention.

(SOURCES: Guy Thwaites, M.R.C.P., research fellow, Oxford University Clinical Research Unit, England; Vincent Quagliarello, M.D., professor of medicine, Yale University, New Haven, Conn.; Oct. 21, 2004, New England Journal of Medicine)

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