Pune: After the use of steroids for routine viral fevers and mild respiratory infections has grown among people, doctors in the city warned that it could increase the risk of serious post-viral fungal lung infections such as pulmonary aspergillosis.
Infectious disease specialists said the trend has become more noticeable in Dec 2025, coinciding with widespread viral infections ranging from common colds to flu-like illnesses.
Specialists said they were increasingly encountering cases of viral-associated pulmonary aspergillosis (VAPA), a condition where a fungal infection develops in the lungs days after an initial viral illness appears to resolve.
“We have certainly been seeing these cases more often in our clinical practice,” said Dr Sujata Rege, consultant – infectious diseases, Symbiosis University Hospital and Jupiter Hospital.
“Matter to worry is that a common thread of using early and unnecessary steroids for otherwise mild viral infections in many patients. Steroids are frequently prescribed – or even self-administered – to bring down fever or cough quickly, despite there being no indication in most viral respiratory illnesses. Steroids should not be used for simple viral fevers or routine respiratory infections. Their use is limited to very specific situations, such as patients requiring oxygen or ICU care,” Dr Rege said.
Pulmonary aspergillosis was earlier thought to occur mainly in diabetic or severely immune-compromised patients. However, doctors said they are now diagnosing the condition in patients with borderline blood sugar levels, asthma, chronic liver or lung disease and occasionally even in those who were otherwise healthy. During this winter, Dr Rege said she has treated around 10 patients with post-viral pulmonary aspergillosis, which is quite high.
Dr Ameet Dravid, infectious disease specialist, Noble Hospital, said, “Steroids are being rampantly misused. There is tremendous pressure on frontline doctors because of the high number of patients coming in with cold and fever, and patients themselves demand quick relief. To provide fast symptomatic relief, steroids are often prescribed within the first week of illness, which results in a disaster.”
He added, “When steroids are given early in a viral infection, the virus can run rampant, and at the same time, fungi like Aspergillus, which are often present in the respiratory tract, get an opportunity to cause pneumonia. This becomes even more dangerous in patients with diabetes or hypertension.”
Dr Dravid said there needs to be a very clear guideline that in viral infections, steroids should not be used at all and should be strictly reserved only for patients who develop serious respiratory complications. “For symptoms like runny nose, body ache or fever, which are self-limiting, steroids are simply not required,” he said.
Dr Piyush Chaudhary, infectious disease specialist, Jehangir Hospital, said, “I have seen nearly three to four pulmonary aspergillosis patients in less than a month and in almost all of them, there was a clear history of steroid use. Diabetes was also a factor in some cases, but the main trigger was steroid exposure. Post-Covid, diagnostic capacity for fungal infections has improved, so we are detecting these cases readily, which could be one contributing factor. However, steroid misuse remains the primary concern.”
He said this season, many patients with routine viral infections have had prolonged cough and upper respiratory tract symptoms lasting two to three weeks. “It has become common practice to prescribe short courses of steroids in such cases. If such a patient also has diabetes or is exposed to construction activity, where Aspergillus spores are more prevalent, it creates favourable conditions for developing fungal lung infections,” he added.
