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Multiple sclerosis and antecedent infections: a case-control study
R A Marrie1, C Wolfson, M C Sturkenboom
1Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
Objectives:
To determine whether there is an excess of respiratory tract infections in the 5-week, 3-month, and 12-month periods before MS symptom onset and if there is an association between MS and a history of infectious mononucleosis (IM).
Background:
The etiology of MS remains unknown, but infection is frequently suggested as a putative etiologic agent. Epidemiologic studies have produced inconsistent evidence for an etiologic role of respiratory tract infections (RTI) and IM in MS.
Methods:
The authors performed a case-control study using the General Practice Research Database from the United Kingdom. There were 225 subjects with definite or probable MS, and 900 controls matched for age, sex, and physician practice. Using computerized patient records, the authors compared the mean rates of RTI per patient in the 5-week, 3-month, and 12-month periods before the date of onset of the first symptoms compatible with MS (index date). They also compared histories of IM.
Results:
In all periods, an increased frequency of RTI was associated with a significantly increased risk of MS. A history of IM was associated with greater than five times the risk of MS (OR = 5.5 [95% CI 1.5 to 19.7]).
Conclusions:
These results support an association between a history of IM and subsequent MS. Respiratory tract infections may precipitate disease onset.
Insights
A history of infectious mononucleosis (IM) significantly increases the risk of developing multiple sclerosis (MS). Respiratory tract infections (RTI) may also precede MS onset, suggesting infections play a role in MS etiology.
Area of Science:
- Neurology
- Epidemiology
- Infectious Diseases
Background:
- The exact cause of multiple sclerosis (MS) is unknown.
- Infections are suspected as potential triggers for MS.
- Previous studies on respiratory tract infections (RTI) and infectious mononucleosis (IM) in MS have yielded conflicting results.
Purpose of the Study:
- To investigate if respiratory tract infections (RTI) are more common before MS onset.
- To determine the association between a history of infectious mononucleosis (IM) and the risk of developing MS.
Main Methods:
- A case-control study was conducted using the UK General Practice Research Database.
- 225 MS patients and 900 matched controls were analyzed.
- Computerized records were used to compare RTI rates and IM history before the MS index date.
Main Results:
- An increased frequency of RTI was linked to a higher risk of MS across all studied periods.
- Individuals with a history of IM had over five times the risk of developing MS (OR = 5.5).
Conclusions:
- A history of infectious mononucleosis (IM) is associated with an increased risk of subsequent multiple sclerosis (MS).
- Respiratory tract infections (RTI) might act as a trigger for MS disease onset.