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Multiple sclerosis and antecedent infections

A case-control study

From Montreal Neurological Institute (Dr. Marrie) and the Department of Epidemiology and Biostatistics (Drs. Wolfson and Abenhaim), McGill University, Montreal; Centre for Clinical Epidemiology and Community Studies (Drs. Wolfson and Abenhaim), The Sir Mortimer B. Davis Jewish General Hospital, Montreal, Canada; Erasmus University Medical School (Dr. Sturkenboom), Pharmacoepidemiology Unit, Departments of Epidemiology and Biostatistics and Internal Medicine II, Rotterdam, the Netherlands; National Research Council (Dr. Sturkenboom), Milan, Italy; Department of Neurology (Dr. Gout), Fondation Rothschild, Paris; and Department of Neurology (Drs. Heinzlef and Roullet), Hospital Tenon, Paris, France.

Address correspondence and reprint requests to Dr. Ruth Ann Marrie, Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, Canada, H3A 2B4.

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.

Key words: MS—Infectious mononucleosis—Respiratory tract infection—Case-control.

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