Multiple sclerosis and antecedent infections: a case-control study.
OBJECTIVE
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.
Marrie
R A
RA
Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.
Wolfson
C
C
Sturkenboom
M C
MC
Gout
O
O
Heinzlef
O
O
Roullet
E
E
Abenhaim
L
L
D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007244:Infectious Mononucleosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology*; D016017:Odds Ratio; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D018570:Risk Assessment; D017678:Sex Distribution; D006113:United Kingdom / Q000453:epidemiology