Infection of the central nervous system, sepsis and amyotrophic lateral sclerosis.
BACKGROUND
Severe infections may lead to chronic inflammation in the central nervous system (CNS) which may in turn play a role in the etiopathogenesis of amyotrophic lateral sclerosis (ALS). The relentless progression and invasive supportive treatments of ALS may on the other hand induce severe infections among ALS patients.


RESULTS
The present study included 4,004 ALS patients identified from the Swedish Patient Register during 1991-2007 and 20,020 age and sex matched general population controls. Conditional logistic regression was used to estimate the odds ratios (ORs) of ALS given a previous hospitalization for CNS infection or sepsis. Cox models were used to estimate the hazard ratios (HRs) of hospitalization for CNS infection or sepsis after ALS diagnosis. Overall, previous CNS infection (OR: 1.3, 95% confidence interval [CI]: 0.8, 2.4) or sepsis (OR: 1.2, 95% CI: 0.9, 1.6) was not associated with ALS risk. However, compared to ALS free individuals, ALS cases were more likely to be hospitalized for sepsis after diagnosis (HR: 2.6, 95% CI: 1.9, 3.5). We did not observe a higher risk of CNS infection after ALS diagnosis.


CONCLUSIONS
Our results suggest that acute and severe infections unlikely contribute to the development of ALS; however, ALS patients are at a higher risk of sepsis after diagnosis, compared to ALS free individuals.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. fang.fang@ki.se
Fang
F
Fang
Honglei
H
Chen
Karin
K
Wirdefeldt
Lars-Olof
LO
Ronnevi
Ammar
A
Al-Chalabi
Tracy L
TL
Peters
Freya
F
Kamel
Weimin
W
Ye
D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D016022:Case-Control Studies; D002494:Central Nervous System Infections / Q000150:complications*; D006801:Humans; D018805:Sepsis / Q000150:complications*; D013548:Sweden