Multiple sclerosis and antecedent infections - A case-control study

Objectives: To determine whether there is an excess of respiratory tract in fections in the 5-week, 3-month, and 12-month periods before MS symptom ons et and if there is an association between MS and a history of infectious mo nonucleosis (IM). Background: The etiology of MS remains unknown, but infec tion is frequently suggested as a putative etiologic agent. Epidemiologic s tudies have produced inconsistent evidence for an etiologic role of respira tory tract infections (RTI) and IM in MS. Methods: The authors performed a case-control study using the General Practice Research Database from the Un ited 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 f irst symptoms compatible with MS (index date). They also compared histories of IM. Results: In all periods, an increased frequency of RTI was associat ed with a significantly increased risk of MS. A history of IM was associate d 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.