#T4TD Infected

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Did you know that a third of relapses are triggered by infections, typically non-specific viral infections? 

The observation that a relapse is more likely to occur in the so-called ‘at risk’ period, typically 5-6 weeks after infection than at other times predates the disease-modifying therapy era of MS. The mechanism is thought to be that infection boosts the immune system non-specifically, which then trigger relapses. This observation was extrapolated to vaccinations, but most vaccine studies now show that vaccines in general, with the possible exception of the yellow fever vaccine*, are safe and are not associated with an increased risk of relapses nor MRI activity. 

* Please note recent data on the live yellow fever vaccine shows that it doesn’t trigger MS relapses. 

Once people are on an effective DMT the link between infections and relapses is not observed. This is another, albeit minor, reason to be on a DMT. However, there is an emerging field in basic science and clinical evidence to support it that recurrent infections drive some of the pathological processes that are responsible for smouldering MS. Systemic inflammation activates CNS microglia that then produce cytokines and inflammatory mediators that have a negative effect on neuronal function. This is why people with MS handle infections so poorly and often don’t get back to baseline after a severe systemic infection. 

Therefore as part of the holistic management of MS, it is a good idea to prevent chronic or recurrent infections. So if you have recurrent or chronic bladder infections, periodontitis (gum disease), chronic sinusitis or recurrent chest infections you need to do something about it. Don’t just accept recurrent infections as your lot in life ask your MS team for advice and help. 

#T4TD = Thought for the Day

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About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

17 comments

  • Very interesting. I’ve had recurrent hsv in my left eye for over 20 years. A few times over the years I’ve noticed MS symptoms around the same time. Often wondered if one was driving the other? Relapse free for 4 years and no hsv either.

    • I have several patients like this, i.e. who have relapses or recurrent neurological symptoms triggered by herpes infections. Three of the them have done very well on long-term prophylactic anti-viral agents.

  • What can the MS team do or offer for infections?
    What is the meaning of the term ‘non-specific infection’?

    • Non-specific infection = these are infections we don’t find the organism, for example, most upper respiratory tract infections.

    • It is very true, but others doctors do not understand these interaction between brain and infections. It is like saying and not believing when I try to explain my decline after infections, either bacterial or virus.
      Only MS Ultra specialists know the connection with cytokines attack response to infections.

  • I believe this, and my neurologist, urologist an ID doc do as well. But we have yet to keep me clear of UTI/colonisations for more than two months. I’m sure as a Google researcher can be that these infections/colonizations are responsible for my deteriorating walk.

  • I assume this is a joke. Asking ms team about recurring infections = tysabri is not associated with infections. Call your gp to deal with it. Ms patients are tired of trying to get their deaf nervous to take them seriously.

    Bozoforgot

  • I’ve have four infections in the last 9 months, two sinus infections, strep, and a UTI. Didn’t know there was anything you could do to prevent them?

  • I discussed infections trigger relapses not that long ago, with a UK MS neurologist, their response was….. there is no proof infections trigger relapses…..

    • Panitch HS. Influence of infection on exacerbations of multiple sclerosis. Ann Neurol. 1994;36 Suppl(Suppl ):S25-S28. doi:10.1002/ana.410360709

      Marrodan M, Alessandro L, Farez MF, Correale J. The role of infections in multiple sclerosis. Mult Scler. 2019;25(7):891-901. doi:10.1177/1352458518823940

      Metz LM, McGuinness SD, Harris C. Urinary tract infections may trigger relapse in multiple sclerosis. Axone. 1998;19(4):67-70.

      Rapp NS, Gilroy J, Lerner AM. Role of bacterial infection in exacerbation of multiple sclerosis. Am J Phys Med Rehabil. 1995;74(6):415-418. doi:10.1097/00002060-199511000-00004

      Buljevac D, Flach HZ, Hop WC, et al. Prospective study on the relationship between infections and multiple sclerosis exacerbations. Brain. 2002;125(Pt 5):952-960. doi:10.1093/brain/awf098

      Giovannoni G, Lai M, Kidd D, et al. Daily urinary neopterin excretion as an immunological marker of disease activity in multiple sclerosis. Brain. 1997;120 ( Pt 1):1-13. doi:10.1093/brain/120.1.1

  • I have had several past relapses triggered by the common cold virus, usually around six weeks post infection so I completely agree that this happens. I also get the occasional cold sore which seems to coincide with an exacerbation in symptoms.

  • It is very true, but others doctors do not understand these interaction between brain and infections. It is like saying and not believing when I try to explain my decline after infections, either bacterial or virus.
    Only MS Ultra specialists know the connection with cytokines attack response to infections.

  • It is very true, but others doctors do not understand these interaction between brain and infections. It is like saying and not believing when I try to explain my decline after infections, either bacterial or virus.
    Only MS Ultra specialists know the connection with cytokines attack response to infections.

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