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. 2022 Aug 2:13:937583.
doi: 10.3389/fimmu.2022.937583. eCollection 2022.

Infectious mononucleosis is associated with an increased incidence of multiple sclerosis: Results from a cohort study of 32,116 outpatients in Germany

Sven H Loosen  1 , Corinna Doege  2 , Sven G Meuth  3 , Tom Luedde  1 , Karel Kostev  4 , Christoph Roderburg  1
Affiliations

Infectious mononucleosis is associated with an increased incidence of multiple sclerosis: Results from a cohort study of 32,116 outpatients in Germany

Sven H Loosen et al. Front Immunol. .

Abstract

Background: The pathogenesis of multiple sclerosis (MS) has not yet been fully uncovered. There is increasing evidence that Epstein-Barr-Virus (EBV) infection, which affects over 90% of people during life and causes infectious mononucleosis, leads to an increased incidence of MS, and thus may play a crucial role in the pathophysiology of the disease.

Methods: Using the Disease Analyzer database (IQVIA) featuring diagnoses as well as basic medical and demographic data of outpatients from general practices in Germany, we identified a total of 16,058 patients with infectious mononucleosis that were matched to a cohort of equal size without infectious mononucleosis based on patients' age, sex, index year and yearly consultation frequency. Incidence of MS was compared within a 10-year follow-up period.

Results: Within 10 years from the index date, the incidence of MS was 22.6 cases per 100,000 person-years among patient with infectious mononucleosis but only 11.9 cases per 100,000 person-years among individuals without infectious mononucleosis. In regression analysis, infectious mononucleosis was significantly associated with the incidence of MS (HR: 1.86, 95% CI: 1.09-3.16). Subgroup analysis revealed the strongest association between infectious mononucleosis and MS in the age group between 14 and 20 years (HR: 3.52, 95% CI: 1.00-12.37) as well as a stronger association in men compared to women.

Conclusion: Infectious mononucleosis is associated with an increased incidence of MS especially in younger individuals. Our data support the growing evidence of a decisive involvement of EBV in the currently unknown pathophysiology of MS and should trigger further research efforts to better understand and potentially prevent cases of this disabling disease in future.

Keywords: EBV; MS; epidemiology; incidence; pathophysiology; virus.

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Conflict of interest statement

Author KK was employed by IQVIA. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Selection of study patients.
Figure 2
Figure 2
Kaplan-Meier curves regarding the incidence of multiple sclerosis diagnosis in patients with and without infectious mononucleosis.
See this image and copyright information in PMC

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