Infectious agents and different course of multiple sclerosis: a systematic review
Multiple sclerosis (MS) causes demyelination of white matter of central nervous system and neuro-degeneration due to inflammation. Different types of MS, as well as disease progression, come with different pathology and pathophysiology. The objective of this study was to evaluate the possible association between different micro-organisms and the relapse or progression of MS. Studies indexed in Medline/PMC, Scopus and Web of Science published without time and language limitation until March 2017 were identified through the search terms “infection” or “infectious” and “multiple sclerosis”. A total of 20878 abstracts were identified through the initial search terms. Selection of articles and assessment of their quality was done based on Cochrane library guidelines. Full texts were reviewed for 33 articles out of which 14 articles met the criteria for inclusion. Different micro-organisms are known to play roles in the pathogenesis of MS and its relapse; including Human herpesvirus 6 (HHV-6), Human herpesvirus 7 (HHV-7), Epstein–Barr virus (EBV), Chlamydia pneumoniae and Torque teno virus (TTV). But in this review only HHV-6, C. pneumoniae and TTV have been considered to play a role in disease progression in some studies and not all of them. This review concluded that some micro-organisms such as HHV-6, C. pneumoniae and TTV have been considered as cofactors to make MS a progressive type. It should be considered that these findings do not necessarily rule out the role of other pathogens in MS progression but may represent population differences or different sensitivity of the technique used.
KeywordsInfection Multiple sclerosis Relapsing–remitting Progressive
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
The authors confirm independence from the sponsors; the content of the article has not been influenced by the sponsors.
- 1.Anderson DW, Ellenberg JH, Leventhal CM, Reingold SC, Rodriguez M, Silberberg DH (1992) Revised estimate of the prevalence of multiple sclerosis in the United States. Ann Neural 31:333–336Google Scholar
- 4.Farid R, Norasteh A, Hatamian H (2016) The effect of core stability exercise program on the balance of patients with multiple sclerosis. Caspian J Neurol Sci 2(4):9–17Google Scholar
- 5.Semnani M, Mashayekhi F, Azarnia M, Salehi Z (2016) Effects of green tea epigallocatechin-3-gallate (EGCG) on proteolipid protein (PLP) and oligodendrocyte transcription factor 1 (Olig1) expression in the cerebral cortex of cuprizone induced multiple sclerosis mice; a western blot study. Caspian J Neurol Sci 2(6):1–9Google Scholar
- 6.Saeidi M, Raftari S, Roudbary S, Rezaeitalab F, Hatamian H (2016) Peripheral neuro electrodiagnostic abnormalities in patients with multiple sclerosis: a cross sectional study. Caspian J Neurol Sci 2(7):41–48Google Scholar
- 7.Janalipour K, Kafi M, Hatamian H, Rezapour P (2017) The effectiveness of yoga therapy in reducing anxiety, stress and depression in women with multiple sclerosis. Caspian J Neurol Sci 3(10):151–158Google Scholar
- 8.Amir F, Ahadi H, Nikkhah K, Seirafi M (2017) The effectiveness of acceptance and commitment group therapy and group logotherapy in reducing perceived stress among MS patients. Caspian J Neurol Sci 3(11):175–184Google Scholar
- 10.Saberi A, Roudbary SA, Hatamian HR, Akbari MS, Sedigh-Rahim-Abadi MR (2012) The type of multiple sclerosis when accompanied with seizure: can seizure predict the progression of MS? Akt Neurol 39:1–5. (text in German) Google Scholar
- 12.Lublin DF, Reingold SC (1996) Defining the clinical course of multiple sclerosis: results of an international survey. Neurology 46:907–11Google Scholar
- 13.Etemadifar M, Moeini P, Nabavi S (2017) Fingolimod versus high dose interferon beta-1a in multiple sclerosis: a randomized clinical trial. Caspian J Neurol Sci 3(8):1–8Google Scholar
- 14.Roudbary S, Yousefzadeh-Chabok S, Behzadnia H, Bakhshayesh-Eghbali B, Emamhadi M, Ghayeghran A et al (2017) Non-adherence to disease-modifying treatments in patients with multiple sclerosis. Caspian J Neurol Sci 3(10):128–134Google Scholar
- 16.Etemadifar M, Ghadimi M, Ghadimi K, Alsahebfosoul F (2017) The serum amyloid β level in multiple sclerosis: a case–control study. Caspian J Neurol Sci 3(11):214–221Google Scholar
- 18.Ashtari F, Saberi A, Shayegannejad V, Khosravi AR, Sherkat R, Khosravi E (2007) Association between Chlamydia pneumoniae infection and carotid atherosclerotic plaques. JRMS 12(4):165–171Google Scholar
- 19.Ashtari F, Shayghannejad V, Saberi A, Karkheyran F, Khosravi E (2007) Chlamydia pneumonia infection and thrombotic ischemic stroke. J Isfahan Med School 24(83):8–14 [Text in Persian].Google Scholar
- 20.Ashtari F, Shayegannejad V, Khosravi AR, Alia Saberi A, Niknazar MA (2006) The influence of Chlamydia pneumoniae infection on Intima-Media-thickness (IMT) in common carotid artery. ARYA Atheroscler 2(3):130–133Google Scholar
- 21.Ashtari F, Shayghannejad V, Saberi A, Rabiei E (2006) Association between Helicobacter pylori infection and carotid atherosclerotic plaque. Iran J Neurol 5(14):8–14Google Scholar
- 22.Ashtari F, Shayegannejad V, Saberi A, Rabiei E (2008) Relationship between Helicobacter pylori immunoglobulin g antibody and thrombotic ischemic stroke. Acta Medica Iranica 46(4):303–306Google Scholar
- 26.Banks T, Rouse B (1992) Herpesviruses—immune escape artists? Clin Inf Dis 14:933–941Google Scholar
- 33.Ordo˜nez G, Pineda B, Garcia-Navarrete R, Sotelo J (2004) Brief presence of varicellazoster viral DNA in mononuclear cells during relapses of multiple sclerosis. Arch Neurol 61:529–532Google Scholar
- 38.Sherbet G (2009) Bacterial infections and the pathogenesis of autoimmune conditions. Br J Med Pract 2:6–13Google Scholar
- 56.Nora-Krukle Z, Chapenko S, Logina I, Millers A, Platkajis A, Murovska M (2011) Human herpesvirus 6 and 7 reactivation and disease activity in multiple sclerosis. Medicina (Kaunas) 47(10):527–531Google Scholar
- 83.Rindfleisch E (1863) Histologisches detail zu der grauen degeneration von gehirn und ruckenmark. Arch Pathol Anat Physiol 26(5–6):474–483Google Scholar
- 85.Contini C, Cultrera R, Seraceni S, Castellazzi M, Granieri E, Fainardi E (2004) Cerebrospinal fluid molecular demonstration of Chlamydia pneumonia DNA is associated to clinical and brain magnetic resonance imaging activity in a subset of patients with relapsing/remitting multiple sclerosis. Mult Scler 10(4):360–369PubMedGoogle Scholar
- 89.Fainardi E, Castellazzi M, Casetta I, Cultrera R, Vaghi L, Granieri E et al (2004) Intrathecal production of Chlamydia pneumoniae-specific high-affinity antibodies is significantly associated with a subset of multiple sclerosis patients with progressive forms. J Neurol Sci 217(2):181–188PubMedGoogle Scholar
- 90.Agostini HT, Ryschkewitsch CF, Baumhefner RW, Tourtellotte WW, Singer EJ, Komoly S et al (2000) Influence of JC virus coding region genotype on risk of multiple sclerosis and progressive multifocal leukoencephalopathy. J Neurovirol 6(2):101–108Google Scholar
- 91.Rasmussena HB, Kellyb MA, Francisc DA, Clausena J (2000) Association between the endogenous retrovirus HRES-1 and multiple sclerosis in the United Kingdom—evidence of genetically different disease subsets? Dis Markers 16(3–4):101–104Google Scholar