B. M. Nagel2, M. Cardeiro2, L. Frankel2, D. Patel2, O. Rashid1,2,3,4,5,6,7 1Michael and Dianne Biennes Comprehensive Cancer Center, Holy Cross Health, Fort Lauderdale, FL, USA 2Nova Southeastern University, Dr. Kiran C. Patel College Of Allopathic Medicine, Fort Lauderdale, FL, USA 3University Of Miami, Leonard Miami School Of Medicine, Miami, FL, USA 4Massachusetts General Hospital, Boston, MA, USA 5Broward Health, Fort Lauderdale, FL, USA 6TopLine MD Alliance, Fort Lauderdale, FL, USA 7Medstar Washington Hospital Center, Washington, DC, USA
Introduction:
Epstein-Barr virus (EBV) is one of the most common human viruses in the world, and most cases of mononucleosis are caused by infection with EBV. EBV seropositivity in the general population reaches percentages over 90% with the proportion of seropositivity in multiple sclerosis (MS) patients being even greater. Approximately 96% of published studies included in the most up-to-date meta-analysis reported a positive association between infectious mononucleosis and MS. Recent findings suggest that EBV may trigger enhanced blood-brain barrier permeability which ultimately leads to increased incidence of MS in these patients; EBV may also trigger a heightened immunological state, consequently decreasing the threshold for activating auto-aggressive T-cells. The purpose of this study was to evaluate the correlation between mononucleosis infection and the incidence of MS.
Methods:
The data was provided by a national database that is compliant with HIPAA. Using ICD-10 and ICD-9 diagnostic codes, the data was filtered to evaluate patients infected with mononucleosis versus patients never infected with mononucleosis. Access to the database was granted by Holy Cross Health, Fort Lauderdale for the purpose of academic research. Standard statistical methods were used to assess patient data from 2010 to 2019.
Results:
Between January 2010 and December 2019, the query was analyzed and resulted in 51,521 patients after matching in the infected and control groups. The groups were matched by sex, age range, treatment, and CCI score. The incidence of multiple sclerosis was 0.469% (242 patients) in the mononucleosis group and 0.199% (103 patients) in the control group. The difference after matching was statistically significant by a p-value of 9.907 x 10-14 with an odds ratio of 2.356 (95% CI = 1.870-2.968).
Conclusion:
The study shows a statistically significant correlation between mononucleosis infection and an increased incidence of multiple sclerosis. Further evaluation is recommended to assess the potential of mononucleosis infection in increasing multiple sclerosis incidence.
