Neurologist, have you noticed these infections in patients with multiple sclerosis?

Recently, a study reported at the American Committee on Treatment and Research of Multiple Sclerosis (ACTRIMS) in 2021 showed that adult patients (≤65 years of age) with multiple sclerosis (MS) are more likely to develop infections due to urinary or renal The number of people hospitalized for infection is 4 times that of the control group, which suggests that clinicians should pay attention to these infections in MS patients.

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Study Introduction This study analyzed the claims data of U.
S.
commercial insurance companies from 2010 to 2019, and included 87,755 patient data (average age 47.
3 years, 75.
7% were women), and MS patients (age 18-64 years old, at least Two or more MS diagnoses with an interval of 30 days, and meet other criteria) are matched with the control group (with any other disease diagnoses at least 30 days apart, and other criteria are met).

 The results of the study show that the relative risk of all types of inpatient infections and most types of outpatient infections in MS patients is significantly increased.

Among outpatients, urinary and renal infections are the most common in MS patients, and they are also the more common types of infections compared with the control group (14.
23% vs.
7.
82%; RR, 1.
82; 95% CI, 1.
77-1.
87; P < 0 .
0001).

Among hospitalized patients, there were far more MS patients hospitalized for urinary and renal infections than the control group (1.
60% vs.
0.
36%; RR, 4.
49; 95% CI, 3.
98-5.
08; P <0.
0001).

In addition, the relative risks of respiratory infections, viral infections, fungal infections, skin infections and opportunistic infections are also higher.

 Expert review Dr.
Barbara Giesser, a neurologist at the University of California, said that more than 80% of MS patients have bladder dysfunction.
It is common for their bladder to not completely empty urine, which can cause patients to be susceptible to bladder and kidney infections.In addition, some patients may try to control their bladder symptoms by restricting fluids, which can also make them prone to infections.

Barbara Giesser said that patients usually avoid discussing with neurologists about genitourinary system dysfunction, but the bladder dysfunction, morbidity, and complications associated with MS patients are treatable and preventable.

Therefore, it suggests that neurologists should actively ask patients about the dysfunction of the genitourinary system and manage them.

 The lead author of the study, Dr.
Riley Bove, also stated that early and effective risk identification should be carried out for MS patients, appropriate first-line interventions such as pelvic floor physical therapy and patient education should be given, and referrals should be made to experienced patients in the treatment of neurogenic bladder as soon as possible.
Department of urologist.

In addition, to ensure that there is no unrecognized immunodeficiency, monitoring of drug side effects is also very important.

Finally, Dr.
Riley Bove also reminded that common symptoms of urinary tract infections in MS patients also include common symptoms in neurogenic bladder, such as urinary urgency, urinary incontinence, and frequent urination.

However, baseline lower urinary tract symptoms may mask the recognition of urinary tract infections, leading to delayed recognition and treatment of infections.

 Reference: Infections - Especially Urinary and Kidney - Are Higher in MS.
Medscape.
Mar 09, 2021.