Multiple Sklerose und Infektionskrankheiten

Zusammenfassung

Der Review greift die vielfältigen und komplexen Verbindungen und Interaktionen zwischen der Multiplen Sklerose einerseits und Infektionen sowie der immunmodulatorischen Therapien andererseits auf. Es wird zunächst anhand der derzeit zur Verfügung stehenden wissenschaftlichen Literatur die Bedeutung von Infektionserkrankungen im Rahmen der Ätiopathogenese der Multiplen Sklerose (Infektions- und Hygienehypothese) dargestellt. Daneben werden die potentiellen Einflüsse verschiedener humanpathogener Mikroorganismen auf den Krankheitsverlauf der Multiplen Sklerose beleuchtet. In einem weiteren Abschnitt wird auf infektiologische Aspekte im Zusammenhang mit denen zur Behandlung der Multiplen Sklerose eingesetzten immunmodulatorischen Therapieverfahren eingegangen. Einerseits werden schwerwiegende Infektionen unter den gängigen Therapeutika zur Behandlung der Multiplen Sklerose und andererseits die derzeit bekannten Gegenanzeigen, Warn- und Handhabungshinweise sowie Nebenwirkungen der verschiedenen immunmodulatorischen Therapieoptionen zusammengestellt. Des Weiteren wird auf die Bedeutung von Impfungen gegen Infektionskrankheiten für das Risiko, an Multipler Sklerose zu erkranken, wie der risikomindernde Effekt der Tetanus- und Diphterie-Impfung, eingegangen und der Einfluss von Impfungen auf den Krankheitsverlauf der Multiplen Sklerose diskutiert. Abschließend weisen wir auf Besonderheiten von Impfungen gegen Infektionskrankheiten unter den verschiedenen den Verlauf der Multiplen Sklerose modifizierenden Therapien und auf Kontraindikationen für Impfungen bei Patienten mit Multipler Sklerose, wie die Impfung mit dem Lebendimpfstoff gegen Gelbfieber, hin.

Abstract

The connections and interactions between multiple sclerosis on one side and infections as well as immunomodulatory treatment on the other side are complex. Based on the currently available scientific literature the impact of infectious diseases on the aetiopathology of multiple sclerosis (infectious- and hygienic-hypothesis) is discussed. Furthermore, potential influences of various pathogenic microorganisms on the course of disease of multiple sclerosis are highlighted. Different immunomodulatory treatments for multiple sclerosis can be associated with serious infections. We review contraindications, warnings and handling instructions as well as adverse reactions concerning these therapies. In addition, the influence of vaccinations against infectious diseases with respect to the risk of developing multiple sclerosis or the risk-minimizing effect of tetanus and diphtheria vaccination is discussed. Special issues concerning prophylactic vaccinations during different immunomodulatory therapies and contraindications for these vaccinations in multiple sclerosis patients, like the yellow-fever life vaccination, have to be considered.

Schlüsselwörter

Multiple Sklerose - Infektionen - Impfungen - Immuntherapeutika

Keywords

multiple sclerosis - infections - vaccinations - disease-modifying treatments

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