作者
Caroline Papeix,C. Donzé,Christine Lebrun-Frénay,French Group For Recommendations In Multiple Sclerosis The Société Francophone de la Sclérose En …,David‐Axel Laplaud,Éric Thouvenot,Xavier Ayrignac,Valérie Pourcher-Martinez,Hélène Zéphir,Jérôme De Sèze,Laure Michel,Caroline Bensa,C. Cara-Dalliere,Anne‐Marie Guennoc,Olivier Casez,Adil Maarouf,Bertrand Bourre,Arnaud Kwiatkowski,Mikaël Cohen,Élisabeth Maillart,Nicolas Collongues,Céline Louapre,G. Androdias,A. Guegen,Bertrand Audoin,G. Mattey,Patricia Bernady,Jean Marc Faucheux,Pierre Labauge,C. Meckies,Bruno Stankoff,P. Tourniaire,Aurélien Dinh,Anne‐Marie Guennoc,F. Durnad-Dubief,Sandrine Wiertlewski,Nathalie Derache,Emmanuelle Le Page,Sophie Pittion,Sandra Vukusic,Pierre Clavelou,Olivier Heinzlef,R. Colamarino,Evelyne Planque,Audrey Rico,C. Sheiber Nogueira,M. de Sèze,Jonathan Ciron,H. Alchaar,Djamel Bensmaïl,Damien Biotti,Pierre Branger,Bruno Brochet,Bernard Castan,Alain Créange,E. Creisson,Thomas Debroucker,Raphaël Depaz,X. Douay,Cécile Dulau,Marion Faucher,Mario Fournier,Agnès Fromont,P. Gallien,Olivier Gout,J Grimaud,Y. HervÉ,Anne Kerbrat,Laurent Kremer,Livia Lanotte,Laurent Magy,Alexandre Mania,Aude Maurousset,Xavier Moisset,Alexis Montcuquet,Thibault Moreau,Nathalie Morel,I. Patry,D. Peaureaux,M.C. Pouget,Aurélie Ruet,C. Saint-Val,J.P. Stahl,F. Taithe,Pierre Tattevin,Mathieu Vaillant,F. Vuoto
摘要
Viral, bacterial, or fungal infections are suspected of triggering multiple sclerosis (MS) and promoting relapses of the disease and are likely to be promoted by immune-active treatments. This raises questions about the infectious workup and preventive treatment of these infections prior to their initiation.To establish recommendations on infections and MS. Provide information to patients and healthcare professionals on the minimal infectious workup to be performed in an MS patient at diagnosis and prior to initiation of immuno-active therapy in MS.The recommendation attempts to answer four main questions about infections and MS. The French Group for Recommendations in Multiple Sclerosis (France4MS) did a systematic review of articles from PubMed and universities databases (from January 1975 to June 2020), using the RAND/UCLA formalized consensus method. The RAND/UCLA method has been developed to synthesize the scientific literature and expert opinions on health care topics and was used for reaching a formal agreement. Twenty-three experts contributed to the detailed review and a group of 63 multidisciplinary health professionals validated the final version of 36 recommendations.It is recommended that MS patients undergo a minimal infectious workup, check their vaccination status at diagnosis, and repeat it during follow-up and before starting immunotherapy. Screening and preventive treatment of viral (group Herpes virus, HPV, JCV, HCV, HBV), bacterial (mycobacteria) and fungal (Cryptococcus) infections is recommended prior to the initiation of certain immuno-active MS therapies.At diagnosis of MS and prior to the choice of therapeutic strategy, it is recommended to update the vaccination schedule of MS patients in reference to the HCSP vaccination schedule and the SFSEP recommendations. Before starting immunosuppressive treatment, it is recommended to inform patients of the risks of infections and to look for a constitutive or acquired immune deficiency. Health professionals and patients should be informed of the updated recommendations on infections and MS.