Recurrent Infections During Independent Risk Factors and Myasthenia Gravis

The following is a summary of “Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study,” published in the July 2023 issue of Neurology by Chien et al.

Myasthenia gravis (MG) patients have a 10% to 20% risk of myasthenic crisis (MC), especially infection-triggered MC with poor outcomes and lack of prognostic factors.

Researchers started a retrospective study to identify clinical manifestations, comorbidities, and biochemical factors associated with recurrent infection-triggered MC in MG patients.

They involved 272 patients diagnosed with MG admitted due to an infection necessitating a minimum of 3 days of antibiotic treatment (January 2001 and December 2019). Patients were classified by their experience of either non-recurrent or recurrent infections. The assessment included gender, age, concurrent illnesses, acetylcholine receptor antibodies, and comprehensive biochemical markers like electrolytes and coagulation profiles. The evaluation also encompassed muscle strength in pelvic and shoulder areas, bulbar and respiratory function, medical interventions such as endotracheal tubes, Foley catheters, or plasmapheresis, length of hospital stay, and identification of cultured pathogens.

The results showed a significant age difference between the recurrent infection group and the non-recurrent group (median age, 58.5 versus 52.0 years). Pneumonia emerged as the most prevalent infection, with Klebsiella pneumoniae being the primary pathogen. Independently associated factors for recurrent disease were diabetes, prolonged partial thromboplastin time, extended hospital stays, and hypomagnesemia. Deep vein thrombosis, thymic cancer, and electrolyte imbalances such as hypokalemia and hypoalbuminemia showed a significant connection to infection risk. Endotracheal intubation, anemia, and plasmapheresis during hospitalization demonstrated inconsistent associations.

They concluded that diabetes, hypomagnesemia, prolonged hospitalization, and elevated aPTT are independent risk factors for recurrent infections in myasthenia gravis patients.

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-023-03306-3