Background: Previous studies have demonstrated that infections might precipitate ischemic strokes (IS). We sought to describe, in a large prospective series, the frequency of previous infection (PI) in IS and intracerebral hemorrhage (ICH), and to assess whether any relationship with stroke subtype or outcome could be identified. Methods: Between January 2005 and December 2010, we studied 1,981 patients with acute stroke. The presence of PI within the month before the stroke was prospectively assessed. PI was correlated with demographic data, vascular risk factors, stroke subtype, and 3-month outcome. Results: A total of 193 (9.7%) patients had suffered a PI, the most common being respiratory tract infections (36.8%), flu or flu-like illness (30.1%), and gastrointestinal infections (12.4%). PI was more frequent in IS cases (10.2%) than in ICH (6.8%) (p = 0.081). Among IS cases, no differences were seen between PI and TOAST subtypes (p = 0.644). For IS, patients with PI were older (p = 0.025), had worse previous functional status (p = 0.002), suffered a more severe stroke (p = 0.002), achieved poor outcome (p = 0.001), and had higher 3-month mortality (p = 0.019). Multivariate analysis showed that IS patients with PI had previous poor functional status (OR = 1.58; p = 0.026) and suffered more severe strokes (OR = 1.02, p = 0.048). After adjustment for confounders, PI has no independent influence on 3-month outcome (OR = 1.15; p = 0.564). Conclusions: PI are observed in 9.7% of stroke cases without differences according to the TOAST subtype. PI are associated with previous poor functional status and with stroke severity, but have no independent influence on the 3-month outcome.

1.
Syrjänen J, Valtonen VV, Iivanainen M, Kaste M, Huttunen JK: Preceding infection as an important risk factor for ischaemic brain infarction in young and middle aged patients. Br Med J 1988;296:1156-1160.
2.
Ameriso SF, Wong VLY, Quismorio FP Jr, Fisher M: Immunohematologic characteristics of infection-associated cerebral infarction. Stroke 1991;22:1004-1009.
3.
Grau AJ, Buggle F, Heindl S, et al: Recent infection as a risk factor for cerebrovascular ischemia. Stroke 1995;26:373-379.
4.
Bova IY, Bornstein NM, Korczyn AD: Acute Infection as a risk factor for ischemic stroke. Stroke 1996;27:2204-2206.
5.
Grau AJ, Buggle F, Becher H, et al: Recent bacterial and viral infection as a risk factor for cerebrovascular ischemia: clinical and biochemical studies. Neurology 1998;50:196-203.
6.
Nencini P, Sarti C, Innocenti R, Pracucci G, Inzitari D: Acute inflammatory events and ischemic stroke subtypes. Cerebrovasc Dis 2003;15:215-221.
7.
Paganini-Hill A, Lozano E, Fischberg G, et al: Infection and risk of ischemic stroke: differences among stroke subtypes. Stroke 2003;34:452-457.
8.
Zurru MC, Alonzo C, Brescacín L, et al: Recent respiratory infection predicts atherothrombotic stroke. Case-control study in a Buenos Aires healthcare system. Stroke 2009;40:1986-1990.
9.
Piñol-Ripoll G, de la Puerta I, Santos S, Purroy F, Mostacero E: Chronic bronchitis and acute infections as new risk factors for ischemic stroke and the lack of protection offered by the influenza vaccination. Cerebrovasc Dis 2008;26:339-347.
10.
Grau AJ, Urbanek C, Palm F: Common infections and the risk of stroke. Nat Rev Neurol 2010;6:681-694.
11.
Clayton TC, Thompson M, Meade TW: Recent respiratory infection and risk of cardiovascular disease: case-control study through a general practice database. Eur Heart J 2008;29:96-103.
12.
Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P: Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004;351:2611-2618.
13.
Kunze AK, Annecke A, Wigger F, et al: Recent infection as a risk factor for intracerebral and subarachnoid hemorrhages. Cerebrovasc Dis 2000;10:352-358.
14.
Grau AJ, Preusch MR, Palm F, Lichy C, Becher H, Buggle F: Association of symptoms of chronic bronchitis and frequent flu-like illnesses with stroke. Stroke 2009;40:3206-3210.
15.
Ois A, Cuadrado-Godia E, Jiménez-Conde J, et al: Early arterial study in the prediction of mortality after acute ischemic stroke. Stroke 2007;38:2085-2089.
16.
Grau AJ, Fischer B, Barth C, Ling P, Lichy C, Buggle F: Influenza vaccination is associated with a reduced risk of stroke. Stroke 2005;36:1501-1506.
17.
Lavallée P, Perchaud V, Gautier-Bertrand M, Grabli D, Amarenco P: Association between influenza vaccination and reduced risk of brain infarction. Stroke 2002;33:513-518.
18.
Naghavi M, Barlas Z, Siadaty S, Naguib S, Madjid M, Casscells W: Association of influenza vaccination and reduced risk of recurrent myocardial infarction. Circulation 2000;102:3039-3045.
19.
Tseng HF, Slezak JM, Quinn VP, Sy LS, Van den Eeden SK, Jacobsen SJ: Pneumococcal vaccination and risk of acute myocardial infarction and stroke in men. JAMA 2010;303:1699-1706.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.