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(Stroke. 2003;34:452.)
© 2003 American Heart Association, Inc.

Original Contributions

Infection and Risk of Ischemic Stroke

Differences Among Stroke Subtypes

A. Paganini-Hill, PhD; E. Lozano, MD; G. Fischberg, MD; M. Perez Barreto, MD; K. Rajamani, MD; S.F. Ameriso, MD; P.N.R. Heseltine, MD M. Fisher, MD

From the Departments of Preventive Medicine (A.P.-H.), Neurology (E.L., G.F., M.P.B., K.R., S.F.A., M.F.), and Medicine (P.N.R.H.) of the Keck School of Medicine of the University of Southern California, Los Angeles. S.F.A. is currently at the Institute for Neurological Research, FLENI, Buenos Aires, Argentina; P.N.R.H. is currently at the Nichols Institute, Quest Diagnostics, San Juan Capistrano, Calif; and M.F. is currently at the Departments of Neurology and of Anatomy and Neurobiology, University of California, Irvine.

Correspondence to Annlia Paganini Hill, PhD, 842 Manzanita Dr, Laguna Beach, CA 92651-1960. E-mail annliahi{at}usc.edu

Background and Purpose— Although prior studies have demonstrated that 25% to 35% of stroke patients have had a recent infection, the role of infection as a risk factor remains unclear. Our aim was to characterize the effect of infectious/inflammatory syndromes on stroke risk.

Methods— Case-control and crossover analyses of 233 cases and 363 controls aged 21 to 89 years were performed. Cases were patients hospitalized with a first ischemic stroke at a Los Angeles, California, medical center. Controls were outpatients in the hypertension, diabetes, and general medical clinics. All subjects were administered a neurological examination, an infection/inflammation (I/I) examination, and an interview to elicit recent I/I history at baseline (within several days of stroke onset) and again approximately 2 months later. Three physicians classified subjects by the presence or absence of I/I within 1 month of the index dates, based on findings of the I/I examination, the interview report, and laboratory results.

Results— Infections, either total or specific, were not found more frequently in cases than controls. However, patients with a recent respiratory tract infection suffered more often from large-vessel atherothromboembolic or cardioembolic stroke than did patients without infection (48% vs 24%, P=0.07). The age- and sex-adjusted relative risk estimate for these subtypes was 1.75 (95% CI, 0.86 to 3.55). The risk was notably high for those without stroke risk factors: 4.15 (95% CI, 1.22 to 14.1) for normotensives, 2.71 (95% CI, 1.04 to 7.06) for nondiabetics, and 1.74 (95% CI, 0.74 to 4.07) for nonsmokers. Patients with a recent respiratory infection also had a more severe neurological deficit on admission than those without infection (P=0.05).

Conclusions— Our results suggest that respiratory tract infection may act as a trigger and increase the risk of large-vessel and/or cardioembolic ischemic stroke, especially in those without vascular risk factors.

Key Words: epidemiology • infection • inflammation • risk factors • stroke, cardioembolic • stroke, ischemic

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