Seropositivity of H. pylori and Typhoid Fever in Dyspesia Iraqi Patients View PDF

Helicobacter pylori are a gram-negative, unipolar, multiflagellate, microaerophilic, gently spiral or curved bacilli. H. pylori infection is known to produce gastrointestinal disorders [1]. H. pylori colonizes the stomach and considers an essential component of the human microbiome. Infection is commonly acquired in the first part of life and persists throughout human life, when left untreated [2,3]. The frequency of H. pylori infection was vary between 8.7% and 85.5% [4]. A study in Iraq, revealed that 64.8% of cases with dyspepsia symptoms (718/1108) were have H. pylori IgG [5].

Typhoid fever is an acute systemic infection produced by Salmonella enteric serovar Typhi. Paratyphoid fever, an analogous clinical condition, is caused by Salmonella enterica serovars Paratyphi A, B, and C. Both typhoid and paratyphoid fevers are collectively named as enteric fevers. Mostly, in endemic areas, most common enteric fever is typhoid [6]. Typhoid fever frequency and size of affected patients appear to have increased over time [7], and outbreak residue elevate in endemic little and medium income would parts [8]. Typhoid fever is familiar in Iraq. For example, from 2007, 2008, 2009 and 2010, a whole of 36 208, 58 247, 49 113 and 49 139, respectively, alleged patients of typhoid fever were registered according to WHO plane in Iraq [9].

The idea that H. pylori elevates the risk of typhoid fever is accepted by some studies and rejected by others in different countries. In India the idea is accepted by Bhan MK, et al. (2002) and found increased threat of typhoid fever in present of immunoglobulin G to H. pylori. This could establish an infection, reflected by inflammation of the lining of the stomach and noticeable immune reaction, rather than just a invasion with H. pylori. This is necessary for the progress of hypochlorhydria and enlarged hazard of enteric infections [10]. In Indonesia the association is spurted by Vollaard AM, et al. (2005) and showed that significant relationship between typhoid fever and H. pylori infection. H. pylori may affect gastric acid production and as a result increase defencelessness to Salmonella typhi infection [11]. In Mohammed FH, et al. (2015) results indicated more H.pylori seropositivity in control than typhoid fever [12]. H. pylori reported to have role in other diseases [13,14].

In Iraq, there is no available study on the connection between H. pylori and typhoid. The aim of present research was to estimate the correlation between seropositivity of H. pylori IgG and typhoid fever in clinically examined patients as dyspeptic and typhoid fever infected.

From May 2016 to February 2018, a total of 213 patients (134 females and 79 male) with age range from 10 to 90 years attending an enterology outpatient clinic, in AL-Najaf province, Iraq, with symptoms of dyspepsia and typhoid fever (as fever, diarrhea, headache) to receive treatment, were referred to serologic diagnosis for both H. pylori and typhoid fever through detect present of anti-H. pylori IgG and anti-Typhoid and paratyphoid IgG and IgM, using the Rapid tests (H. pylori Antibody Rapid Test Cassette by BIOZEK, Netherlands, for anti-H. pylori IgG; Typhoid IgG/IgM Rapid Test Cassette by BIOTECH, Germany, for anti-Typhoid IgG and IgM).

A sample of venous blood was aspirated and separated by centrifuge for each patient. The sera were used to serologic diagnosis. For the both rapid tests used in this study, if C band is developed, the assay is valid, and T band(s) are read. Colored T band in H. pylori Antibody Rapid Test Cassette read as positive and in respect to Typhoid IgG/IgM Rapid Test, the case with positive IgG (T1 band) or IgM (T2 band) or both (T1&T2 bands) were regarded as positive diagnostic results.

Statistical Analysis

Our results were analyzed using software (packages Graph pad prism 6) for windows 2007. Chi-square (X²) investigate was used for determine statistically significant differences between variables. P values < 0.05 were calculated significant.

Of a total of 213 clinically examined as dyspeptic and typhoid fever infected patients, 134 (63.0%) were females and 79 (37.0%) were males .In this study, 82 (38.5%) of 213 patients were seropositive for typhoid fever and 131 patients were seronegative. Moreover, 128 (60.1%) of 213 patients were seropositive for H.pylori IgG (51 case, 39.8%, typhoid seropositive, and 77 case, 60.2%, typhoid seronegative) and 82 were seronegative.

From the 82 serologic diagnosis as typhoid fever positive patients, 51 (62.2 %) were also seropositive for H. pylori IgG (co-infection) [and 31 (37.8 %) were seronegative for H. pylori IgG]. In respect to the 131 serologic diagnosis as typhoid fever negative patients, 77 (58.8 %) were seropositive for H. pylori IgG [and 54 (41.2 %) were seronegative for H. pylori IgG] (Table 1).

Table 1: H. pylori IgG and typhoid fever seroprevelance in clinically examined patients as dyspeptic and typhoid fever infected.

The serologically diagnosed of co-infections was found to be higher in female (33/51, 64.7%) than in male (18/51, 35.3%) (Table 2).

Table 2: H. pylori IgG seroprevelance according to gender and typhoid seroprevelance in clinically examined patients as dyspeptic and typhoid fever infected.

The age of cases was range between 10 and 90 years, the H. pylori seropositive patients (128) were divided into eight (8) age groups. Totally, the more susceptible age was the age group (30s), 33/128 (25.8%), but in respect to the serologically diagnosed co-infections, the age group (40s) was more susceptible, 15/51 (29.4%) (Table 3).

Table 3:  H. pylori IgG seropositivity according to age group and typhoid seroprevelance in clinically examined patients as dyspeptic and typhoid fever infected.

Therefore, the seropositivity of H. pylori IgG were higher in typhoid seropositive patients, than Typhoid seronegative patients; co-infection higher in female than in male; and the more susceptible age group was 40s (29.4%). However, the statistical analysis showed insignificant association between H. pylori with typhoid fever (P value = 0.6203), gender (P value = 0.4770) and age groups (P value = 0.0745).

H. pylori colonize more than half of the people in their superior digestive system and typhoid fever produce an expected 21.7 million diseases and 217,000 loss of life [15].

The present study results revealed the seropositivity of H. pylori IgG was elevated in typhoid seropositive cases (62.2 %), than typhoid seronegative patients (58.8%); the co-infection was advanced in female (64.7%) than male (60%) and more prevalence among age group (40 yrs) (29.4%). However, the mentioned percentages were insignificant in population of AL-Najaf province (Iraq). Our results did not support the significant association revealed by previous studies.

This study like to Mohammed et al. results, in Khartoum, Sudan, in respect of insignificant connection between H.pylori and enlarged threat of typhoid fever and differ from it in that H. pylori positivity raised in control. They explain this result may be due to small sample size (45 typhoid cases and 45 controls) and differences in the used examined techniques (ELISA IgG for H. pylori and rapid test for typhoid) [12]. We used the same diagnostic technique, which is rapid test for 213 patients. A study has been shown that the gastric-acid barrier to be a main protective system against salmonella infections [16].

This study disagree with results of Bhan MK, et al. (2002); Vollaard AM, et al. (2005) and Alavi SM, et al. (2010) in Delhi, India; Jakarta, Indonesia and Ahvaz, Iran, respectively. They found that H. pylori seropositivity were significantly linked with an enlarged risk of Typhoid fever [10,11,17]. Vollaard AM, et al. (2005) evaluated the association as the Salmonella could affect gastric acid production and as a result boost vulnerability to Salmonella typhi invasion. H. pylori infection can contributes significantly to gastric microbiota dysbiosis [18]. There is relative between H. pylori infection and other diseases, for example, in Iraq, Tawfeeq et al. (2019) demonstrate correlation between type II diabetes mellitus and H. pylori infection [19].

All of these differences in the previous results could as a results of Varity in targeted populations, health, and sample size.

Our study indicates that H. pylori seropositive dyspepsia more vulnerable to typhoid fever particularly in female and 40s ages and suggest there was insignificant relationship amongst seropositivity of H. pylori and typhoid fever within dyspepsia patient. More studies in different populations and disease are needed.

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