Scholars LITERATURE La Prensa Medica Argentina

DOI: https://doi.org/10.47275/0032-745X-291 Research Article Volume 107 Issue 1

Seropositivity of H. pylori and Typhoid in Dyspepsia Iraqi Patients Ali Razzaq Hussein1* and Nawfal H Aldujaili2 1Directorate of Education in AL-Najaf, Ministry of Education, AL-Najaf, Iraq 2Department of Biology, Faculty of Science, University of Kufa, AL-Najaf, Iraq

Abstract Background: There are many studies that highlight the association between seropositivity with in human populations and there is no study in Iraq. Aim: Our study designed to estimate the correlation between the seroprevalence of H. pylori and Typhoid fever in clinically examined patients as dyspeptic and typhoid fever infected. Methods: From May (2016) to February (2018), a total of 213 patients (134 females and 79 males) attending an enterology outpatient clinic in AL-Najaf province, Iraq. The patients with an age range from 10 to 90 years and with symptoms of dyspepsia and typhoid fever (as fever, diarrhea, ), were referred to serologic diagnosis of against H. pylori (IgG) and Typhoid (IgG and/or IgM), using the Rapid Tests Cassette. Results: 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. The serologic co-infection diagnosed in 51 (24.0%) patients. The seropositivity of typhoid fever was higher in H. pylori seropositive patients, co-infections (62.2%), than H. pylori seronegative patients (37.8%). The co-infection was more in female (64.7%) than male (35.3%). In respect of age H. pylori seropositivity was more prevelance (25.8%) in 30s age group where as co-infection was more prevalence in 40s age group (29.4%). But the statistical analysis showed insignificant association of H. pylori with typhoid fever (P value = 0.6203), gender (P value = 0.4770) and age groups (P value = 0.0745). Conclusion: Our study indicates that H. pylori seropositive dyspepsia was more susceptible to typhoid fever particularly in female and 40s ages and suggest there was insignificant relationship amongst seropositivity ofH. pylori and typhoid fever within dyspepsia patient. Keywords: H. pylori; Typhoid Fever; Dyspepsia

*Correspondence to: Ali Razzaq Hussein, Directorate of Education in AL-Najaf, Ministry of Education, AL-Najaf, Iraq; Tel: 009647804252192; E-mail: alialhussini. [email protected] Citation: Hussein AR, Aldujaili NH (2021) Seropositivity of H. pylori and Typhoid Fever in Dyspepsia Iraqi Patients. Prensa Med Argent, Volume 107:1. 291. DOI: https://doi.org/10.47275/0032-745X-291. Received: May 13, 2020; Accepted: June 13, 2020; Published: June 18, 2020; Journal Issue: February, 2021 Introduction is typhoid [6]. Typhoid fever frequency and size of affected patients appear to have increased over time [7], and outbreak residue elevate in Helicobacter pylori are a gram-negative, unipolar, multiflagellate, endemic little and medium income would parts [8]. Typhoid fever is microaerophilic, gently spiral or curved bacilli. H. pylori infection is familiar in Iraq. For example, from 2007, 2008, 2009 and 2010, a whole known to produce gastrointestinal disorders [1]. H. pylori colonizes of 36 208, 58 247, 49 113 and 49 139, respectively, alleged patients of the stomach and considers an essential component of the human typhoid fever were registered according to WHO plane in Iraq [9]. microbiome. Infection is commonly acquired in the first part of life and persists throughout human life, when left untreated [2,3]. The The idea that H. pylori elevates the risk of typhoid fever is accepted frequency of H. pylori infection was vary between 8.7% and 85.5% [4]. by some studies and rejected by others in different countries. In India A study in Iraq, revealed that 64.8% of cases with dyspepsia symptoms the idea is accepted by Bhan MK, et al. (2002) and found increased (718/1108) were have H. pylori IgG [5]. threat of typhoid fever in present of immunoglobulin G to H. pylori. This could establish an infection, reflected by inflammation of the Typhoid fever is an acute systemic infection produced by lining of the stomach and noticeable immune reaction, rather than enteric serovar Typhi. Paratyphoid fever, an analogous just a invasion with H. pylori. This is necessary for the progress of clinical condition, is caused by serovars Paratyphi hypochlorhydria and enlarged hazard of enteric infections [10]. In A, B, and C. Both typhoid and paratyphoid are collectively named Indonesia the association is spurted by Vollaard AM, et al. (2005) as enteric fevers. Mostly, in endemic areas, most common enteric fever and showed that significant relationship between typhoid fever and

Prensa Med Argent, Volume 107:1 Pages: 1-3 Citation: Hussein AR, Aldujaili NH (2021) Seropositivity of H. pylori and Typhoid Fever in Dyspepsia Iraqi Patients. Prensa Med Argent, Volume 107:1. 291. DOI: https://doi.org/10.47275/0032-745X-291.

H. pylori infection. H. pylori may affect gastric acid production and The serologically diagnosed of co-infections was found to be higher as a result increase defencelessness to Salmonella typhi infection in female (33/51, 64.7%) than in male (18/51, 35.3%) (Table 2). [11]. In Mohammed FH, et al. (2015) results indicated more H.pylori The age of cases was range between 10 and 90 years, theH. pylori seropositivity in control than typhoid fever [12]. H. pylori reported to seropositive patients (128) were divided into eight (8) age groups. have role in other diseases [13,14]. Totally, the more susceptible age was the age group (30s), 33/128 In Iraq, there is no available study on the connection between H. (25.8%), but in respect to the serologically diagnosed co-infections, the pylori and typhoid. The aim of present research was to estimate the age group (40s) was more susceptible, 15/51 (29.4%) (Table 3). correlation between seropositivity of H. pylori IgG and typhoid fever Table 2: H. pylori IgG seroprevelance according to gender and typhoid seroprevelance in in clinically examined patients as dyspeptic and typhoid fever infected. clinically examined patients as dyspeptic and typhoid fever infected. Materials and Methods Gender Typhoid Total P value + Ve -Ve From May 2016 to February 2018, a total of 213 patients (134 Female No 33 45 78 0.4770 females and 79 male) with age range from 10 to 90 years attending % 64.7 58.4 60.9 an enterology outpatient clinic, in AL-Najaf province, Iraq, with Male No 18 32 50 symptoms of dyspepsia and typhoid fever (as fever, diarrhea, headache) % 35.3 41.6 39.1 to receive treatment, were referred to serologic diagnosis for both H. Total No 51 77 128 pylori and typhoid fever through detect present of anti-H. pylori IgG % 39.8 60.2 100 and anti-Typhoid and paratyphoid IgG and IgM, using the Rapid tests (H. pylori Rapid Test Cassette by BIOZEK, Netherlands, Table 3: H. pylori IgG seropositivity according to age group and typhoid seroprevelance in for anti-H. pylori IgG; Typhoid IgG/IgM Rapid Test Cassette by clinically examined patients as dyspeptic and typhoid fever infected. BIOTECH, Germany, for anti-Typhoid IgG and IgM). Age groups Typhoid Total P value + Ve - Ve No A sample of venous was aspirated and separated by centrifuge 10s No 4 12 16 0.0745 for each patient. The sera were used to serologic diagnosis. For the both % 7.8 15.6 12.5 rapid tests used in this study, if C band is developed, the assay is valid, 20s No 5 19 24 and T band(s) are read. Colored T band in H. pylori Antibody Rapid % 9.8 24.7 18.8 Test Cassette read as positive and in respect to Typhoid IgG/IgM Rapid 30s No 13 20 33 Test, the case with positive IgG (T1 band) or IgM (T2 band) or both % 25.5 26.0 25.8 (T1&T2 bands) were regarded as positive diagnostic results. 40s No 15 10 25 % 29.4 13.0 19.5 Statistical Analysis 50s No 5 5 10 Our results were analyzed using software (packages Graph pad % 9.8 6.5 7.8 prism 6) for windows 2007. Chi-square (X2) investigate was used for 60s No 7 5 12 determine statistically significant differences between variables.P % 13.7 6.5 9.4 values < 0.05 were calculated significant. 70s No 1 5 6 % 2.0 6.5 4.7 Results 80s + 90s No 1 1 2 % 2.0 1.2 1.5 Of a total of 213 clinically examined as dyspeptic and typhoid fever Total No 51 77 128 infected patients, 134 (63.0%) were females and 79 (37.0%) were males % 39.8 60.2 100 .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 Therefore, the seropositivity ofH. pylori IgG were higher in typhoid were seropositive for H.pylori IgG (51 case, 39.8%, typhoid seropositive, seropositive patients, than Typhoid seronegative patients; co-infection and 77 case, 60.2%, typhoid seronegative) and 82 were seronegative. higher in female than in male; and the more susceptible age group From the 82 serologic diagnosis as typhoid fever positive patients, was 40s (29.4%). However, the statistical analysis showed insignificant 51 (62.2%) were also seropositive for H. pylori IgG (co-infection) [and association between H. pylori with typhoid fever (P value = 0.6203), 31 (37.8%) were seronegative for H. pylori IgG]. In respect to the 131 gender (P value = 0.4770) and age groups (P value = 0.0745). serologic diagnosis as typhoid fever negative patients, 77 (58.8%) were Discussion seropositive for H. pylori IgG [and 54 (41.2%) were seronegative for H. pylori IgG] (Table 1). H. pylori colonize more than half of the people in their superior digestive system and typhoid fever produce an expected 21.7 million Table 1: H. pylori IgG and typhoid fever seroprevelance in clinically examined patients as dyspeptic and typhoid fever infected. diseases and 217,000 loss of life [15]. H. pylori Typhoid Total P value The present study results revealed the seropositivity of H. pylori + Ve - Ve IgG was elevated in typhoid seropositive cases (62.2%), than typhoid H. pylori + ve No 51 77 128 0.6203 seronegative patients (58.8%); the co-infection was advanced in female % 62.2 58.8 60.1 (64.7%) than male (60%) and more prevalence among age group (40 H. pylori - ve No 31 54 85 % 37.8 41.2 39.9 yrs) (29.4%). However, the mentioned percentages were insignificant Total No 82 131 213 in population of AL-Najaf province (Iraq). Our results did not support % 38.5 61.5 100 the significant association revealed by previous studies.

Prensa Med Argent, Volume 107:1 Pages: 2-3 Citation: Hussein AR, Aldujaili NH (2021) Seropositivity of H. pylori and Typhoid Fever in Dyspepsia Iraqi Patients. Prensa Med Argent, Volume 107:1. 291. DOI: https://doi.org/10.47275/0032-745X-291.

This study like to Mohammed et al. results, in Khartoum, Sudan, in pylori infection in obesity and its clinical outcome after bariatric surgery. World J respect of insignificant connection between H.pylori and enlarged threat Gastroenterol, 20: 647-653. of typhoid fever and differ from it in that H. pylori positivity raised in 5. Jaff MS (2011) Relation between ABO blood groups and Helicobacter pylori infection control. They explain this result may be due to small sample size (45 in symptomatic patients. Clinical and Experimental Gastroenterol 4: 221-226. typhoid cases and 45 controls) and differences in the used examined 6. Mastroeni P, Maskell D (2006) Salmonella Infections: Clinical, Immunological and techniques (ELISA IgG for H. pylori and rapid test for typhoid) [12]. Molecular Aspects. Cambridge University Press, United Kingdom. We used the same diagnostic technique, which is rapid test for 213 7. Kim J-H, Im J, Parajulee P, Holm M, Cruz Espinoza LM, et al. (2019) A Systematic patients. A study has been shown that the gastric-acid barrier to be a Review of Typhoid Fever Occurrence in Africa, Clinical Infectious Diseases 69: main protective system against salmonella infections [16]. S492-S498. 8. Kim S, Lee KS, Pak GD, Excler JL , Sahastrabuddhe S, et al. (2019) Spatial and This study disagree with results of Bhan MK, et al. (2002); Vollaard Temporal Patterns of Typhoid and Paratyphoid Fever Outbreaks: A Worldwide Review, AM, et al. (2005) and Alavi SM, et al. (2010) in Delhi, India; Jakarta, 1990-2018. Clin Infect Dis 69:S499-S509. Indonesia and Ahvaz, Iran, respectively. They found that H. pylori 9. World Helath Organization (2013) Country Cooperation Strategy for WHO and Iraq seropositivity were significantly linked with an enlarged risk of Typhoid 2012-2017. (1st edtn), Regional Office for the Eastern Mediterranean. fever [10,11,17]. Vollaard AM, et al. (2005) evaluated the association 10. Bhan MK, Bahl R, Sazawal S (2002) Association between Helicobacter pylori infection as the Salmonella could affect gastric acid production and as a result and increased risk of typhoid fever. J Infect Dis 186: 1857-1860. boost vulnerability to Salmonella typhi invasion. H. pylori infection can 11. Vollaard AM, Ali S, Widjaja S, Asten HA, Visser LG, et al. (2005) Identification contributes significantly to gastric microbiota dysbiosis [18]. There is of typhoid fever and paratyphoid fever cases at presentation in outpatient clinics in relative between H. pylori infection and other diseases, for example, Jakarta, Indonesia. Trans R Soc Trop Med Hyg 99: 440-450. in Iraq, Tawfeeq et al. (2019) demonstrate correlation between type II 12. Mohammed FH, Elhag WI, Abdallha H, Ali H (2015) Association between Helicobacter diabetes mellitus and H. pylori infection [19]. pylori infection and increased risk of typhoid fever in Khartoum- Sudan. Journal of Biomedical and Pharmaceutical Research 4: 118-122. All of these differences in the previous results could as a results of 13. Khorshed MB, Azeez A, AL-Shagi ASH (2019) Evaluation of Prevalence of the Varity in targeted populations, health, and sample size. Metabolic Syndrome: In The Kirkuk Hospitals Reviewers from Employees Associated with H. pylori AB Test as a Case Study. Prensa Med Argent 105: 135. Conclusions 14. Yu Y, Cai J, Song Z, Wang J, Wu L (2019) Association of Helicobacter pylori infection Our study indicates that H. pylori seropositive dyspepsia more with metabolic syndrome in aged Chinese females. Experimental and Therapeutic vulnerable to typhoid fever particularly in female and 40s ages and Medicine 17: 4403-4408. suggest there was insignificant relationship amongst seropositivity of 15. Cotticelli L, Borrelli M, d’Alessio AC, Menzione M, Villani A et al. (2006) Central H. pylori and typhoid fever within dyspepsia patient. More studies in serous chorioretinopathy and Helicobacter pylori. European journal of ophthalmology different populations and disease are needed. 16: 274-278. 16. Giannella RA, Selwyn A, Broitman, Zamcheck N (1973) Influence of gastric acidity on References bacterial and parasitic enteric infections. Ann Intern Med 78: 271-276.

1. Khalil MZ (2004) The association of helicobacter pylori infection with coronary artery 17. Alavi SM, Etemadi M, Azmi M (2010) Association between chronic infection disease: Fact or fiction? Saudi J Gastroenterol 10: 132-139. of Helicobacter pylori and typhoid fever in Khuzestan. Scientific Medical Journal 9:107-113. 2. Ernst PB, Peura DA, Crowe SE (2006) The translation of Helicobacter pylori basic research to patient care. Gastroenterology 130:188-206. 18. Guo Y, Zhang Y, Gerhard M, Gao J-J, Mejias-Luque R et al. (2019) Effect of Helicobacter pylori on gastrointestinal microbiota: a population-based study in Linqu, 3. Everhart JE (2000) Recent developments in the epidemiology of Helicobacter pylori. a high-risk area of gastric cancer. Gut 0: 1-10. Gastroenterol Clin North Am 29: 559-578. 19. Tawfeeq RD, Amin ZA, Nuraddin SM, Jalal A, Baiz SKH (2019) Relationship between 4. Carabotti M, D’Ercole C, Iossa A, Corazziari E, Silecchia G, et al. (2014) Helicobacter type II diabetes mellitus and Helicobacter pylori infection in Erbil city. Zanco J Med Sci 23: 43-50.

Prensa Med Argent, Volume 107:1 Pages: 3-3