Helicobacter pylori infection and typhoid fever in Jakarta, Indonesia

• Published in: Epidemiology and infection Vol. 134; no. 1; pp. 163 - 170
• Main Authors: VOLLAARD, A. M., VERSPAGET, H. W., ALI, S., VISSER, L. G., VEENENDAAL, R. A., VAN ASTEN, H. A. G. H., WIDJAJA, S., SURJADI, CH, VAN DISSEL, J. T.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-02-2006
• Subjects: Achlorhydria; Acids; Adolescent; Adult; Age; Antibodies; Bacteriology; Biological and medical sciences; Blood plasma; Case-Control Studies; Developing countries; Environmental Exposure; Female; Fever; Fundamental and applied biological sciences. Psychology; Gastric Acid - secretion; Gastric juice; Gastrins - blood; Gastritis; Helicobacter Infections - complications; Helicobacter pylori; Households; Humans; Hygiene; Immunoglobulin A - analysis; Immunoglobulin G - analysis; Indonesia - epidemiology; Infections; Infectious diseases; LDCs; Male; Medical research; Microbiology; Middle Aged; Miscellaneous; Plasma; Predisposing factors; R&D; Research & development; Risk Factors; Salmonella; Salmonella typhi; Salmonella typhi - pathogenicity; Secretion; Tropical diseases; Typhoid; Typhoid fever; Typhoid Fever - epidemiology; Typhoid Fever - etiology; Asia; Indonesia; Jakarta Indonesia; Netherlands; Infection; Human; Spirillales; Helicobacter pylori; Microbiology; Bacteriosis; Spirillaceae; Digestive diseases; Bacteria; Salmonellosis; Typhoid; Epidemiology
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268805004875

We evaluated the association between typhoid fever and Helicobacter pylori infection, as the latter microorganism may influence gastric acid secretion and consequently increase susceptibility to Salmonella typhi infection. Anti-H. pylori IgG and IgA antibody titres (ELISA) and gastrin concentration (RIA) were determined in the plasma of 87 blood culture-confirmed typhoid fever cases (collected after clinical recovery) and 232 random healthy controls without a history of typhoid fever, in the Jatinegara district, Jakarta. Patients with typhoid fever more often than controls were seropositive for H. pylori IgG (67% vs. 50%, P<0·008), when antibody titres were dichotomized around median titres observed in controls. H. pylori IgA seropositivity was not associated with typhoid fever. Plasma gastrin concentrations indicative of hypochlorhydria (i.e. gastrin ⩾25 or ⩾100 ng/l) were not significantly elevated in typhoid fever cases compared to controls (P=0·54 and P=0·27 respectively). In a multivariate analysis, typhoid fever was independently associated with young age (<33 years, median age of the controls) [odds ratio (OR) 7·93, 95% confidence interval (CI) 3·90–16·10], and H. pylori IgG seropositivity (OR 1·93, 95% CI 1·10–3·40). Typhoid fever was independently associated with H. pylori IgG seropositivity, but not with elevated gastrin concentration. Therefore, the association suggests a common risk of environmental exposure to both bacteria, e.g. poor hygiene, rather than a causal relationship via reduced gastric acid production.