title: Helicobacter pylori infection and typhoid fever in Jakarta, Indonesia.
abstract: 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 > or =25 or > 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.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
authors.forename: A M
authors.initials: AM
authors.lastname: Vollaard
authors.forename: H W
authors.initials: HW
authors.lastname: Verspaget
authors.forename: S
authors.initials: S
authors.lastname: Ali
authors.forename: L G
authors.initials: LG
authors.lastname: Visser
authors.forename: R A
authors.initials: RA
authors.lastname: Veenendaal
authors.forename: H A G H
authors.initials: HA
authors.lastname: Van Asten
authors.forename: S
authors.initials: S
authors.lastname: Widjaja
authors.forename: Ch
authors.initials: Ch
authors.lastname: Surjadi
authors.forename: J T
authors.initials: JT
authors.lastname: Van Dissel
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004781:Environmental Exposure; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D005755:Gastrins / Q000097:blood; D016481:Helicobacter Infections / Q000150:complications*; D006801:Humans; D006920:Hygiene; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012485:Salmonella typhi / Q000472:pathogenicity; D014435:Typhoid Fever / Q000453:epidemiology* / Q000209:etiology*
chemical_list: D005755:Gastrins; D007070:Immunoglobulin A; D007074:Immunoglobulin G