Effect of concurrent infection of Helicobacter pylori with Toxoplasma gondii infection on gastric pathology - BMC ... - BMC Infectious Diseases

The global prevalent H. pylori infection is known to have the potential rise to various complications in the gastroduodenal region, including cancer development [2]. However, its successful eradication is predicted to decrease the occurrence of gastric cancer significantly (GC) [20].

The present study revealed a substantial prevalence rate of 75.6% and 67% among symptomatic patients who sought medical care at the Outpatient Clinics of the Gastroenterology unit at NLI using H. pylori antigen in stools and histopathological examination as diagnostic procedures, respectively. These findings were close to a recent study by Kishk et al. [22] and reports from Africa, which exhibited the highest prevalence of H pylori infection, with a rate of 70.1%. In contrast, Oceania demonstrated the lowest prevalence, with a rate of 24.4%. The prevalence also exhibited significant variation among different countries, ranging from a minimum of 18.9% in Switzerland to a maximum of 87.7% in Nigeria [19].

The variations in infection rates were attributed to differences in research methodology, participant diversity and inclusion criteria, number of participants, and approaches used for detecting H. pylori [15].

In the present study, the assessment of infection with H. pylori was conducted using different diagnostic procedures for symptomatic patients. Our study revealed false positive results detected by the SAT exhibited and were negative in gastric biopsies. These results contrasted with a recent study conducted in Uganda, which emphasized the exceptional role of the SAT in detecting H. pylori in regions with a high prevalence of the disease Owot et al. [24] and agreed with the results of Zubair et al. [33] who reported the limited sensitivity and diagnostic accuracy of the HPSA test.

The study found that several socio-demographic variables were associated with H. pylori infection. These variables included increasing age, residing in rural areas, and lower educational level, which agreed with previously studied risk factors for infection in earlier studies in Egypt and African countries [3, 15]. Abdominal pain and dyspepsia were the presenting symptoms of most cases in the current work, which agreed with many researchers as they contributed to many cases of infection with H. pylori [15, 22].

In our study, screening for the virulent strains of H. pylori was done for patients with positive immune staining; 37/55 (67%) patients had isolated Vac As1 variant, 11/55 (20%) patients had combined Vac As1 and Cag A variants and 7 /55 ( 12.7%) patients had combined Vac As1, Cag A and Vac As2 variants. Similar results were obtained by Kishk et al. [22], who showed that all strains with the CagA gene were VacA gene positive.

Concerning the genotypes of CagA and VacA, it was observed that the VacA s1 allele, which was the most prevalent, agreed with a prior investigation conducted on patients from Cuba; the presence of the VacA gene was observed in 61.6% of the H. pylori strains examined, with this gene being identified as the predominant virulence factor in most of the strains [13]. Nevertheless, the findings of this study opposed the previous research conducted by Kishk et al. [22] [12], where they observed that the VacA+/CagA − genotype s1 had the lowest prevalence. Conversely, a separate study conducted in Algeria revealed the presence of the CagA gene in 58% of the examined patients [5].

Interestingly, CagA + was not found in our study as a single genotype. It was rather linked to VacA s1 in (11/55) or to Vac As2 alle in (7/55) patients, and this was consistent with [22]. Additionally, the lower percentage of the VacA s2 genotype is considered a less virulent form as compared with the acutely damaging VacA s1, as stated by Falsafi et al. [12]. This study investigated the association between the VacA and CagA genotypes and clinical outcomes, as endoscopic results showed. Patients with the combined 2 or 3 variances showed significantly deteriorated histopathological features than patients with a single Vac As1 variant (P < 0.05).

The significant impact of association of H. pylori and T. gondii on gastric inflammation severity was reported in this study, which is documented for the first time based on research on different databases.

The potential correlation between H. pylori and T. gondii was investigated in the context of gastritis and the development of peptic ulcers. The observed correlation can be attributed to the fecal-oral route, a frequently seen infection pathway for both pathogens. The elevated rates of H. pylori discovery in feline fecal samples have prompted consideration of potential zoonotic transmission of these infections [6, 16].

In earlier studies, the co-infection of H. pylori with either Ascaris lumbricoides or T. gondii resulted in modified H. pylori gastritis in mouse experimental models [10]. The present study's findings indicate that among a cohort of 31 individuals who were simultaneously infected with both H. pylori and T. gondii, a substantial majority (80.6%) experienced gastritis of moderate to severe intensity. The results were in line with Ghazy et al. [16].

This report presents novel findings regarding the impact of toxoplasmosis on the severity of gastritis in humans. Specifically, it is the first documented record to investigate and compare patients with isolated H. pylori infection and those with combined H. pylori and T. gondii infection. The results indicated that patients with combined infections exhibited significantly more advanced inflammation stages than patients with isolated infections (P < 0.05). However, when examining the relationship between the titer of Toxoplasma antibodies and the stage of chronic inflammation (r = 0.167, P = 0.395) as well as the degree of activity (r = 0.103, P = 0.600), no statistically significant association was seen for either variable. The findings of this study were incongruent with the research conducted by Ghazy et al. [16] since their study demonstrated a positive correlation between the severity of gastritis cases and elevated levels of serum anti-Toxoplasma IgG.

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