Relationship Between Helicobacter Pylori Seropositive Patients And Throat Infection

ABSTRACT

The most common complaint among patients in the out-patient clinics are sore

throat, and the most frequent diagnosis is chronic non-specific pharyngitis. Chronic

pharyngitis is still controversial. Helicobacter pylori, besides being the major cause

of chronic gastritis, might also be involved in playing role in the upper respiratory

tract infection.

This study aimed to determine the relationship between H. pylori infection and

throat infection and its possible role in the etiology and pathogenesis of bacterial

pharyngitis and tonsillitis. This was achieved by determination of antibody titer in

patients with H. pylori infection. Not only that but also the presence of Streptococcus

pyogenes, the main pathogen involved in throat infection, was investigated via

culturing, and the assessment of the relationship between H. pylori infection and the

aggravation of the sore throat infection.

From volunteers questionnaire data and three hundred and seven samples of throat

swabs from tonsils and aurophaynx were collected and cultured from H. pylori

seropositive and apparently healthy people. Conventional bacteriological methods

were applied for isolation of bacteria among which is Streptococcus pyogenes.

Pathogenic sore throat causing bacteria were isolated from 74% tonsils and 76.3%

pharynx of whole samples. 78.2% individuals had pathogenic bacteria in tonsil and

auropharynx, but clinical respiratory signs were observed only in 9.7% of the whole

individuals. Streptococcus pyogenes was the most predominant bacteria, PCR was

conducted to confirm their identity, and dependingly 14..% of them were detected

by PCR using spy1258 primer.Three hundred and seven blood samples were also collected from the same participants correspondingly for the determination of Anti-Helicobacter pylori IgG and IgA measurement. So that, IgG titer was found to be significantly correlated with IgA ratio (at 99% confident interval, 2 tailed). In this study H. pylori positive cases were found to be significantly correlated with upper digestive tract signs (at 99% confident interval, 2 tailed). Besides the upper digestive tract illness signs were correlated with sore throat (at 95% confident interval, 2 tailed).

This study revealed a significant correlation between H. pylori infection and sore

throat, theoretically due to the accompanied laryngeopharyngeal reflux which in

turn reduces the throat pH enhancing the condition for S. pyogenes and other acidic

pH tolerant pathogens. The results showed that the prevalence of H. pylori infection

in our population is quite high (88.2%), this infer that the infection is elevated in

Sudan during last years and expected to keep increasing unless further studies and

solutions applied. S. pyogenes has been found to be the most causative agent of

bacterial sore throat in Sudan whether it is related to H. pylori infection or not. In

spite of commonly using ICT rapid test for H. pylori diagnosis in Sudanese labs and

Hospitals, our study revealed the ICT antibody-based is not very reliable.

It is recommended to search the correlation between H. pylori positive infection and

viral throat infection because it is also frequent than bacterial throat infection.

Testing this research hypothesis should be followed depending on isolation of H.

pylori, instead of conducting serological tests, with the isolation of S. pyogenes. The

reuse of same antibiotics against H. pylori must be eschewed to avoid bacterial

resistance. Such resistance is common in patients who had previous antibiotic

treatment. Humoral immunity does not protect against H. pylori cellular does protect

(Kuster et al, 2009). Further research in cellular immunity of H. pylori is needed. It

is essential to develop a new PCR primer, specific for Streptococcus pyogenes and

sensitive for its all strains to replace spy1258 primer. ICT method of H infection diagnosis should be avoided and replaced by more trusted methods.