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Concomitant Infection of Helicobacter pylori and Intestinal Parasites in Adults Attending a Referral Centre for Parasitic Infections in North Eastern Italy.

ABSTRACT: BACKGROUND:Helicobacter pylori and intestinal parasites are estimated to infect with high burden worldwide. However, their concomitant infections are poorly determined in industrialized countries, such as Italy. In this study we aim at describing the presence of H. pylori as well as the proportion of coinfections with intestinal parasites among subjects who attended a referral center for tropical diseases in Northern Italy. METHODS:This was a case-control study. Screening for H. pylori and parasites was performed on stool samples of 93 adults from different geographical origin (Africa, Asia, South-America, East-Europe and Italy). H. pylori infection was examined by CLIA and its cagA positivity was determined by rtPCR. Intestinal parasites (i.e., protozoa and helminths) were examined by microscopy and rtPCR. RESULTS:Sixty-one out of 93 patients (66%) were positive to H. pylori and 31 (33%) were cagA+. Among H. pylori positives, 45 (74%) had a concomitant infection. The coinfection H. pylori-Blastocystis was the most frequent one, followed by H. pylori-E. coli. Multivariable logistic regression showed that positivity to H. pylori was associated with having a coinfection. CONCLUSION:Our data suggested that H. pylori and intestinal parasitic infections are fairly common in subjects who attended a referral center for tropical diseases in Northern Italy. The high rate of H. pylori infection, and especially the positivity to the virulent cagA+, should be taken into consideration in subjects undergoing screening for parasitic infections.

SUBMITTER: Pomari E

PROVIDER: S-EPMC7465117 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Concomitant Infection of <i>Helicobacter pylori</i> and Intestinal Parasites in Adults Attending a Referral Centre for Parasitic Infections in North Eastern Italy.

Pomari Elena E Ursini Tamara T Silva Ronaldo R Silva Ronaldo R Leonardi Martina M Ligozzi Marco M Angheben Andrea A

Journal of clinical medicine 20200724 8

<h4>Background</h4><i>Helicobacter pylori</i> and intestinal parasites are estimated to infect with high burden worldwide. However, their concomitant infections are poorly determined in industrialized countries, such as Italy. In this study we aim at describing the presence of <i>H. pylori</i> as well as the proportion of coinfections with intestinal parasites among subjects who attended a referral center for tropical diseases in Northern Italy.<h4>Methods</h4>This was a case-control study. Scre ...[more]

PMID: 32722134

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Project description:AimTo compare the Helicobacter pylori (H. pylori) eradication rate of clarithromycin-based triple therapy, metronidazole-based triple therapy, sequential therapy and concomitant therapy.MethodsA total of 680 patients infected with H. pylori were divided into 4 groups and each group was treated with a different eradication therapy. Clarithromycin-based triple therapy was applied to the first group [rabeprazole, amoxicillin and clarithromycin (PAC) group: proton pump inhibitor (PPI), amoxicillin, clarithromycin], whereas the second group was treated with metronidazole-based triple therapy [rabeprazole, amoxicillin and metronidazole (PAM) group: PPI, amoxicillin, metronidazole]. The third group was treated with rabeprazole and amoxicillin, followed by rabeprazole, clarithromycin and metronidazole (sequential group). The final group was simultaneously treated with rabeprazole, amoxicillin clarithromycin and metronidazole (concomitant therapy group). In the case of a failure to eradicate H. pylori, second-line quadruple and third-line eradication therapies were administered.ResultsThe per protocol (PP) analysis was performed on 143, 139, 141 and 143 patients in the PAC, PAM, sequential and concomitant groups, respectively. We excluded patients who did not receive a C(13)-urea breath test (22, 20, 23 and 22 patients, respectively) and patients with less than an 80% compliance level (5, 11, 6 and 5 patients, respectively). The eradication rates were 76.2% (109/143) in the PAC group, 84.2% (117/139) in the PAM group, 84.4% (119/141) in the sequential group and 94.4% (135/143) in the concomitant group (P = 0.0002). All 14 patients who failed second-line therapy were treated with third-line eradication therapy. Among these 14 patients, 6 infections were successfully eradicated with the third-line therapy. Both PP and intention-to-treat analysis showed an eradication rate of 42.9% (6/14). In the PAC group, 3 of 4 patients were successfully cured (3/4, 75%); 2 of 2 patients in the PAM group (2/2, 100%) and 1 of 5 patients in the sequential group (1/5, 20%) were also cured. In the concomitant group, all 3 patients failed (0/3, 0%).ConclusionThe eradication rate for the concomitant therapy was much higher than those of the standard triple therapy or sequential therapy (ClinicalTrials.gov number NCT01922765).

Project description:Helicobacter pylori (H. pylori) classified as a class I carcinogen by the World Health Organization (WHO) plays an important role in the progression of chronic gastritis and the development of gastric cancer. A major bioactive component of Evodia rutaecarpa, evodiamine, has been known for its anti-bacterial effect and anti-cancer effects. However, the inhibitory effect of evodiamine against H. pylori is not yet known and the inhibitory mechanisms of evodiamine against gastric cancer cells are yet to be elucidated concretely. In this study, therefore, anti-bacterial effect of evodiamine on H. pylori growth and its inhibitory mechanisms as well as anti-inflammatory effects and its mechanisms of evodiamine on H. pylori-induced inflammation were investigated in vitr. Results of this study showed the growth of the H. pylori reference strains and clinical isolates were inhibited by evodiamine. It was considered one of the inhibitory mechanisms that evodiamine downregulated both gene expressions of replication and transcription machineries of H. pylori. Treatment of evodiamine also induced downregulation of urease and diminished translocation of cytotoxin-associated antigen A (CagA) and vacuolating cytotoxin A (VacA) proteins into gastric adenocarcinoma (AGS) cells. This may be resulted from the reduction of CagA and VacA expressions as well as the type IV secretion system (T4SS) components and secretion system subunit protein A (SecA) protein which are involved in translocation of CagA and VacA into host cells, respectively. In particular, evodiamine inhibited the activation of signaling proteins such as the nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB) and the mitogen-activated protein kinase (MAPK) pathway induced by H. pylori infection. It consequently might contribute to reduction of interleukin (IL)-8 production in AGS cells. Collectively, these results suggest anti-bacterial and anti-inflammatory effects of evodiamine against H. pylori.

Dataset Information

Concomitant Infection of Helicobacter pylori and Intestinal Parasites in Adults Attending a Referral Centre for Parasitic Infections in North Eastern Italy.

Publications

Concomitant Infection of <i>Helicobacter pylori</i> and Intestinal Parasites in Adults Attending a Referral Centre for Parasitic Infections in North Eastern Italy.

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