Association Between Helicobacter Pylori Infection and Intestinal Parasite Infection in River Nile State, Sudan

Among the most common diseases in the world are intestinal parasite infections; an estimated 3.5 billion people are affected, and 450 million people are infected [1]. These infections are considered a serious public health problem as they cause anemia with iron deficiency, retardation of growth in children, and other physical and mental health problems [2]. One example is a pathogenic intestinal protozoon that infects the small and/ or large intestine [3]. Or an intestinal worm, such as Ascaris lumbricoides, Trichuris trichiura, Enterobius vermicularis, and hookworms, which affect people in tropical countries [4]. It is estimated that H. pylori infects more than 50% of the world population [5]. With highest burden among developing countries like those in Africa [6]. G. lamblia has also a worldwide distribution affecting approximately 200 million people globally with 500,000 new cases per year [7].

Besides similar mode of transmission and strong co-relation to socioeconomic levels [8], urease production by H. pylori helps intestinal parasites and bacteria to easily cross the stomach’s acid environment [9]. While infections with this strain of bacteria typically don’t cause symptoms, they can lead to diseases in some people, including peptic ulcers, and an inflammatory condition inside your stomach known as gastritis. Helicobacter pylori are adapted to live in the harsh, acidic environment of the stomach. These bacteria can change the environment around them and reduce their acidity so they can survive [10]. The spiral shape of Helicobacter pylori allows them to penetrate your stomach lining, where they’re protected by mucus and your body’s immune cells are not able to reach them. The bacteria can interfere with your immune response and ensure that they’re not destroyed. This can lead to stomach problems. Helicobacter pylori are mainly transmitted by the oral-fecal route [11]. Gastric adenocarcinoma is heterogeneous cancer. First, it is necessary to distinguish the tumors arising from the gastric proximal stomach (cardia), as most of them are not linked to Helicobacter pylori infection from those found in the distal part of the stomach. Among tumors from the distal stomach, based on histology, it is usual to differentiate two types of cancer lesions: the intestinal type and the diffuse type according to the Lauren classification. Intestinal-type cancer is the most frequent. It corresponds to a slow evolution of the gastric mucosa which becomes atrophic; then intestinal metaplasia appears, followed by dysplasia and ultimately in situ gastric carcinoma and metastatic carcinoma. This is the so-called Correa cascade, which was described before Helicobacter pylori were discovered and appear late in life [12].

A. Study design: Cross-sectional study design.
B. Study area: The study was conducted in river Nile state, Sudan, from April to July 2018.
C. Study population: All individual males and females were infected by the intestinal parasite during the study period.
D. Sampling technique: Stool sample in clean dry container tested by stool ICT antigen.
E. Sampling collection: The sample was collected under the aseptic condition in a clean dry container and examined freshly within minutes.
F. Data collection: Personal and clinical data were collected by direct interviewing questionnaires from each subject and stool sample.
G. Data analysis: Data were analyzed through SPSS version 23.
H. Ethical consideration: Permission to carry out the study was obtained from the College of Health, Elshaikh Abdallah Elbadri University. All specimen donors were examined and informed for the study before the collection of the sample and verbal consent was taken from them.

This is a descriptive cross-sectional study conducted in river Nile state during the period from April to July 2018, to Association between Helicobacter pylori and the intestinal parasite was collected data, out of the 50 patients tested 10 were Helicobacter pylori and intestinal parasite positive, 40 patients with an intestinal parasite and negative Helicobacter pylori; (Tables 1-5).

Table 1:Distribution of study group according to gender.

Table 2:Distribution of study group according to age.

Table 3:Distribution of Helicobacter pylori in study group.

Table 4:Frequency of Parasitic infection among study group.

Table 5: Relationship between Helicobacter pylori and Parasites.

This study was conducted on 50 patients infected with intestinal parasites to detect Helicobacter pylori infection; the positive Helicobacter pylori infection was detected by using Immuno-a chromatography test antigen. The study shows that distribution of gender, male 33 (66%) and female 17 (34%) the age between less than 10 to more than 40 years, and parasite infection distribution found in the study Entamoeba histolytica 58%, Giardia lamblia 36% and Hymenolepis nana 6%. 10 patients with an intestinal parasite and Helicobacter pylori and 40 patient negative Helicobacter pylori and positive intestinal parasite in our study we found that E. histolytica and Giardia Lamblia are the most common intestinal parasites found with Helicobacter pylori among another intestinal parasite. in a previous study done by Kazeman H et al. [13] relationship between Helicobacter pylori infection in Ilam iran 2014. A total of 130 patients with 65 positives of Helicobacter pylori and intestinal parasite infection based on ELIASA the parasite was found Giardia lamblia 30.7% and Entamoeba histolytica 10% [13]. In another study done by Seid A et al. [14] co-infection of intestinal parasites and Helicobacter pylori in a hospital in northeast Ethiopia in 2015, Resulted: in a total of 363 patient consecutive adults based on serological ICT test Helicobacter pylori and intestinal parasite detection in 225 (70.5%) Giardia lamblia 22.3%of isolated parasite (p=0.05) [14]. also, a study done by Torres J et al. [15] association of intestinal parasites and Helicobacter pylori in children and adults from a Mexican community in 2003 study population included 120 children and 88 adult from a low socioeconomic level village determined by serum ELISA parasite infection by microscope examination [15]. Result; by contrast, adults with intestinal parasite infection had significantly lower Helicobacter pylori prevalence than adults without the parasite 62.6%) (p=0.006). also, the male and female percentage was analyzed and found that males are more infected than females, with a most patients infected in age (20-30) years the relationship between Helicobacter pylori and intestinal parasite is very weak Helicobacter pylori (P=0.91)..

The study concluded that Helicobacter pylori infection was detected in meager value with 10 positive samples from 50 samples among whom that infected with intestinal parasite revealing that there was no significant association between Helicobacter pylori and intestinal parasite with [P=0.91].

1. Jayalakshmi S, Dharanidevi S (2016) The prevalence of intestinal parasitic infections in a tertiary care hospital in southern India-a retrospective study. Int J Curr Microbiol App Sci 5(10): 718-723.
2. Okyay P, Ertug S, Gultekin B (2004) Intestinal parasites prevalence and related factors in school children, a western city sample Turkey. BMC Public Health 4(64).
3. Farthing MJ, Kelly P (2005) Protozoal gastrointestinal infections. Medicine 33(4): 81-83.
4. Smyth JD (1990) Foundations of parasitology. In: Schmidt GD, Roberts LS (Eds.), (4^th edn), Parasitology Today 6(3): 89.
5. World Gastroenterology Organization Global Guideline (2011) Helicobacter pylori in developing countries. J Dig Dis 12(5): 319-326.
6. Olokoba A, Gashau W, Bwala S, Adamu A, Salawu FK (2013) Helicobacter pylori infection in Nigerians with dyspepsia. Ghana Med J 47(2): 79-81.
7. Ivanov AI (2010) Giardia and giardiasis. Bulgarian J Vet Med 13(2): 65-80.
8. Yakoob J, Jafari W, Abid S, Tafari N, Hamid S, et al. (2005) Giardiasis in patient with dyspeptic symptoms. World J Gastra enteral 11(42): 6667-66705.
9. David TJ, William AP, Markell EK, Vege S (2006) Medical parasitology, Saunders Elsevier, New York, USA.
10. Marshall B, Warren JR (1984) Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. The Lancet 323(8390): 1311-1315.
11. Sanganabhatla D, Sunder RS. Pylori related peptic ulcer disease-overview.
12. Mégraud F, Bessède E, Varon C (2015) Helicobacter pylori infection and gastric carcinoma. Clinical Microbiology and Infection 21(11): 984-990.
13. Kazemian H, Heidari H, Kardan YJ, Shavalipour A, Ghafourian S, et al. (2016) Relationship between Helicobacter pylori infection and parasitic infection in patients in Ilam. Infect Epidemiol Med 2(2): 15-17.
14. Seid A, Tamir Z, Kasanew B, Senbetay M (2018) Co-infection of intestinal parasites and Helicobacter pylori among upper gastrointestinal symptomatic adult patients attending Mekanesalem Hospital, northeast Ethiopia. BMC Research Notes 11(1): 144.
15. Torres J, Perez GP, Ximenez C, Muñoz L, Camorlinga PM (2003) The association of intestinal parasitosis and pylori infection in children and adults from a Mexican community with high prevalence of parasitosis. Helicobacter 8(3): 179-185.