Helicobacter pyloriinfection and typhoid fever in Jakarta, Indonesia

Abstract

SUMMARYWe evaluated the association between typhoid fever andHelicobacter pyloriinfection, as the latter microorganism may influence gastric acid secretion and consequently increase susceptibility toSalmonella typhiinfection. Anti-H. pyloriIgG 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 forH. pyloriIgG (67%vs. 50%,P<0·008), when antibody titres were dichotomized around median titres observed in controls.H. pyloriIgA seropositivity was not associated with typhoid fever. Plasma gastrin concentrations indicative of hypochlorhydria (i.e. gastrin ⩾25 or ⩾100 ng/l) were not significantly elevated in typhoid fever cases compared to controls (P=0·54 andP=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], andH. pyloriIgG seropositivity (OR 1·93, 95% CI 1·10–3·40). Typhoid fever was independently associated withH. pyloriIgG 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.