Diagnosis of Helicobacter pylori Infection in Low Out-Outcome Country: Rapid Urease Test, Serological Test, versus Direct Microbiological Examination with Gram Stain
Introduction: Helicobacter pylori is a gram-negative bacillus responsible for numerous gastroduodenal pathologies, and this infection is a public health problem. The prevalence of infection with this bacterium remains high in countries with limited resources. Diagnosis relies mainly on numerous invasive and noninvasive methods. The aim of this work was to evaluate the different indirect diagnostic methods using bacterial cultures. Methods: We conducted a cross-sectional and analytical study from January to May 2022 in the gastroenterology departments of Douala General Hospital and Douala Military Hospital. All patients aged 18 years and older who were in the gastroenterology consultation and agreed to participate were included in our study. Sociodemographic, clinical, and paraclinical data were collected. Urease, liquid urea, and culture tests were performed from the specimens obtained by fibroscopy. Serological tests were performed on the blood sample. Results: 101 patients were included, 58 were female and 43 were male, for a sex ratio of 1.3. The mean age was 44.2 ± 16 years. The prevalence of infection was 90.5%, 44.1%, 40.6% and 21.8% for serology, direct microbiological examination, RUT (rapid urea test) and culture, respectively. Comparison of the different tests showed sensitivity and specificity of 67.1% and 64%, respectively, for RUT, 100% and 73.7%, respectively, for direct microbiological examination, and 100% and 14.8%, respectively, for serology. The positive and negative predictive values were 39.5% and 100% for serology, 39% and 85% for RUT, and 55.6% and 100% for direct microbiological examination, respectively. Conclusion: The prevalence of Helicobacter pylori infection depends on the type of test used. Direct examination is more reliable than RUT and serology.
References
[1]
Warren, J.R. and Marshall, B. (1983) Unidentified Curved Bacilli on Gastric Epithelium in Active Chronic Gastritis. The Lancet Journal, 321, 1273-1275. https://doi.org/10.1016/S0140-6736(83)92719-8
[2]
McColl, K.E.L. (2010) Helicobacter pylori Infection. The New England Journal of Medicine, 362, 1597-1604. https://doi.org/10.1056/NEJMcp1001110
[3]
Goodwin, C.S., Mendall, M.M. and Northfield, T.C. (1997) Helicobacter pylori Infection. The Lancet, 349, 265-269. https://doi.org/10.1016/S0140-6736(96)07023-7
[4]
Stefano, K., Marco, M., Federica, G., Laura, B., Barbara, B., Gioacchino, L., et al. (2018) Helicobacter pylori, Transmission Routes and Recurrence of Infection: State of the Art. Acta Biomedica Atenei Parmensis, 89, 72-76.
[5]
Go, M.F. (2002) Natural History and Epidemiology of Helicobacter pylori Infection. Alimentary Pharmacology & Therapeutics, 16, 3-15. https://doi.org/10.1046/j.1365-2036.2002.0160s1003.x
[6]
Mezmale, L., Coelho, L.G., Bordin, D. and Leja, M. (2020) Review: Epidemiology of Helicobacter pylori. Helicobacter, 25, e12734. https://doi.org/10.1111/hel.12734
[7]
Kotilea, K., Bontems, P. and Touati, E. (2019) Epidemiology, Diagnosis and Risk Factors of Helicobacter pylori Infection. In: Kamiya, S. and Backert, S., Eds., Helicobacter pylori in Human Diseases: Advances in Microbiology, Infectious Diseases and Public Health, Springer International Publishing, New York, 17-33. https://doi.org/10.1007/5584_2019_357
[8]
Agbor, N.E., Esemu, S.N., Ndip, L.M., Tanih, N.F., Smith, S.I. and Ndip, R.N. (2018) Helicobacter pylori in Patients with Gastritis in West Cameroon: Prevalence and Risk Factors for Infection. BMC Research Notes, 11, Article No. 559. https://doi.org/10.1186/s13104-018-3662-5
[9]
Kouitcheu Mabeku, L.B., Noundjeu Ngamga, M.L. and Leundji, H. (2018) Potential Risk Factors and Prevalence of Helicobacter pylori Infection among Adult Patients with Dyspepsia Symptoms in Cameroon. BMC Infectious Diseases, 18, Article 278. https://doi.org/10.1186/s12879-018-3146-1
[10]
Andoulo, F.A., Noah, D.N., Tagni-Sartre, M., Ndjitoyap Ndam, E.C. and Blackett, K.N. (2013) Epidémiologie de l’infection à Helicobacter pylori à Yaoundé: De la particularité à l’énigme Africaine. The Pan African Medical Journal, 16, 115. https://doi.org/10.11604/pamj.2013.16.115.3007
[11]
Andoulo, F.A., Ngatcha, G., Tagni-Sartre, M., Sida, M.B. and Ndam, E.N. (2015) Helicobacter pylori Infection and Peptic Ulcer Disease in Children and Adolescents from the Age Range of 6 to 18 Years Old in Yaounde (Cameroon). Health Sciences and Disease, 16, 1-6.
[12]
Lee, Y.C., Dore, M.P. and Graham, D.Y. (2022) Diagnosis and Treatment of Helicobacter pylori Infection. Annual Review of Medicine, 73, 183-195. https://doi.org/10.1146/annurev-med-042220-020814
[13]
Guevara, B. and Cogdill, A.G. (2020) Helicobacter pylori: A Review of Current Diagnostic and Management Strategies. Digestive Diseases and Sciences, 65, 1917-1931. https://doi.org/10.1007/s10620-020-06193-7
[14]
Heluwaert, F. (2022) Helicobacter Pylori: Diagnostic, Indications et modalités d’éradication. FMC Post'U, 2022, 85-94.
[15]
Werme, K., Bisseye, C., Ouedraogo, I., Yonli, A.T., Ouermi, D., Djigma, F., et al. (2015) Diagnostic moléculaire d’helicobacter pylori par PCR chez les patients en consultation gastroentérologique au Centre Médical Saint Camille de Ouagadougou. The Pan African Medical Journal, 21, Article 123. https://doi.org/10.11604/pamj.2015.21.123.6001
[16]
Chey, W.D., Leontiadis, G.I., Howden, C.W. and Moss, S.F. (2017) ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. American Journal of Gastroenterology, 112, 212-239. https://doi.org/10.1038/ajg.2016.563
[17]
Delarras, C. (2007) Microbiologie pratique pour le laboratoire d’analyses et de contrôle sanitaire. Lavoisier, Paris.
[18]
Kpossou, A.R., Kouwakanou, H.B., Ahouada, C., Vignon, R.K., Sokpon, C.N.M., Zoundjiekpon, V., et al. (2021) Infection par Helicobacter pylori: Prévalence et facteurs associés dans une population tout venant d’après une recherche par test respiratoire à l’urée marquée au carbone 14. The Pan African Medical Journal, 40, Article 266. https://doi.org/10.11604/pamj.2021.40.266.22378
[19]
Gudina, E.K., Amare, H., Ali, S., Berhane Arefayine, M., Tewolde, D., Tesfaye Eshete, M., et al. (2022) Diagnostic Challenges of Helicobacter pylori Infection in Ethiopia: A Community-Based Cross-Sectional Study. Canadian Journal of Gastroenterology and Hepatology, 2022, Article ID: 4013020. https://doi.org/10.1155/2022/4013020
[20]
Sabbagh, P., Mohammadnia-Afrouzi, M., Javanian, M., Babazadeh, A., Koppolu, V., Vasigala, V.R., et al. (2019) Diagnostic Methods for Helicobacter pylori Infection: Ideals, Options, and Limitations. European Journal of Clinical Microbiology & Infectious Diseases, 38, 55-66. https://doi.org/10.1007/s10096-018-3414-4
[21]
Lee, J.Y. and Kim, N. (2015) Diagnosis of Helicobacter pylori by Invasive Test: Histology. Annals of Translational Medicine, 3, 10.
[22]
Redéen, S., Petersson, F., Törnkrantz, E., Levander, H., Mårdh, E. and Borch, K. (2011) Reliability of Diagnostic Tests for Helicobacter pylori Infection. Gastroenterology Research and Practice, 2011, Article ID: 940650. https://doi.org/10.1155/2011/940650
[23]
Van Horn, K.G. and Dworkin, B.M. (1990) Direct Gram Stain and Urease Test to Detect Helicobacter pylori. Diagnostic Microbiology and Infectious Disease, 13, 449-452. https://doi.org/10.1016/0732-8893(90)90075-7
[24]
Oyedeji, K.S., Smith, S.I., Arigbabu, A.O., Coker, A.O., Ndububa, D.A., Agbakwuru, E.A., et al. (2002) Use of Direct Gram Stain of Stomach Biopsy as a Rapid Screening Method for Detection of Helicobacter pylori from Peptic Ulcer and Gastritis Patients. Journal of Basic Microbiology, 42, 121-125.
