Research Letters
Seroprevalence ofHelicobacter pylori Infection in Children in Northwest Region of Turkey: Relationship
with Iron Deficiency Anemia
Helicobacter pylori infection shows worldwide dis-tribution, predominantly in countries or regions with poor socioeconomic conditions [1]. Recently, inves-tigators focused on the role of H. pylori, in the development of extragastrointestinal diseases, includ-ing iron deficiency anemia (IDA) [2, 3]. IDA is common in the world and its frequency was reported as 37% in Duzce [4] and 6.5–33% [5] in other regions of Turkey, in children. Despite of studies supporting the role of H. pylori infection in the development of IDA [2, 6–10], some studies from developing countries failed to find such association [11–14] and the development of IDA was explained with mal-nutrition which leads inadequate iron intake besides reduces in the gastric acid barrier that allows bacterial colonization [15]. This study was designed with the aim of investigating H. pylori seroprevalence in children, in Duzce, the northwest region of Turkey and the association with IDA development.
A total of 288 asymptomatic children (aged 6 months to 17 years), were screened for anti-H.pylori IgG with ELISA (IBL, Germany) and for IDA. Children were first applied a questionnaire and venous blood was drawn for antibody testing, complete blood count and biochemical tests. The subjects were divided into three groups based on their ages: Group A (6 months to 6 years, n ¼ 26), Group B (7–12 years, n ¼ 89) and Group C (13–17 years, n ¼56). Data was evaluated by 2test.
From a total of 288 children (125 girls—43.4%, 163 boys—56.6%) with the mean age 11.06 years, overall seropositivity of anti-H. pylori IgG antibodies was 23.9%, increasing with age, 4.4%, 39.1%, 56.5% in Groups A, B and C, respectively (2¼16.27, p <0.001). No statistical difference was present between genders (p > 0.05) and seropositivity was inversely related to economic status (p < 0.01).
Of 69 seropositive objects, 39 (56.5%) were diagnosed as IDA, while the remaining with normal hematological parametres were considered as con-trols. No statistical difference was observed between the groups (2¼2.35, p > 0.05). H. pylori infection prevalences were increasing with age in both groups, 7.7%, 41.0% and 51.3% in Groups A, B, C, respectively, in IDA groups (2¼18.23, p < 0.001) and 0%, 36.7% and 63.3% Groups A, B, C, respectively in controls (2¼27.3, p < 0.001).
Some serological studies conducted in asympto-matic Turkish population showed the overall sero-positivity rates ranging between 30.9% and 78.5%,
in children [16–25]. Our results with 23.9% is slightly lower than other results from Turkey, but shows similarities with the increasing pattern [20, 23].
In conclusion, as our study group predominantly included children with poor socioeconomic condi-tions, inadequate dietary intake of iron is thought to be the leading factor influencing IDA, and our results showing no association between IDA and H. pylori infection may be related with this condition. The growing body of evidence suggesting that H. pylori infection predispose to anemia should expand the scope of investigations, concerning other predispos-ing factors to IDA, especially in developpredispos-ing countries in which both diseases are common.
AYSEDEMETKAYAa, ESRAGENCAYa, CIHADIYEELIFOZTURKa, and TANERYAVUZb
a
Department of Microbiology andbDepartment of Pediatrics, Duzce University, Medical Faculty, Konuralp, Duzce, Turkey doi:10.1093/tropej/fmn028 Advance Access Published on 27 April 2008
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Correspondence: Ayse Demet Kaya. E-mail <ademetkaya@superonline.com>.
Antibody Responses and Resistance against Ascaris lumbricoides Infection among Venezuelan Rural
Children: The Influence of Ethnicity
Summary
We studied the production of anti parasite antibodies and the resistance against A. lumbricoides infection among the school population of three different Venezuelan ethnic groups: Warao Amerindians, Afro- Americans and white ‘Creole’ descendents. The prevalence and intensity of A. lumbricoides were determined before and after 1 year of anthelminthic treat-ment. Parasitic loads were associated to pre-treatment serum levels of anti A. lumbricoides IgE and IgG4 antibodies. The intensity of the infection and the proportion of re-infected children were significantly lower (p < 0.0001) among the Warao Amerindians, exhibiting higher levels of IgE (p < 0.0001) and lower levels of IgG4 (p < 0.0001) compared to their non-Amerindian counterparts. IgE levels corre-lated inversely with the proportion of re-infected children, whereas the levels of IgG4 were positively associated. These results suggest that ethnicity may influence the balance of IgE/IgG4 levels, modulating the intensity of A. lumbri-coides and the resistance to the infection.
Introduction
An atopic condition may favor the production of elevated levels of anti A. lumbricoides IgE, conferring protection against this parasite in rural children [1], whereas elevated anti- parasite IgG4 levels have been associated to high parasitic loads and persistence of the infection [2]. We studied whether differences in ethnicity among distinct groups of rural children would affect the production of these antibodies and their effectiveness on protection against this infection.
Material and Methods
We evaluated 401 school children belonging to three well-defined ethnic groups [3]: Warao Amerindians from the Delta of the Orinoco River, Afro– Americans from the Central coast and white ‘Creole’ from the Venezuelan Andes. The groups shared similar socio-economic conditions and com-parable prevalence of A. lumbricoides (Table 1). Stool examinations were performed by the Kato–Katz technique before and 6 months after 1 year of bi-monthly treatment with Albendazole (400 mg in single dose). Parasitic loads were associated to pre-treatment levels of IgE and IgG4 against A. lumbricoides antigens determined by an ELISA
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