Haematological Correlates of Helicobacter pylori Infection Amongst Children Receiving Care in a Private Setting in Port Harcourt, Rivers State

Helicobacter pylori is a spiral shaped, gram-negative bacterium that basically colonizes the digestive tract of humans. It is an established cause of anaemia, leucopenia and thrombocytopenia and affects 70-95% of children in developing countries. We carried out a retrospective study of 140 children, presenting with abdominal discomfort and/or vomiting in a private hospital in Port Harcourt, South-South, Nigeria. Positive serology for H.pylori was established using IgG test kit and Full blood counts were done with an autoanalyzer. Sixty four (45.7%) of the children studied were serologically positive for H.pylori infection, while 54.3%(76) were negative. H.pylori was detected in virtually all age groups of children studied. Ten (15.6%) of the children with H.pylori positive serology had anaemia, 3.1%(2) had leucopenia and 12.5%(8) had leucocytosis. None of these was statistically significant. The overall seroprevalence of H.pylori in the children studied was high. Similarly, there was a high prevalence of haematologic derangements in the children with positive H.pylori assay compared to those children with negative serology for H.pylori. This was however not statistically significant. Routine screening of children with symptoms of abdominal discomfort for H.pylori and commencement of treatment for those with positive serology results is not recommended without confirmatory test.


INTRODUCTION
elicobacter Pylori is a spiral shaped, gram negative 1 highly motile bacterium . It was first identified in H 1 1982 and named Campylobacter pylori. However, the nomenclature was changed to Helicobacter pylori in 1989. It colonizes the stomach of children and adolescents, producing urease and lipopolysaccharides, both of which have been found to enhance survival of the 2 organism despite the acidic environment of the stomach . Basically, H.pylori is acquired after birth, Transmission from person to person can be through breastfeeding, oral- 3 to-oral, and oral-faecal transmission . Poor hygienic practices as well as overcrowding has been found to 4 increase the risk of transmission . Other risks of transmission include low socio-economic status, older 5,6 age and proximity with pets . H.pylori colonizes the gastrointestinal mucosa and can cause diarrhea, malabsorption, gastritis, peptic ulcer and [7][8][9][10] in older people gastric carcinoma . | pg. 130 Akhimienho et al., Haematological Correlates of Helicobacter pylori Infection The finding of H.pylori in salivary secretions, dental plaques, tonsils, oesophagus and treated drinking water is a clear indication that there is a possibility of human-tohuman transmission occurring either through the oral- 11 oral or the faeco-oral route . The prevalence of H pylori infection globally is above 50%, with a higher prevalence in developing nations. (70-90% in, developing countries; 12 30-40% in developed countries) . Although H.pylori is an established cause of gastritis and iron deficiency anaemia, its involvement in the 13 haematological system is rather unclear .H.pylori has however been associated with the development of iron deficiency anaemia, Vit B12 deficiency, immune 14 mediated thrombocytopenia and neutropenia . The aim of this study is to determine the prevalence of H.pylori infection amongst children presenting with abdominal pain and vomiting, as well as to determine the possible association between some haematologic parameters and H.pylori in these children. analysed. WBC count of less than 4000 cells/mm was 3 taken as leucopenia, while that greater than 11,000/mm was taken as leukocytosis. PCV values of less than 18%, 24% and 30% were taken as severe, moderate and mild 17 anaemia respectively . The prevalence of H.pylori infection was determined and the statistical significance of the adjusted seropositive rates among comparison groups was also tested. P-value of less than 0.05 was set at level of significance.

RESULTS
One hundred and forty children with a mean age of 10.5 years (SD: ± 4.9), mean weight of 44kg (SD: ± 21), comprising 73 (54.3%) males with a F:M ratio of 1:1.04 had their serum samples tested for IgG antibody reaction to H. pylori. Sixty-four children (45.7%) were serologically positive for H. pylori IgG antibodies while seventy-six (54.3%) were negative. Overall, the mean packed cell volume/ haemoglobin concentration and total white blood cell count among the children included in this study were 35.6% (SD: ± 5.7) or (11.9g/dl; SD: ± 1.9) and 9 6.8 x 10 (SD: 2.75) respectively. H.pylori seropositivity was detected in virtually all paediatric age categories presenting to this facility with gastrointestinal symptoms of recurring abdominal pain, discomfort or vomiting, with an increased proportion noted to be observed among early adolescent age group (figure1). The H. pylori seropositive prevalence was 45.7%. The seroprevalence of H. pylori did not vary by age or sex distribution among the study population. The highest proportion of children that tested positive to H. pylori IgG test were among the 12 -17 years age group when compared to their seronegative counterparts. The least however was among the < 1 -4 years age group. There was no statistically significant mean difference in the mean total white blood cell counts and haemoglobin levels between the H. pylori positivechildren and the H. pylorinegative counterparts (Table2).

Akhimienho et al., Haematological Correlates of Helicobacter pylori Infection
Overall, there was no statistically significant difference in the total WBC count subgroups (leucopenia or leucocytosis) studied among children who were serologically positive for H. pylori IgG antibodies when compared to their serologically negative counterparts. However, female children who were H. pylori seropositive were more likely than their female seronegative counterparts to have anaemia. Although, there was no significant difference in anaemia with regards to sex categories, there was an increasing trend towards worsening degrees of anaemia among children who were H. pylori seropositive when compared to their seronegative counterparts. This, albeit, was not statistically significant. (Table3)   formal education among others The cohort of children in this study, however, were all from the middle and upper socioeconomic class and had parents who were enrolled in various company or privately affiliated health insurance schemes in Port Harcourt Metropolis. In this study it was observed that the prevalence of H. pylori seropositivity increased with age, irrespective of age and sex and was apparently more prevalent among the early adolescent group. This has been similarly 2 29 19 reported by other authors in Nigeria Iran and Uganda , but nevertheless unnoticed in a study among children in 20 East Sudan .Our findings simply exclude gender as a likely element for H. pylori infection in children and seems to agree with other authors who also reported that gender may not play a role in H. pylori infection 22,29,30 acquisition in children . The overall prevalence of anaemia in this study was 10% with a prevalence of 15.6 % in the H.pylori positive group and 6.6% in their H. pylori negative counterparts which was not statistically significant. Interestingly, it was observed that females with H. pylori infection were significantly more likely to have anaemia than their female H. pylori negative counterparts. Our findings were comparable to reports from Ruiz-Alvarez et 31 al ,which assessed the association between H. Pylori infection and anaemia among 269 children in Havana city that showed that despite having higher prevalence of anaemia (20%), the H.pylori infection showed no association with the haemoglobin levels in all the children, yet, a significant association between irondeficiency anaemia and H. pylori infection was found in girls but not in boys. Similarly, in a study by Wewer et 32 al ,which assessed the IgG seroprevalence of H. pylori among 438 Danish children with recurrent abdominal pain, with 91 healthy children control revealed no significant differences among the two groups according to the levels of haemoglobin. Conversely, the findings by 33 Gilbert et al among a cohort of 105 Kenyan children (35 cases and 70 controls), aged 5 -15years, which demonstrated that the mean haemoglobin level among the H. pyloriseropositivecases was significantly lower than their controls, contrasted ours. The authors attributed their findings to the duo-effect of rapid growth and H. pylori infection which may haveresulted in disturbances in iron metabolism and absorption causing iron deficiency. The haemoglobin levels in our study showed no association with H.pylori seropositivity in the children in this study when severity of anaemia was considered. Albeit, there was a slight trend towards more severe anemia occurring in children who had a positive H. pylori IgG test. Likewise, in this current study, no significant difference was found between the levels of total white blood cell count between children who were H. pylori seropositive and their seronegative counterparts. There wasno statistically significant difference between children with H. pylori positivity and negativity in regards to presence 32,34 of leucocytosis or leucopaenia. Other authors had reported similar findings among children with no significant difference being observed while using surrogate markers of systemic inflammation like leucocytes, neutrophil/lymphocyte ratios or platelets Authors therefore inferred that these parameters were unhelpful in the distinction between children with or without H. pylori infection, severity or pre/post treatment status.

CONCLUSION
This study showed a high seroprevalence of H pylori infection amongst children presenting with abdominal discomfort and vomiting. Furthermore, the prevalence of anaemia, and WBC derangement in the children with H. pylori infection was also high, although this was not statistically significant.

Recommendations
In light of the high prevalence of H.pylori infection amongst children with abdominal discomfort, all children presenting with symptoms of abdominal discomfort should be evaluated for H.pylori and treated if serology is positive.