Sex differences in urea breath test results for the diagnosis of Helicobacter pylori infection: a large cross-sectional study

Abstract Background Helicobacter pylori causes peptic ulcer disease and gastric cancer only in a subset of infected persons. Sex differences were shown in results of urea breath test (UBT), a commonly used test for the diagnosis of H. pylori infection. However, factors that might explain these differences, or affect UBT values, are not fully understood. We examined differences in UBT values between H. pylori-infected men and women while adjusting for background characteristics such as age, body mass index (BMI), and smoking. Methods A cross-sectional study was undertaken using coded data from the computerized database of Maccabi Health Services in Israel. Included were adults examined for UBT during 2002–2012 and were found H. pylori positive (UBT > 3.5‰). Multivariable linear mixed models were performed to assess the relationship between sex and UBT quantitative results, while adjusting for background characteristics. Results A total of 76,403 patients were included (52% of examined patients during the study period). Adjusted mean UBT value was significantly higher in women 33.8‰ (95% CI 33.4, 34.1) than in men 24.9‰ (95% CI 24.5, 25.3). A significant (P < 0.001) interaction was found between sex and smoking, showing diminished sex-differences in UBT results in smokers. Adjusted mean UBT values increased significantly with age and decreased with BMI, and it was higher in people who lived in low vs high socioeconomic status communities and lower in smokers vs non-smokers. Conclusions Systemic differences exist between men and women in quantitative UBT results. Host-related and environmental factors might affect UBT quantitative results. These findings have clinical implications regarding confirmation of the success of H. pylori eradication after treatment in various subgroups

Pentraxin 3 and Shigella LPS and IpaB Antibodies Interplay to Defeat Shigellosis

Shigella causes moderate to severe diarrhea or dysentery after invading the colon mucosa. Long Pentraxin 3 (PTX3) is recognized as the humoral component of the innate immune response to bacterial pathogens. We examined the interplay between levels of PTX3 and levels of anti-Shigella lipopolysaccharide (LPS) and anti-Shigella type 3 secretion system protein-IpaB antibodies in children during acute shigellosis and after recovery. PTX3 concentrations in serum and stool extracts were determined by sandwich ELISA using commercial anti-PTX3 antibodies. Serum IgG, IgM, and IgA anti-S. sonnei LPS or anti-S. sonnei IpaB were measured using in house ELISA. Children with acute shigellosis (n = 60) had elevated PTX3 levels in serum and stools as compared with recovered subjects (9.6 ng/mL versus 4.7 ng/mL, p &lt; 0.009 in serum and 16.3 ng/g versus 1.1 ng/g in stool, p = 0.011). Very low levels of PTX3 were detected in stools of healthy children (0.3 ng/g). Increased serum levels of PTX3 correlated with high fever accompanied by bloody or numerous diarrheal stools characteristic of more severe shigellosis while short pentraxin; C-Reactive Protein (CRP) did not show such a correlation. PTX3 decreased in convalescence while anti-Shigella antibodies increased, switching the response from innate to adaptive toward the eradication of the invasive organism. These data can inform the development of Shigella vaccines and treatment options

No evidence of an increase in the incidence of norovirus gastroenteritis hospitalizations in young children after the introduction of universal rotavirus immunization in Israel

Following the introduction of universal immunization against rotavirus, concerns were raised regarding pathogen-replacement of rotavirus by norovirus. The study aim was to examine the incidence and characteristics and norovirus gastroenteritis before and after the introduction of universal rotavirus immunization in Israel. We studied 1179 stool samples collected between November 2007 and December 2014 for a prospective hospital-based surveillance study of children aged 0–59 months hospitalized for gastroenteritis. A real-time RT-PCR assay was used to identify genogroup II (GII) norovirus in extracted fecal RNA samples. Overall, the weighted percentage of norovirus positive patients was 10.9%. Norovirus positivity was similar in the pre-universal rotavirus immunisation years (2008–2010) and the universal years (2011–2014), the respective average annual incidence of norovirus gastroenteritis was 1.6 (95% CI 0.6–2.3) per 1000 and 1.1 (95% CI 0.8–1.4) per 1000 children. Rotavirus was detected in 36.8% and 19.6% of the patients in the pre-vaccine years and the universal vaccine years, with an estimated incidence of 5.5 (95% CI 3.4–7.6) per 1000 and 2.1 (95% CI 1.6–2.7) per 1000 children, respectively. Most patients (59.1%) with norovirus gastroenteritis were infants aged 0–11 months. Norovirus was detected all year round with a significant 3-month peak from September through November. In conclusion, norovirus continues to be a leading cause of acute gastroenteritis associated with hospitalizations in young children. Future norovirus vaccines should target young infants. There was no evidence of pathogen-replacement by norovirus following the introduction of universal rotavirus immunization in Israel

<i>H</i>. <i>pylori</i> infection prevalence according to sociodemographic characteristics.

<p><i>H</i>. <i>pylori</i> infection prevalence according to sociodemographic characteristics.</p

Age adjusted and age specific odds ratios and 95% confidence intervals of the associations of H. pylori infection, and gastric and duodenal ulcers, with diabetes mellitus, by age (in years) and BMI (< and >25 kg/m2).

<p>Age adjusted and age specific odds ratios and 95% confidence intervals of the associations of H. pylori infection, and gastric and duodenal ulcers, with diabetes mellitus, by age (in years) and BMI (< and >25 kg/m2).</p

Prevalence of diabetes mellitus according to <i>H</i>. <i>pylori</i> infection, and gastric and duodenal ulcers, by age group and BMI.

<p>Prevalence of diabetes mellitus according to <i>H</i>. <i>pylori</i> infection, and gastric and duodenal ulcers, by age group and BMI.</p

Prevalence of <i>H</i>. <i>pylori</i> infection (%) (urea breath test>3.5) by age group (in years) and country of birth; Maccabi Health Services, Israel 2002–2012.

<p>† Excluding countries that belonged to the Former Soviet Union.</p

Adjusted odds ratio and 95% confidence intervals of the associations of H. pylori infection, and gastric and duodenal ulcers, with diabetes mellitus by age (in years) and BMI (< and >25 kg/m2).

<p>Adjusted odds ratio and 95% confidence intervals of the associations of H. pylori infection, and gastric and duodenal ulcers, with diabetes mellitus by age (in years) and BMI (< and >25 kg/m2).</p